AAPA candidates afraid of name change and independent PA rights

[ProSpectre]

Boatswain, I have much respect for your opinion and your experience. I think PAs like you, who are able to practice at the top of your license and experience, make our profession look good, and I honestly aspire to be in a similar role when I have a similar level of experience. 

As to your question, I don't think having independent PA boards are designed to circumvent physicians; as you and others have said, board certified physicians are still the gold-standard for independent practice, and they will remain so. However, boards with majority PAs on them are most likely to look out for the common good of our profession on issues effecting PAs, and would put us on par with other similar professions. 

Similarly, the goals of OTP are to allow the profession to catch up legislatively where PAs are in practice, allow PAs to take responsibility for their own practice, be recognized for the work they do by being able to bill medicare directly, and to remove broad state level regulation that shouldn't be a one-size fits all option when there are PAs with your level of experience or more that are subject to the same supervisory requirements as a new grad PA. Allowing the employer and physician to determine, at the practice level, what level of supervision a PA has simply makes sense, and won't divorce us from the physicians we work with. I have worked with PAs with over a decade of experience that were quite competent in their job and yet had to have a physician co-sign every schedule II drug they wrote, no matter the amount (which caused her physician colleagues to roll their eyes -- this was in an oncology practice where these prescriptions are common).

OTP doesn't advocate for independent practice at any length of time, not in the same way physicians are independent, which for some reason seems to be a major sticking point for many. These types of changes are simply designed to put us on par with our competitors in the market (NPs of course), not completely take away the relationship that we have with MD/DOs (which I don't think will change much for most PAs). I don't know if you follow the Huddle, but there was just a new thread this weekend where PAs from 5 different states across the country were talking about hospital systems in their states preferentially hiring NPs over PAs -- this is a very real problem, and as someone entering the profession in the near future, something that worries me quite a bit. I have no desire to practice with full independence, and If I did I would have gone to medical school, which I was capable of doing. I do intend on doing a residency, and would like to be able to practice up to the level of training I have, but no more. I think that is all most PAs that are in favor of OTP would like. 

[Boatswain2PA]

1 hour ago, ProSpectre said:

OTP doesn't advocate for independent practice at any length of time, not in the same way physicians are independent, which for some reason seems to be a major sticking point for many.

So, if "not in the same way physicians are independent", then in what way?  

Again, I'm all for removing all the useless bureaucratical hurdles (like co-signing, chart review, etc).

 

[ProSpectre]

I think you are reading further into it than I intended -- in no way will there be independence. Period. Which is my point; those against OTP seem to not get this aspect of it. 

[Boatswain2PA]

I understand the current version of OTP doesn't equal independence.  I'm all for OTP.  Stupid regulatory burdens (co-sign, chart review, etc) need to go away.  However I don't see the need for ANOTHER regulatory board, we practice medicine, we should fall under BOM.

However I know many of the loudest voices for OTP, just like the loudest voices for PAFT, are all for independent practice rights.

[ProSpectre]

8 minutes ago, Boatswain2PA said:

I understand the current version of OTP doesn't equal independence.  I'm all for OTP.  Stupid regulatory burdens (co-sign, chart review, etc) need to go away.  However I don't see the need for ANOTHER regulatory board, we practice medicine, we should fall under BOM.

However I know many of the loudest voices for OTP, just like the loudest voices for PAFT, are all for independent practice rights.

 

I may not be well versed enough in the intricacies of that particular aspect of OTP to comment intelligently on it, but I think it would at the least be worthwhile to have more representation of PAs on the medical boards (and/or more representation by physicians who actually supervise PAs). Representation that has the interests of our profession first and foremost (after good patient care of course) is quite important, especially moving forward in trying to remove some of these outdated regulatory burdens. 

I started a thread to discuss some of the questions about OTP, and would welcome your comments there. 

https://www.physicianassistantforum.com/topic/46143-dialogue-on-optimal-team-practice/

[CorpsmanUP]

On 4/9/2018 at 0:07 PM, Boatswain2PA said:

So, since I've been practicing for >5 years in emergency medicine, and working VERY independently, I should be able to get an independent license?

With an independent license would I be able to start doing fluoroscopy or total knee replacements tomorrow?  What about neonatology...sounds like that pays very well.

I get the frustration of being tied to the docs....I really do.  Makes me frustrated too!  But the push for independent practice rights just doesn't fly with reality.  

I'm ALL for getting rid of the restrictive laws (# of PAs a doc can supervise, legal requirements for chart review, cosignature, etc), but I just can't see "independent practice rights" (and let's be honest, that's the goal of many who push OTP) being a good thing for the entire PA profession (remember, PAs do more than FP and EM).

This is a spurious argument, and I think you know it Boats. Just like Physicians are credentialed, so would PAs be. You are not going to get a hospital credentialing committee to sign off on that. As for private practice, practicing outside your training is a quick route to denial of reimbursement from insurance and/or a malpractice suit when you screw up.

I believe, and know a lot of physicians that share this sentiment, that while a physician trained in their specialty is the gold standard, a PA is better than a physician practicing out of their specialty. 

i.e, EM MD> EM PA> FP MD in emergency medicine, Neonatologist > Neo PA > general practice Pediatrician in regards to neonatology. 

 

[EMEDPA]

the independent PA boards is the least important part of OTP to me. I am all for medical boards regulating us, but would like appropriate PA representation, maybe even majority PA representation, on the PA committee.

[corpsman89]

Arizona already has their own PA board. As far as I know it has been run flawlessly and judgement is made by PAs who understand the complexities that are unique to our profession. 

Obviously the most important part is not making our collaborating physicians legally responsible for the care we give, and also allowing the practice level to decide proper collaboration requirements. From what I understand, if you work for an organization that doesn't want to deal with collaboration requirements you would basically practice as a NP with full practice authority?

[CAAdmission]

Increasing responsibility with increasing experience is the norm in all medical training, whether involving med students or residents. Experienced clinicians oversee care and gradually delegate increased responsibilities. 

[Boatswain2PA]

4 hours ago, corpsman89 said:

Arizona already has their own PA board.

Really?  Wasn't aware of that at all.

[corpsman89]

2 hours ago, Boatswain2PA said:

Really?  Wasn't aware of that at all.

For a while too. 

 

[pafrankc]

On ‎4‎/‎8‎/‎2018 at 9:45 PM, Joelseff said:

IF they were violating existing laws protecting us but I wonder if NCCPA is under some other law or regulation being they are our certifying body? Maybe they avoided violating antitrust this way somehow.

Sent from my SAMSUNG-SM-G891A using Tapatalk
 

I am not a lawyer (thankfully).  NCCPA is probably exempt from antitrust as a certifying organization.  It is when they actively lobby a state to require PAs to take their examination as a condition of employment that I think they cross the line to anti-trust

[Anachronist]

I would appreciate if the moderators would delete posts by obvious spam accounts, especially those with deliberate inflammatory political references. If the discussion is to be had, and it should be, it should not be done under these terms. IMHO of course.

[corpsman89]

22 minutes ago, Anachronist said:

I would appreciate if the moderators would delete posts by obvious spam accounts, especially those with deliberate inflammatory political references. If the discussion is to be had, and it should be, it should not be done under these terms. IMHO of course.

What exactly are you referring to? 

[Anachronist]

47 minutes ago, corpsman89 said:

What exactly are you referring to? 

The originator of this thread. "OP" as it were. 

[corpsman89]

2 hours ago, Anachronist said:

The originator of this thread. "OP" as it were. 

OK, but "deliberate inflammatory political references."

What are you talking about? 

This forum is unique because they do not just delete posts left and right. If you want a perfectly PC, happy go lucky, rainbows and butterflies forum I suggest you focus your attention on AAPAs Huddle. 

[Gordon, PA-C]

On 4/10/2018 at 6:39 PM, CJAdmission said:

Increasing responsibility with increasing experience is the norm in all medical training, whether involving med students or residents. Experienced clinicians oversee care and gradually delegate increased responsibilities. 

Yes but the key word here is "training"

I will submit to you that PAs who are working on the job and not in a residency/fellowship program are not likely being "trained" in any formal way that compares to a residency.

This goes back to this fundamental argument:

Is working as a PA for 2 or 3 years in a given field (say EM) the same thing as doing an EM residency?  I think anyone who works in EM (or any other field) will tell you those things are NOT equivalent.

Formal training like residency prepares you for increased responsibilities in a way that work experience does not.  I've seen PAs with 10 years of work experience who are not as well "trained" as a PA who only has 2 years of work experience but also did a 1 year residency.