Hey everyone, there are still tickets available for those who are interested in the Loma Linda PA program. We have changed our event from zoom to being ON CAMPUS. There will be prizes raffled off. Due to some restrictions still being in place, the tickets that are being sold will only allow one person per ticket. More info on the flyer and event bright website. Thank you so much! Hope to see you there. https://www.eventbrite.com/e/llus-3rd-annual-pre-pa-conference-tickets-145958073527
prePA conference final draft flyer On CAMPUS.pdf
Future Standards for PAs and NPs
Bob Blumm, PA, DFAAPA, PA-C Emeritus
Standards: it seems as if everyone is talking about them today. We are either creating standards, improving standards, setting new standards or raising standards. Ultimately, as decades pass, standards grow, and this seems appropriate considering the health care needs in the United States and our world standing in that sphere. Like most Americans, I had always assumed that we were naturally - Number One - but was disheartened to discover that my assumptions were grounded in my patriotism and not in evidence-based studies. Depending upon the source and the year, the US typically ranks in the top 20 or 30% and shockingly behind all other nation members of the G-10 (including many smaller countries). This surprising revelation gave me pause to reflect on our “standard of care.”
What does the word “standard” connote to the average PA, NP, or patient in terms of academic achievement? It might be interpreted as an entry-level bachelor’s or master’s degree - or perhaps even a doctoral degree. Many of these advanced levels could never have been imagined in the past but are now very much a part of the 2021 working world for PAs and NPs. How quickly times change with more and more clinicians earning doctorate degrees – spurring insurance companies and administrators to establish yet even newer benchmarks based on this academic proliferation. If we as a profession do not set our own standards, someone else or another profession will surely try to do it for us. If ever we needed cohesive leadership, it is now! Maybe you are the person who can lead us into the future?
What do I personally think of standards? I believe that standards are a very positive modifier of our practice protocols and approaches to medicine. I see the patient as the ultimate winner when a profession has high standards. Standards lead to increased study and competence. Standards are set and maintained by academia, education secured at conferences, and CME provided by associations. They are enhanced by experience and certified by procedural attestation such as those through residency rotations. There will, in the near future, be a mandated procedural attestation required within all institutions of medical care. When looking at medical specialties, we note that either a residency or a specialized track of education and experience defines what an institution requires for an NP or a PA to be hired.
Most of the specialty areas need highly experienced, highly motivated, and extremely well-educated PAs and NPs and are willing to provide a mini residency. Some of these specialties require additional education, CME, preceptorship, and a specialized curriculum in addition to an advanced degree. I will repeat a sentence that I wrote ten years ago: “The time is quickly coming upon us that will no longer place on a resume ‘PA seeking a hospitalist role, ---- willing to learn, seeking physician willing to teach.’” That time became a reality more than five years ago. Physicians are engaged in their own fight for survival, focused on issues which affect their profession, leaving little time for the altruism of the past when they sought to be the “teacher” to a nonphysician. The economy, new health care laws, insurance mandated reimbursements, malpractice issues, and the huge financial debt incurred while becoming doctors have caused them to protect their own turf and areas of responsibility.
What will possibly be the standard for the PA in the next few decades? PAs will be a graduate of a doctoral program, be highly intelligent, and have the interest to further their education by means of residencies of various lengths to best prepare for the arduous task of caring for an additional 31 million patients in a decade with decreasing numbers of physicians. The PA will be a team member that possesses a team attitude and team spirit as the care of patients will be delivered by highly trained team members. Personally, I see this as a positive move and will be comforted as a patient to realize that all of the medical personnel with whom I have a relationship share a unified approach and attitude that will enhance my treatment, wellness and outcome. I think that the nursing profession will continue to grow in this same direction as they are recognized experts in so many specialties today.
This shared approach to patient care will require many signatures and notes on the EMR which can become tricky for many clinicians. With a team approach, opportunities for medical error will require heightened vigilance. And when errors occur - who is responsible - the institution, or the clinician? It is and has always been the clinician, and these errors are often due to the exhaustion felt by providers: reading every note, reviewing every test, and reconciling every new medication order. Prior to my own retirement, I began to feel the exhaustion of doing the detective work and realized that I was becoming a relic. As malpractice exposures rise, so too the need for a personal malpractice policy. Younger clinicians are much better suited to the demands of this ever-increasing administrative multi-tasking than those of us from an earlier vintage. This new era makes a malpractice instrument essential, now more than ever. Be careful and refrain from choosing based on cost alone, without fully understanding the policy terms and the provider’s history in the healthcare market. “New” companies with new perks come and go and may not exist in a few years, when you might need them. Make your own educated decision to prevent hardships in the future.
I was just offered a job as a new grad in psych at a private practice outpatient clinic in the Houston, Tx area. My hours would be 9-6 or (10-6 with no lunch break) Tuesday - Friday and a possible Saturday shift from 9-1 which I am clarifying now as to if this is set in stone or not since it was unclear. They told me I would be shadowing the first two weeks and then after that I will slowly see my own patients while consulting with the doc after each patient. They currently have one NP who they hired as a new grad and trained.
Salary: I told them I was looking for 100k since that is the average for a new grad in Texas and they offered me this breakdown: 92k for years 1-2, 102k for years 3-4, and 113k for years 5-6. Then, a bonus set up like this: starting at 6 months, a quarterly bonus at 65% patient occupancy is a 1k bonus quarterly, at 75% patient occupancy a 1750 bonus quarterly and at 90% occupancy and greater a 3k bonus quarterly. The bonus seems okay but I have no idea how to gauge this since idk if I will even be hitting these numbers as a new grad. They told me the NP currently sees follow ups in 15 min slots or 4 an hour with a break after to chart and that new pt visits are 1 hour. They told me my follow ups would be set for 30 minutes instead of 15 since I am new.
PTO: 7 days first year (this seems very low to me and was also not broken down into CME or sick days so now I have no idea if I even get CME days so that will be in my email back with questions)
Malpractice coverage and 401k with 5% match effective after first year. It was also unclear if the 401k is not effective at ALL until the first year or if just the matching so I will be asking this as well. Need to ask if this includes tail coverage?
Overall, I am happy to have a job offer but wondering if this is a good one. I would like to counter with a base salary of 96-97 possibly since a 1k bonus for three quarters in my first year would put me at the average new grad salary in Texas of 100k. Does this seem unreasonable? I also really don't like how the salary is already structured for the next 6 years and how I do not get a yearly raise to match inflation even. Is this common? What do you all think I should include in my counter? Overall, is this a good offer and would you take it as a new grad? Is it a bad idea for me to counter? Please help!! Thank you!
Edit to add: they do not offer health insurance if this makes a difference. Thank you!
I am a new grad PA practicing for about 4 months. I work in occ med/urgent care. Without getting into specifics. A patient had and intraarticular finger fracture. I treated/ splinted conservatively and referred the patient stat to a hand specialist on the date of injury, who did not get seen until 2 months after her date of injury, due to WC insurance. The patient was unable to have surgery due to the timing of being seen by the surgeon. The patient will have permanent and stationary deficits and need future medical care for possible joint fusion. The patient is currently undergoing PT. Not only did I do a disservice to the patient as far as ensuring timely care, but the referral department did as well. How do I manage this going further? Obviously try to regain as close to normal function prior to the patients injury. I am learning from this experience when referring, especially with intraarticular fractures. I feel like this is my first error in patient care that has affected the patients condition and has directly impacted the patients quality of life and functionality. How should I proceed? Any recommendations? Not looking for validation nor looking for critique (no more than I am already giving myself). Need suggestions on how to proceed further in my attitude and semi guilt with this case. Thank you in advance.