"A New Type of Physician" --DMS???

[Guest Paula]

The LMU program has been discussed on AAPA's Huddle months ago and I think we discussed it on the Forum months or a year ago when it was first proposed.

Initially it was just for Tennessee .  Not sure if that is still the case and if a graduate would have to practice in TN.  

My guess is the legislation will languish for a while in committee or be sent for further study.  I can't imaging the TN Medical Board actually supporting it.

 

It seems a bit like the Missouri plan for the Assistant Physician designation for unmatched Medical School resident. 

[corpsman89]

In the video the senator wanted to wait until Jan/Feb 2018 to vote on the bill. The Tennessee Medical Association did not completely support it, but they said they liked it. Whatever that means.

[Joelseff]

On 7/1/2017 at 8:50 PM, corpsman89 said:

In the video the senator wanted to wait until Jan/Feb 2018 to vote on the bill. The Tennessee Medical Association did not completely support it, but they said they liked it. Whatever that means.

Where is the video? What did they like and not like?

[8404PA]

On 7/1/2017 at 2:07 AM, Joelseff said:

Keep us posted on this if you can get more info. Esp re: the legislation.

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On 7/1/2017 at 3:30 AM, corpsman89 said:

That's great! Have you heard anything about the legislation?

 

 

Yeah, we start our 4th quarter Wednesday and i'll ask them about it. 

[corpsman89]

11 hours ago, Joelseff said:

Where is the video? What did they like and not like?

http://tnga.granicus.com/MediaPlayer.php?view_id=354&clip_id=13408

click on SB0850

[Joelseff]

I posted this on clinician1.com search for DMS Tennessee and it should come up. The hyperlink is not working. There were a few responses mostly confusion or negative. The confused remarks though seemed to not even bother to read the bill. Perhaps TL;DR. But one of the negative views was from a leader in the AAPA and I think PAFT and is the founder of the site who once endorsed doctorate level education on that site. Which is surprising seeing as that site usually is for advancement of the PA profession maybe I'm one of only a few ppl who see this as a positive development ?

 

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[Marinejiujitsu]

I see it as positive too Joelseff. We need this or more reasonable PA-DO/M.D. programs without the 3-5 yr residency.

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[aimyhtixela]

So what is the difference between the LMU DMS program versus Lynchburg's DMSc? Is it just the latter being online? Would the two become interchangeable? Let's say a resident at the Arrowhead EMPA program gets the DMSc from Lynchburg. If that person practices in TN, can they transition as a primary care doc? I read that LMU counts experience in the ED as prereq for the program. [emoji848]


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[LT_Oneal_PAC]

On 7/7/2017 at 4:31 AM, Joelseff said:

I posted this on clinician1.com search for DMS Tennessee and it should come up. The hyperlink is not working. There were a few responses mostly confusion or negative. The confused remarks though seemed to not even bother to read the bill. Perhaps TL;DR. But one of the negative views was from a leader in the AAPA and I think PAFT and is the founder of the site who once endorsed doctorate level education on that site. Which is surprising seeing as that site usually is for advancement of the PA profession maybe I'm one of only a few ppl who see this as a positive development ?

 

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I think Dave Mittman's dislike of it is A) we already have enough credits to have a doctorate with our current education. B) linking a doctorate with the increase scope of practice. C) this program, from its own admission, is an entirely new kind of provider, supporting that PA education isn't enough to have full practice authority.

im a proponent of doctorate education as well, and this would be good if OTP hadn't passed, but now I think it would hinder the passage of OTP at the state level.

[Joelseff]

I understand that point of view but let's be real, we are never going to get anyone to see equivalence of a Doctorate with our masters no matter how much we claim that. And with the way things are, a doctorate *seems* to be the way to independence. I see this as a way of circumventing (in a way) the need for name change and autonomy. OTP is a good move too but it's not as bold as the DMS from where I stand and if DMS gains traction I'm riding that train.

Dont get me wrong, I'm still down wit' OTP (yeah you know me) but this might be the better solution. It's all so new though that I'm waiting in the cut to see what actually gains momentum but really appreciate both moves for advancement for PAs.

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[DizzyJ]

13 hours ago, aimyhtixela said:

So what is the difference between the LMU DMS program versus Lynchburg's DMSc? Is it just the latter being online? Would the two become interchangeable? Let's say a resident at the Arrowhead EMPA program gets the DMSc from Lynchburg. If that person practices in TN, can they transition as a primary care doc? I read that LMU counts experience in the ED as prereq for the program.


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The curriculum and length of program is different.  The LMU program has medical science modules in : Nephrology; Neurology; Pulmonology; Psychiatry; Cardiology; Endocrinology; Hematology; Gastroenterology; Infectious Disease.  The second year with residency and primary care clinical applications.  Lynchburg is 12 months with classes in health care admin, global health issues, healthcare law, etc...  I do not see them as being interchangeable at this time as Lynchburg doesn't have clinical medicine courses aside from disaster medicine. 

[Ridiculopathy]

On July 11, 2017 at 8:57 PM, Joelseff said:

I understand that point of view but let's be real, we are never going to get anyone to see equivalence of a Doctorate with our masters no matter how much we claim that. And with the way things are, a doctorate *seems* to be the way to independence. I see this as a way of circumventing (in a way) the need for name change and autonomy. OTP is a good move too but it's not as bold as the DMS from where I stand and if DMS gains traction I'm riding that train.

Dont get me wrong, I'm still down wit' OTP (yeah you know me) but this might be the better solution. It's all so new though that I'm waiting in the cut to see what actually gains momentum but really appreciate both moves for advancement for PAs.

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Haha u funny bro! ?

[wdtpac]

On 7/11/2017 at 7:57 PM, Joelseff said:

I understand that point of view but let's be real, we are never going to get anyone to see equivalence of a Doctorate with our masters no matter how much we claim that. And with the way things are, a doctorate *seems* to be the way to independence. I see this as a way of circumventing (in a way) the need for name change and autonomy. OTP is a good move too but it's not as bold as the DMS from where I stand and if DMS gains traction I'm riding that train.

Dont get me wrong, I'm still down wit' OTP (yeah you know me) but this might be the better solution. It's all so new though that I'm waiting in the cut to see what actually gains momentum but really appreciate both moves for advancement for PAs.

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I think we need to get this to the AAPA for OTP marketing.... lol

[Joelseff]

Looks like Washington state may be joining Tennessee on this.

 

 

Sorry for the screenshot don't know how to upload a pdf. This was taken from jmj11's post on the Washington state forum here http://www.physicianassistantforum.com/index.php?/topic/43489-Doctorate-of-Medicine---Washington-State (thanks to him by the way!)

 

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[JMPAC]

This sounds like an awesome step in the right direction and probably another confusing title for patients, lol. Or would you introduce your self as Dr. So-and-so? Is that was NPs will be doing? Maybe everyone will get used to the fact that "doctor" comes with a variety of different educational backgrounds.
Can I also add that I love the idea that I read somewhere in a different post of changing PA to MP (medical practitioner)? Can we get that legislation going? I think saying MP would be soooo much better than something with the word "assistant" in it. I've had a couple cases recently where the patient or family is confused about why they're only seeing "the assistant" during their ED visit. I'm happy to explain the career of PA to people but it kind of stinks that I have to.
Sorry to get off subject. I'd be all about that DMS if an employer would pay for it! Got enough student loan debt to last me for many years, haha. [emoji30]


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[Grinder993]

The DMS is one option.  A necessary and appropriate option.  Dave Mittman has been against Doctoral level PA training for at least a decade that I have been posting about it on this site.  To say that going the DMS route admits that PA training is not good enough is a reason to not support the DMS is ludicrous.  We have the word "assistant" in our title...ergo not good enough!  LOL

The very survival of the PA profession requires us to move toward independence.  I have always been a huge supporter of PA Residency programs as well.  I would like to see other pathways to DO/MD as another option.  Currently the only option is the traditional full time pathway and that is just not feasible for most working people.  The advances in technology and education make it completely reasonable to be able to complete the didactic portions of training online while requiring on site attendance for lab work.  There needs to be acknowledgment of the value of the years of working experience a PA may have.  I have been practicing for 12 years as an EM PA.  I have logged well over 50,000 patient contacts.  Is that disregarded?  I currently work in a remote critical access ER where I am the sole provider.  There is one hospitalist upstairs and that is usually an NP.  That's right an entire hospital staffed by APPs!  The doctors have said this would be a sign of the apocalypse but, so far ....no apocalypse, just patients being taken care of in an underserved area.

We have to move forward, I am happy to see what the DNP is doing.  They have the lobby and the money to push forward independent practice.   They will get it I guarantee it.  We will have to follow the path they have blazed or continue in this abusive relationship with our MD masters until they tire of us and put an end to our profession entirely.

Riddle me this:  if PA training is so "subpar" to MD training....why does CMS reimburse us at 85%?  Doesn't that indicate our services are 85% that of an MD providing the same service?  So are we only 15% deficient?  Furthermore if we are only 15% deficient....why are we paid roughly 60% less than an MD on average???    

[PA778]

I've been lurking this particular thread for a while. After some digging, unfortunately, I noticed that the bills in both the state house and senate have been "withdrawn". After further research (as I didn't understand what would cause a bill to be withdrawn), I found that if a bill's sponsor doesn't show up to explain to the committee the merits of the bill, the bill is generally automatically withdrawn. As a newly accepted PA student, I would have loved to have had this opportunity. After personal life circumstances prevented me from leaving the state (3 children who do not live with me), I neither have the opportunity nor the desire (I enjoy the idea of career flexibility, no call, family life, etc) to become an MD/DO. I keep searching (probably an unhealthy amount of googling) for any legislation anywhere that might help us down the road. I am not suggesting that PA's should share equal footing with MD/DO, but should be able to practice to the fullest extent of their training without necessarily a supervisory role.

[corpsman89]

31 minutes ago, PA778 said:

 I neither have the opportunity nor the desire (I enjoy the idea of career flexibility, no call, family life, etc) to become an MD/DO.

Hate to burst your bubble, but as a PA you will likely take call and have less of an opportunity for family life compared to an MD/DO after training. 

[ventana]

I will do over 7200 hours of call this year (as a PA not a doc)

[EMEDPA]

4 hours ago, corpsman89 said:

Hate to burst your bubble, but as a PA you will likely take call and have less of an opportunity for family life compared to an MD/DO after training. 

yup, my md colleagues work 1/3 less and make 2-3x my salary

[Joelseff]

Hate to burst your bubble, but as a PA you will likely take call and have less of an opportunity for family life compared to an MD/DO after training. 

This is true in a lot of places. I took call in every job I had except for my current spot which also pays more than the others.

So while I would agree that PA work is not always rosier than our MD/DO colleagues, it's not a hard and fast rule.

Though I agree with corpsman89 that don't go in expecting this type of situation.

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[TrekkieByDay]

On 2/11/2018 at 8:04 PM, ventana said:

I will do over 7200 hours of call this year (as a PA not a doc)

 

On 2/11/2018 at 3:14 PM, corpsman89 said:

Hate to burst your bubble, but as a PA you will likely take call and have less of an opportunity for family life compared to an MD/DO after training. 

Sadly, those of us w/ families aren't worried about *working hard* or working long hours, but rather about the insane time commitment that becoming a full MD/DO would entail. We can't live off student loans when our own kids are just a few years from college. We can't take the risk of putting all the time & commitment & debt into med school and then not getting a residency. 

Being a PA is a great solution for those of us who couldn't pursue med school earlier in life. 

[lkth487]

Also there's definitely many specialties with minimal to no call if that's your thing. Many of them are not competitive either with a lot more spots than people wanting to fill them.

A good no/minimum call specialty would be PM&R.  Pediatrics can be pretty chill if you find the right practice.  My friend just finished an allergy and immunology fellowship after a pediatrics residency and just signed for $300k for 3 days of (9hrs/day) clinic per week and zero call.  So it's definitely doable.  MD Doesn't mean forever nights and weekend call and PA doesn't mean a call or night/weekend free life.  It's a very job, specialty and geography dependent.  

[lkth487]

On 8/22/2017 at 5:27 PM, Grinder993 said:

 

Riddle me this:  if PA training is so "subpar" to MD training....why does CMS reimburse us at 85%?  Doesn't that indicate our services are 85% that of an MD providing the same service?  So are we only 15% deficient?  Furthermore if we are only 15% deficient....why are we paid roughly 60% less than an MD on average???    

I wouldn't try to find any reasons behind reimbursements.  I could spend an hour creating a vast differential for a complicated patient, using knowledge and expertise that might have taken me a decade to acquire and I'd get paid nothing for it.  Or I can do a procedure in 2 mins which I can teach my brain dead weed smoking cousin to do with just a few hours of training and I'd get thousands. 

[Joelseff]

Also there's definitely many specialties with minimal to no call if that's your thing. Many of them are not competitive either with a lot more spots than people wanting to fill them.
A good no/minimum call specialty would be PM&R.  Pediatrics can be pretty chill if you find the right practice.  My friend just finished an allergy and immunology fellowship after a pediatrics residency and just signed for $300k for 3 days of (9hrs/day) clinic per week and zero call.  So it's definitely doable.  MD Doesn't mean forever nights and weekend call and PA doesn't mean a call or night/weekend free life.  It's a very job, specialty and geography dependent.  

I worked PM&R my first job out of school. Took a whole mess load of call! Lots of post procedure issues like dural HA's and early pain med refill calls. I actually took more call in PM&R than IM/HIV.

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