Moderator EMEDPA Posted February 10, 2012 Moderator Share Posted February 10, 2012 For clarity...I agree with residencies and do agree that credentialing is easier after having completed one. I also think that residences are a great idea now since significant DHCE has gone the way of the do-do bird. I don't think that they should be "required"... and I think the CAQ is "slippery slope" lathered with astroglide... we are in agreement then. I agree residencies are a good idea. I wouldn't force them on anyone. I took the caq because I am in a position in which I needed first hand experience of the exam. sure, it's a slippery scope. it's worse actually, probably a cliff. Link to comment Share on other sites More sharing options...
Contrarian Posted February 10, 2012 Share Posted February 10, 2012 dnp helps you own a primary care cash only practice, not really any advantage over msn np... NOPE...!!! Your research is sorely LACKING... You are a NO-GO at this station...!! Try again Contrarian P.s... hint: Insurance companies DO pay/reimburse NPs directly for primary care services they provide (didn't YOU want to maintain your ability to practice FP ...???) and Psych services provided by NPs. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 10, 2012 Moderator Share Posted February 10, 2012 NOPE...!!!Your research is sorely LACKING... You are a NO-GO at this station...!! Try again Contrarian P.s... hint: Insurance companies DO pay/reimburse NPs directly for primary care services they provide (didn't YOU want to maintain your ability to practice FP ...???) and Psych services provided by NPs. look what I wrote; ADVANCED PROCEDURES(say sigs, treadmills, vasectomies, low risk ob deliveries, etc). sure, anyone can do primary care. a pa can, a msn np can, a dnp np can. the trick is practicing FULL SCOPE fp and that means procedures....the more rural you are the more procedures you need to do because no one else around can do them....now get someone to pay for them...sure, I can buy a flex sig and stick it up anyone's backside who lets me...getting paid for it is another thing entirely unless they pay cash....aside from any future state rule that requires a dnp to practice what do you see as the advantage of dnp over an msn np aside from bragging rights? Link to comment Share on other sites More sharing options...
Contrarian Posted February 10, 2012 Share Posted February 10, 2012 Dude... maybe its been a LOOOOOONG time since you done Primary Care but... MOST of it isn't prodcedures. The Advantage of a DNP will be the ability to semi-retire as program Faculty. Also... in this community... there are 3-4 50/50 practices (half "walk-in" half scheduled) owned and run by NPs. There are also lots of Psych practices doing well that are owned by NPs. The ADVANTAGE: They don't need to stand with their hat in their hand (Like me and JMJ11) to ensure that a Physician somewhere will bless us with their time, presence, and signatures. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 10, 2012 Moderator Share Posted February 10, 2012 The ADVANTAGE: They don't need to stand with their hat in their hand (Like me and JMJ11) to ensure that a Physician somewhere will bless us with their time, presence, and signatures. I do primary care several days/mo at a free clinic. sure, there is lots of rx refills, referals, etc but I do a decent # of procedures every time I am there(often stuff that they would send the pt to the hospital for if I wasn't there). you didn't answer the advantage of dnp over msn np. can't they both work solo and teach? Link to comment Share on other sites More sharing options...
Contrarian Posted February 10, 2012 Share Posted February 10, 2012 Yes they can both work solo and teach... but only the DNP will be able to teach in both NP and DNP programs. The Non-Dnp programs will go away... and the N Ps without Doctorates won't be qualified to sit as Faculty in the DNP programs. The solo without kissing a physician's A$$, the low malpractice insurance premiums and the end of cyclic testing for revenue generation are the MAJOR advantages that I'd be seeking. Also... the biggest employers in my area really only hire NPs. There are a few token PAs but for the most part Peace Health is a NP shop... and WA is a NP state. So as my practice evolves... I'd like to lessen my dependence on physician/s influence on my ability to practice. Link to comment Share on other sites More sharing options...
Contrarian Posted February 10, 2012 Share Posted February 10, 2012 Former EMT-P and CCRN that graduated from a dual FNP/PA program. Have both PA and FNP certificates and notations on Transcripts I am Licensed as PA and FNP in California but didn't take the national FNP boards before the Masters in Nursing requirement took effect. So since I never completed a MSN... I can only license as a PA outside of California. Since I have kept my RN license... I'd simply need to complete a distance RN-->MSN or RN-->DNP program. If I did this... it would be a simple matter of submiting my new MSN or DNP and my FNP certificate (along with resume demonstrating my uninterrupted clinical experience functioning as a "mid-level") to sit for one of the national exams. Last I checked... If I completed a MSN or DNP... I would be able to sit for the FNP exam and the Psych NP exam. Because I already have the FNP certificate and I have a UNMC MAsters concentrated in Psychiatry. My only real hesitation is that I REALLY am not quite in the mood to pay to read and write a bunch of "fluffy" crap for a few yrs. Link to comment Share on other sites More sharing options...
foreveryoung Posted February 10, 2012 Share Posted February 10, 2012 So CAQs and residencies may create a slippery slope, however, with the exponential growth of medical knowledge, the profession may have to adjust our high standards to assure that the quality of our profession is high. Degree creep and specialty programs are not the way to do it... residences, CAQs and CME standards are the best bet we have... As PAs, by working with SPs and continuing to increase our knowledge as demonstrated through residences, CAQs and numbers of CME hours, we demonstrate that we are professionals who aim to continue to grow in our medical knowledge and skill and not become stagnant... Want to prevent CAQs and residencies from becoming required? We, as a profession, need to make sure we are always growing in both knowledge and skill and not just doing things cause that is how we always have. Link to comment Share on other sites More sharing options...
Acromion Posted February 24, 2012 Share Posted February 24, 2012 I decided to become a PA because just about every patient I have spoken to tells me how much they love seeing their PA. That is what motivates me, so as long as I can provide outstanding medical care to my patients, I don't care if I am called a "mid-level." I became a PA because I don't want to specialize, I don't want to be a doctor, I don't want to do a residency, and I don't want to practice independently. The trend that will be prevailing in medicine for the foreseeable is towards more primary care and decreased costs.The PA profession will continue to grow because we fill this niche so well. It's simple supply and demand. PA's can competently supply much of what MD's can, but for a lower cost. I love the fact that PA's, regardless of what specialty they work in, must maintain the same competency in primary care. Do you realize how valuable this is? I have talked to many specialist docs who rely on their PA's for their knowledge of primary care. So why mess with a good thing? Link to comment Share on other sites More sharing options...
sailordeac Posted February 26, 2012 Share Posted February 26, 2012 I just finished my surgery rotation, and PA residencies came up in conversation with my supervising MD. He felt that residencies weren't entirely necessary for PAs (in surgery, anyway), and the PA agreed with him. His view is that if you have a SP that's patient enough to work with you and train you to his/her specifications, you'll do fine without the residency. I thought that was pretty interesting - the practice has several PAs, and I think only one did a residency...but all are VERY good at what they do and "functioning at the highest possible level for a PA" as the surgeon put it. This conversation was a little food for thought for me. I'm sort of leaning toward general surgery or some type of surgical subspecialty, and with graduation rapidly approaching, I can already see that there will be a large learning curve for my first job (especially since my HCE was in primary care). I've sort of thought about applying for a surgical residency, but if I did one, I would be foregoing additional income and would be slower to get my loans repaid...but it would allow me to come out ahead skills-wise and feeling a little more comfortable for that first job. It is a tough decision. Link to comment Share on other sites More sharing options...
andersenpa Posted February 26, 2012 Share Posted February 26, 2012 Residency is a personal choice for those who want to accelerate the learning curve. Also, speaking as someone who did a residency, I can say that there are things I did in residency that I would have NEVER done outside of a postgrad situation. So while from this surgeon's perspective it's not necessary b/c his PAs do everything he has trained them to do, there are ways in which a residnecy provides a broader and more well rounded surgical education for a PA which may not be measurable to an outsider. Link to comment Share on other sites More sharing options...
treejay Posted February 26, 2012 Share Posted February 26, 2012 Great forum. Great thoughts. Thanks for all your contributions. One much less profoundly intellectual thought I'll offer is that the appap.org website sucks. It's ugly. But more importantly, the matrix of program listings is way outdated. from October 2010. I am currently a PA student in didactics and I have my sights heavily on doing a residency upon graduation. Looking at the program matrix of available programs on the website, I'm seeing residencies that are no longer offered, and I don't see residencies that I do know ARE available, but not listed. Granted some of those not listed might be not affiliated with APPAP formally. Point is, many agree residencies will play a role in the next generation of PA graduates (or practicing PAs). The resources should be available in a clean, professional manner. Right now their website (and the info I want to glean from it) looks pretty rough. Just my 2 cents, no more Link to comment Share on other sites More sharing options...
andersenpa Posted February 27, 2012 Share Posted February 27, 2012 Agree. The APPAP site layout is utterly un-navigable. Link to comment Share on other sites More sharing options...
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