FPAR/OTP Passed!

[EMEDPA]

the name is the only difference. the "pillars" are the same. new grads(and everyone else for that matter) will have scope of practice determined at the practice level. what this allows for is physicians to opt out of any supervision or chart review if they so choose. they could choose 100% chart review for a new grad or 0% for a senior PA. it's still up to the doc.

[Joelseff]

the name is the only difference. the "pillars" are the same. new grads(and everyone else for that matter) will have scope of practice determined at the practice level. what this allows for is physicians to opt out of any supervision or chart review if they so choose. they could choose 100% chart review for a new grad or 0% for a senior PA. it's still up to the doc.

Oh, so wait, wouldn't it eliminate the requirement for an SP?  If there is no SP/PA relationship on paper, why would we need to define our scope at the "practice level?" Maybe I'm missing something? 

[EMEDPA]

the practice can determine the extent of md participation. it could be zero. in MI, PAs still have a "participating physician of record" who is not responsible for the actions of the PA.

 

so, in summary, someone could work for a practice with zero oversight and no physician involvement all the way up to 100% chart review and md sees every pt.

from the document:

"PAs would continue to collaborate with physicians in accordance with their education, training, and experience."

 

once again, there could be no physician of record or the practice could require more stringent oversight.

we need to see how this plays out in individual states.

[Joelseff]

the practice can determine the extent of md participation. it could be zero. in MI, PAs still have a "participating physician of record" who is not responsible for the actions of the PA.

 

so, in summary, someone could work for a practice with zero oversight and no physician involvement all the way up to 100% chart review and md sees every pt.

from the document:

"PAs would continue to collaborate with physicians in accordance with their education, training, and experience."

 

once again, there could be no physician of record or the practice could require more stringent oversight.

we need to see how this plays out in individual states.

Ok i see. That's not quite what I thought when I read the FPAR proposal but it's a good start I suppose...

 

Yeah we'll see how the states respond.

 

I already contacted my chapter and they told me their rep is going to update us on the changes and she would call me back. I'll keep you guys posted on anything I hear.

 

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[treejay]

why the change in language from FPAR to OTM?  What are the implications of this change ?

[Boatswain2PA]

the name is the only difference. the "pillars" are the same. new grads(and everyone else for that matter) will have scope of practice determined at the practice level. what this allows for is physicians to opt out of any supervision or chart review if they so choose. they could choose 100% chart review for a new grad or 0% for a senior PA. it's still up to the doc.

Maybe "the practice" can determine the extent of MD participation, but it will be a jury who determines who has the deepest pockets for the first stupid malpractice case. It won't be the PA, and (in today's environment) won't be the physician....so it will likely be "The Practice" who then rolls against the PA or their "participating physician of record" who suddenly DOES become responsible for the actions of the PA.

 

Sorry E, but this is bullshit. Like you said at the very end....it's still up to the Doc....which makes them the last one holding the lucky charms that the lawyers are after.

Oh, so wait, wouldn't it eliminate the requirement for an SP? If there is no SP/PA relationship on paper, why would we need to define our scope at the "practice level?" Maybe I'm missing something?

If we didn't have one.....then POSSIBLY. But that isn't the case yet.

 

Next question should be asked...SHOULD a 2-year masters-trained (with a MAYBE 1-year residency trained) provider practice medicine without ANY supervision? Would you send your granddaughter to such person??

the practice can determine the extent of md participation. it could be zero. in MI, PAs still have a "participating physician of record" who is not responsible for the actions of the PA.

 

so, in summary, someone could work for a practice with zero oversight and no physician involvement all the way up to 100% chart review and md sees every pt.

from the document:

"PAs would continue to collaborate with physicians in accordance with their education, training, and experience."

 

once again, there could be no physician of record or the practice could require more stringent oversight.

we need to see how this plays out in individual states.

The law may state the physician of record is "not responsible for the actions of the PA"....but case law will determine that.

 

For example - the state law where I live in CLEARLY says that if a non-custodial parent works overtime in order to achieve goals in excess of child-support guidelines, then such overtime or excessive work shall not be considered as income for the determination of child support. Unfortunately, every lawyer will tell you that THAT verbage is absolutely ignored in court.

 

So, while the law may CLEARLY say the physician of record is "not responsible for the actions of the PA"....I wouldn't want to be the physician on the front lines of THAT first legal fight.

 

"So.....members of the jury......what does the term 'PHYSICIAN ASSISTANT' mean to you?"......

 

 

Sorry to rain on your parade....but I foresee a $hitshow in the weather forecast.

[rev ronin]

Hey Boats, you're absolutely right that bad case law can really screw people up, and that lawyers will always go for deep pockets.  BUT new law resets that playing field: it can still go badly, but without new legislation the playing field never changes.

[Boatswain2PA]

Sorry Rev, new law doesn't reset the playing field.  The sharks (lawyers) will go after whoever has the most money.  If that's the CMGs who hire the "newly independent" PAs, that's fine.  Or they will go after the $350K-$600K//year Docs (vice the $100K/year PAs).

End result....the courts will be the final arbitrator.

Wait for the first $hitshow.  That will tell you what direction the wind is blowing.

[Boatswain2PA]

I just want to add one thing, on a personal level....'m not trying to be the guy who bitches without a solution to the problem.  I just see a problem without a solution.....and a whole bunch of well intentioned folks using a sledge hammer to make a solution fit the problem.

 

[Joelseff]

I'm waiting to be briefed by the Rep from my State organization. I was excited about the push because of what I thought (and this could entirely be my original misinterpretation so my bad for that) it was going to be and this update, from what I see, is just a shuffling of the SP role...

 

I get what Boats is saying. "Perhaps these aren't the Droids we're looking for..."

 

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[rev ronin]

Sorry Rev, new law doesn't reset the playing field.

Sure they do--courts rule one way, legislature says "that's not what we meant!" and passes a slightly-differently-worded law next session. Happens all the time!

 

Nothing about FPAR is going to change the need for liability insurance.  We'll always need that, and yeah, it might be a ton more expensive without an involved SP.

 

Even if this doesn't move anything forward, it changes the conversation, so I'm not seeing the downside.

[sas5814]

Not to be cynical, but that will never pass in Texas.  No way, no how.

Yes and no. TAPA is firmly in the pocket of TMA and can't blow their nose without finding out if the physicians approve but it won't last forever. As I said in another post we will be 52nd after American Somoa and Puerto Rico but it will come eventually even if it takes replacing everyone in TAPA with new people who can move the profession forward. If you think I am being hard on them did you see the HOD vote stating we will never open our practice act(s) to non PAs? Guess who tried that and got spanked by 20 years of past TAPA leadership and a grassroots effort to stop it. TAPA. I just hope this has been a wake up call for Texas PAs and TAPA and things finally start to change.

[ventana]

Boats - you say you don't want to be that person complaining about the solution - but your are that person with the above statements......

 

 

Some of your points are reasonable, but the overal fatalistic tone just says you are burned out and bitter....

This might indeed be the case, but lets not be down at such a time with great advancement (unless you specifically had a huge role in it and felt like you peronsally failed)

 

I do not mean to attack you, and that is not the point - it is just an incredibly negative rally against everything type stance that you have taken......

 

As for the whole insurance thing..... well let the chips fall - if we have to pay a bit more (or a lot) and we stop being the invisible providers then I am all for it. Right now everyone benefits from us, except for us!

[Boatswain2PA]

I know you're not attacking me Jeff, I've got thick skin.  It's just a discussion.

I promise I'm not burned out OR bitter about this.  It really doesn't affect me AT ALL.  By the time it DOES, I'll be beyond ready to retire.

Regarding the insurance.  My point was that the Docs are ALWAYS going to get added to the lawsuits, no matter WHAT the law states.  The sharks are going to go after the money, and Docs make more, so are bigger targets.  

I REALLY don't get why we are pushing for a separate licensing board though.  We practice medicine....why not licensure from the BOM?

[rev ronin]

I REALLY don't get why we are pushing for a separate licensing board though.  We practice medicine....why not licensure from the BOM?

I'd be fine with this if the NPs had to be in the same board too.

 

Heck, here in Washington the DOs and MDs have separate boards.  The NDs, DPMs, and DCs all have separate boards.  Us?  Meh, lumped in with EITHER the DOs or MDs.  Or both if you're a masochist like me and want to pay twice for the privilege for working for both flavors of physicians.

[sas5814]

"I REALLY don't get why we are pushing for a separate licensing board though. We practice medicine....why not licensure from the BOM?"
 

 

Because the physicians will still be writing our rules and running our profession. Let me promise you they would expect to be the final word on matters releated to PAs (as they currently are in many places) and they have their own interests front and center and ours...well somewhere between nowhere and 2nd place.

I have know some really good physicians on medical boards and I have known some arrogant (insert donkey word here) and I think the latter is almost a requirement to be board president. As we move towards OTP if we are still regulated by the medical boards the work will be a thousand times harder because the medical board will obstruct us at every turn. OTP is about being the captains of our own ship.

[ventana]

I know you're not attacking me Jeff, I've got thick skin.  It's just a discussion.

 

I promise I'm not burned out OR bitter about this.  It really doesn't affect me AT ALL.  By the time it DOES, I'll be beyond ready to retire.

 

Regarding the insurance.  My point was that the Docs are ALWAYS going to get added to the lawsuits, no matter WHAT the law states.  The sharks are going to go after the money, and Docs make more, so are bigger targets.  

 

I REALLY don't get why we are pushing for a separate licensing board though.  We practice medicine....why not licensure from the BOM?

 

 

I'd be fine with this if the NPs had to be in the same board too.

 

Heck, here in Washington the DOs and MDs have separate boards.  The NDs, DPMs, and DCs all have separate boards.  Us?  Meh, lumped in with EITHER the DOs or MDs.  Or both if you're a masochist like me and want to pay twice for the privilege for working for both flavors of physicians.

 

 

"I REALLY don't get why we are pushing for a separate licensing board though. We practice medicine....why not licensure from the BOM?"

 

 

Because the physicians will still be writing our rules and running our profession. Let me promise you they would expect to be the final word on matters releated to PAs (as they currently are in many places) and they have their own interests front and center and ours...well somewhere between nowhere and 2nd place.

I have know some really good physicians on medical boards and I have known some arrogant (insert donkey word here) and I think the latter is almost a requirement to be board president. As we move towards OTP if we are still regulated by the medical boards the work will be a thousand times harder because the medical board will obstruct us at every turn. OTP is about being the captains of our own ship.

 

 

 

 

I really think we need to control our own

I would want a PA judging me if I had to go before the board, not some MD or DO

 

Has to do with professional responsibility

 

As for deep pockets - that is what malpractice is for.            if we are doing 100% of the work, and are part of a team, why would be not be held responsible??  I carry the same 1m/3m coverage as my doc.....