Are we really ready to hang out our own shingle?

[ventana]

I fill a doc job. Paid like one.  

 

My CP is great, but almost all my questions to him are about his style of medicine, and not medical “I need help” questions.  He is director so I follow his lead on high risk situations.  But he adds nothing to the medical management.  I function independently but am handcuffed to him.    

 

OTP.  Yes.  Please.  

[PACali]

4 hours ago, LT_Oneal_PAC said:

I’m curious why everyone is still worried about offending physicians. It hasn’t affected the NPs at all and being physician’s “competition” (I don’t think most rank and file MDs see it this way) hasn’t prevented NPs from being hired over us by either physicians themselves who want to do less paperwork with less responsibility for clinical care they didn’t provide nor by admin who have physician staff that don’t want to supervise without compensation. 

 

1

Agree. Any competent physicians are not offended. All the physicians I work with, support the OTP movement, simply because they don't want the responsibility for the clinical care they didn't provide. 

[Joelseff]

Just got this in the mail today from CAPA

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[Guest Paula]

OTP has left the barn and is in the process of being introduced in a number of states.  I'm surprised that anyone is surprised about OTP.  We've (AAPA and pro-active PA's) have been working for this for the last 3 years.  

 

[EMEDPA]

34 minutes ago, Paula said:

OTP has left the barn and is in the process of being introduced in a number of states.  I'm surprised that anyone is surprised about OTP.  We've (AAPA and pro-active PA's) have been working for this for the last 30 years.  

 

FIXED THAT FOR YOU....:)

[Jofriend]

10 hours ago, LT_Oneal_PAC said:

The AAPA is not forcing this down anyone’s throat. They are offering it as support to any state that wishes to pursue it. If you do not like it, talk with and join your state chapter because the ship has sailed at AAPA.

I’m curious why everyone is still worried about offending physicians. It hasn’t affected the NPs at all and being physician’s “competition” (I don’t think most rank and file MDs see it this way) hasn’t prevented NPs from being hired over us by either physicians themselves who want to do less paperwork with less responsibility for clinical care they didn’t provide nor by admin who have physician staff that don’t want to supervise without compensation. 

 

As for the survey results, ask and ye shall receive. Before you mention the 12,000 respondents, this is the greatest number of respondents we’ve had for any survey and it was sent to members and nonmembers:

Survey results are in from more than 12,000 PAs, retired PAs, and PA students regarding Full Practice Authority and Responsibility (FPAR) as proposed by AAPA’s Joint Task Force on the Future of PA Practice Authority. Overall, 72 percent of respondents expressed support for it. Read the report(s), complilation of respondant comments, or view slides to see what PAs had to say.

https://news-center.aapa.org/wp-content/uploads/sites/2/2017/03/fpar.report.state_.FINAL_.pdf

I am a member of my state's PA chapter and this has not been a topic of conversation at either our annual meeting or in regular website/newsletter communications.  After 37 years as a PA, I am concerned about the opinions of physicians and when I've casually mentioned this to the secure people that I work with, it did not resonate with them in the least.  In the short term, while they do need to sign my practice agreement, I care what they think.  And in the long term, if we continue to need legislation working on our behalf, we would benefit from wholehearted physician support.  How can this be viewed as anything but a move toward independent practice? 

As to survey results, somehow NCCPA was able to get a 50% response rate re. salaries with their last effort.  Not only did the AAPA survey only have 10,199 participants of whom 1,368 were students, when asked whether they would support the elimination of provisions in laws and regulations that require a PA to have and/or report a supervisory, collaborating or other specific relationship with a physician, only  63.7% in the AAPA survey said yes.  So to conclude that 72% of all PAs are in favour of this measure is presumptuous.  It is also presumptuous to imply that PAs that do not see eye to eye with this effort are passive about promoting the profession. 

I appreciate that people that have devoted their time, effort and energy via AAPA toward the furtherance of our profession.  I truly am.  It is vital.  However, adopting a condescending and combative attitude around this issue and what was manifested in the recent conflict with the NCCPA around credentialing is counterproductive.  It is divisive among our ranks and the NCCPA arguments often conflicted with the literature and available information about credentialing.  Here we go again.  We have got to use evidenced based data and public health measures to promote our agenda.  Caution and reason please. 

 

[LT_Oneal_PAC]

12 minutes ago, Jofriend said:

I am a member of my state's PA chapter and this has not been a topic of conversation at either our annual meeting or in regular website/newsletter communications.  After 37 years as a PA, I am concerned about the opinions of physicians and when I've casually mentioned this to the secure people that I work with, it did not resonate with them in the least.  In the short term, while they do need to sign my practice agreement, I care what they think.  And in the long term, if we continue to need legislation working on our behalf, we would benefit from wholehearted physician support.  How can this be viewed as anything but a move toward independent practice? 

As to survey results, somehow NCCPA was able to get a 50% response rate re. salaries with their last effort.  Not only did the AAPA survey only have 10,199 participants of whom 1,368 were students, when asked whether they would support the elimination of provisions in laws and regulations that require a PA to have and/or report a supervisory, collaborating or other specific relationship with a physician, only  63.7% in the AAPA survey said yes.  So to conclude that 72% of all PAs are in favour of this measure is presumptuous.  It is also presumptuous to imply that PAs that do not see eye to eye with this effort are passive about promoting the profession. 

I appreciate that people that have devoted their time, effort and energy via AAPA toward the furtherance of our profession.  I truly am.  It is vital.  However, adopting a condescending and combative attitude around this issue and what was manifested in the recent conflict with the NCCPA around credentialing is counterproductive.  It is divisive among our ranks and the NCCPA arguments often conflicted with the literature and available information about credentialing.  Here we go again.  We have got to use evidenced based data and public health measures to promote our agenda.  Caution and reason please. 

 

No one is being combative or condescending. You may feel that way or marginalized because the majority here support it, but I’m simply stating facts. 72% overall supported OTP and the ship has sailed at the national level. I’m glad your apart of your state chapter. If you haven’t heard anything, then I doubt your state is proceeding forward with it and so you have little to worry about. Contact your state chapter and see their feelings on it.

The physicians you work with may not like it, but all mine do. Let’s leave anecdote out of the discussion. Personally I can not recall the last thing they helped us pass legislatively.

I don’t see what’s wrong with getting student input. It’ll be their profession longer than it will be mine or yours.

12,000 is more than the votes in the AAPa elections, so I would say that’s a good number.

i agree caution is needed, as it must be done very carefully to pass. I think this is the only reasonable solution to help our profession keep up with the changing healthcare landscape.

[EMEDPA]

we need this or the NPs will own the non-physician provider market in 20 years.

[Jofriend]

9 hours ago, EMEDPA said:

we need this or the NPs will own the non-physician provider market in 20 years.

Agree.  But we need to go forward with wisdom.  

[gbrothers98]

59 minutes ago, Jofriend said:

Agree.  But we need to go forward with wisdom.  

Lot of hard earned wisdom already in place on this forum from OTP advocates. 

Doubt the AAPA nor the collective PAs commenting here are aiming to alienate physicians but they are making a seat for the profession at the lunchtable. Current and future PAs require this step forward. Physicians whom are threatened by this believe that they are still at the top of the healthcare hierarchy and are not insightful into the changes that continually occur in the healthcare workforce. PAs that are concerned about OTP should refer to the preceding sentence. 

Anecdotal case in point, local hospital ED transitioning to NP staffing with telehealth backup. Nearby PA owned and run ED group with successful coverage of 2 EDs over the course of 30 and 10 years not a consideration.....due to restrictive state law requiring supervision ratio of 1 physician to 4 PAs. Rate limiting effect for our profession while NPs are poised to exploit workplace opportunities without those restrictions. Why?

Central to OTP is shifting from local supervision with state law and medical board oversight to local collaboration with PAs providing oversight either as a separate state board (preferred) or a subset of an existing medical board. What this boils down to is we take care of our own, the good and the bad. That is what every other similar clinician does in healthcare.

We have  spent too long believing our link to physicians has been all upside and no down. NPs being hired over a PA due to state statute rather than capabilities is wrong. Being unable to obtain direct reimbursement for a service while similar clinicians may is legal restraint of trade. Scrambling to replace a disabled or suddenly departed supervising physician in order to work reveals the fragile framework our professional lives are supported by. 

Support OTP in your state. This is the path to a better workplace for PAs present and future.

George Brothers PA-C

[surgblumm]

Great article and great posts by PAs throughout the USA. Every State as their rules and practice provisions and many are outdated. I am withholding a generalization but believe that their are many PAs who are ready for this forward move and that there are just as many, for various reasons, that are not ready. Experience remains our residency and I am a firm beleiver that we need to gather the experience while we are under the watchful eye of a collaborating physician but there remains a time that we have become competent and expert in dealing with numerous disease states and at that time we are ready to assume full responsibility. The big question still remains: who determines that we have reached that pinnacle?

[Joelseff]

Great article and great posts by PAs throughout the USA. Every State as their rules and practice provisions and many are outdated. I am withholding a generalization but believe that their are many PAs who are ready for this forward move and that there are just as many, for various reasons, that are not ready. Experience remains our residency and I am a firm beleiver that we need to gather the experience while we are under the watchful eye of a collaborating physician but there remains a time that we have become competent and expert in dealing with numerous disease states and at that time we are ready to assume full responsibility. The big question still remains: who determines that we have reached that pinnacle?

I think PA Brothers answered your question above. We should be regulated by OUR OWN board or the medical board with majority PA involvement and input.  They can determine what parameters we can set as far as credentialing and evaluation of experience etc. I hope and think PAs are intelligent and for the most part cautious (read: know our limitations) enough to not just grant free reign to unqualified practitioners. I have a friend who was my classmate in PA school who sits on our state's PA board who tells me that in California, the board is very diligent about regulating PAs in order to protect our reputation.

 

As far as "hanging our own shingle" [emoji849]... Why do I always think of Zoster when I hear that [emoji38]. I think OTP mustn't be thought of as independence that is at least as in the same way as the NPs have been pushing for. The NPs seem to have a "we want independence and you all can kiss it if you don't agree" mentality while the OTP approach is emphasizing the need for the preservation of the team environment. I used to disagree with this and in the recent past have decried the OTP movement as a half hearted attempt to placate PAs desiring autonomy (or heck, independence) but did not want to bite the physician hands. I no longer see it as that.

 

I see it now as how it is written. Optimal Team Practice guidelines. We continue to work with our physician (and other) teammates which has been demonstrably successful the past 5 decades but we are also declaring we are our own profession and don't always need big daddy Medicine there to hold our hand every day. That's really what I think a lot of PAs want but when it first came out, all we saw and what it looked like was "Independence!" which in reality I think no longer truly exists in medicine today.

 

The NP move for independence has caused some division among NPs and their colleagues, MD/DO and PAs, (in a collective sense for the most part and not necessarily provider to provider I must add). I think the framers of OTP are trying to sidestep that landmine on the way to getting reduced or elimination of restrictions at work. The resistance I can and do see is the physician body telling us "you can't have it both ways" either you let us put you on a leash or you don't get the help (again this will likely be more from the physician lobby/boards vs actual physicians day to day). We'll see how it plays out. But again I will emphatically say "I'm down wit OTP!" (YEAH you know me!)

 

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[sas5814]

Joelseff I too decried OTP initially for the very reason you outlined and, I too, have had a change of heart. I think, at it's core, OTP is about eliminating outdated rules and regulations to improve access to care and preservation of the profession in a changing medical and political landscape.

Most of the physicians I know agree with the concept. To the ones that don't I ask...what do you do when you are confronted with a problem that is outside your experience or scope of practice? Read, consult, or refer. Me too. That usually moves us to the questions of who will be "watching" or regulating PAs in this new paradigm. My answer, again, is....our board just like your board regulates you based on statute and good medical practice guidelines. At some point the question of bad actors comes up.... malpractice, operating outside of scope etc. Same answer....we all have bad actors and we all should have systems in place to deal with them. If you have to have a perfect group to exist physician's would have needed to fold up their tent a long time ago.

 

Most of the arguments are based in fear and lack of understanding. Some are based in hubris and good old fashioned greed. All those arguments notwithstanding this is not just an important change for the profession but a necessary one.

[Joelseff]

Agreed!

We need to make T shirts with
"I'm Down Wid O.T.P" on them lol. (for those scratching their heads: look up naughty by nature OPP or click here https://g.co/kgs/EJbG8A)

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[Monte]

As a new grad, I've seen that a majority of job postings for APPs are NP geared. It's unfortunate, but I don't blame them. Honestly I would hire a NP over a PA simply based on laws and no other knowledge. We need changes.. opportunities.

[ApolloPA]

OP not that I disagree with you, but you’re also asking this question in an echo chamber.  

[Gordon, PA-C]

On 2/23/2018 at 3:11 PM, EMEDPA said:

if implemented as intended states could allow that, likely with a provision as is done with nps in some states that they practice for X years first.

That's not how it works.  NPs in independent practice states can hang their own shingle from day 1.  There's no rule about making them pratice for X years first.

Scary thought huh?  100% online FNP program can open up a 100% independent practice with less hours than an associates degree and BS shadowing as their only clinical experience.

[PACali]

On 2/23/2018 at 10:09 PM, wookie said:

 You also need to consider that PA's in ER do more fast track than docs. I can see a PA with 20 years of experience not having intubated a patient or ran a code.

 

I think a PA with 20 years of fast track experience, he or she should get OTP in the fast track. 

[EMEDPA]

17 hours ago, Gordon, PA-C said:

That's not how it works.  NPs in independent practice states can hang their own shingle from day 1.  There's no rule about making them pratice for X years first.

Scary thought huh?  100% online FNP program can open up a 100% independent practice with less hours than an associates degree and BS shadowing as their only clinical experience.

True in some states. others require x yrs of collaboration before independence.

[2234leej]

In Illinois, they recently passed a bill that allows NPs to practice independently after 1 year of collaboration with physicians or APPS. Additionally, they have to extensive pharmacology CEUs on top of their advanced practice CEUs. It's very surprising, given that Illinois is a terrible state for anything other than MDs/DOs.

[kidpresentable]

Is it likely we’ll have to foot the bill for malpractice coverage when OTP rolls out?

[ventana]

5 hours ago, kidpresentable said:

Is it likely we’ll have to foot the bill for malpractice coverage when OTP rolls out?

I already do.....

But no OTP

And i really see no value to sitting down to lunch with my doc once every 3 months "to meet the supervision" requirements...

[LT_Oneal_PAC]

11 hours ago, kidpresentable said:

Is it likely we’ll have to foot the bill for malpractice coverage when OTP rolls out?

Not any more likely than it is now. Your employer will cover your malpractice insurance just like they do for docs, if it’s negotiated into your contract. PAs that own their practice have to already as shown above.