Supervision vs Collaboration

[ProSpectre]

I heard recently that Tennessee is the 6th state to pass legislation changing the language for PA-to-physician relationships from "supervision" to "collaboration". I know this is a positive for the profession, but can anyone explain if this changes how PAs in Tennessee will actually practice, or is it simply a step in the right direction for OTP? I don't think it does anything to change co-signature requirements, physician-to-PA ratios, or the requirement for PAs to have a formal agreement with a specific physician in order to practice. My guess is that each individual change like that must be done piece by piece. 

I'm just trying to better understand the process of how this change in legislative language will eventually lead to less red-tape for PA practice (similar to NPs in the states they are less restricted in).

Link to the AAPA announcement: https://www.aapa.org/news-central/2018/05/tennessee-pas-achieve-collaboration/ 

[EMEDPA]

it's more a PR thing. now the official state regs don't list PAs as requiring "supervision", but working in collaboration with physicians. words matter. this is a good change. in my state certified PAs are sponsored, not supervised. 

[ProSpectre]

16 minutes ago, EMEDPA said:

it's more a PR thing. now the official state regs don't list PAs as requiring "supervision", but working in collaboration with physicians. words matter. this is a good change. in my state certified PAs are sponsored, not supervised. 

Makes sense. That's what I was thinking, I just wanted to make sure I was clear; I'm definitely glad to see these types of changes. It seems like this change in legislative language is a good first step for states to make then, and should make later changes that do more to improve the practice environment an easier sell. 

 

[corpsman89]

Perception matters. Words Matters. Language matters. 

It's sort of the same thing as title change. Changing our title will do nothing immediately in changing the way we practice. However, changing our title (and getting assistant out of our title) will have lasting effects due to better perception from people in power and patients alike. 

Supervision = Subservience, or that we aren't qualified to make decisions on our own. 

Collaboration = Teamwork, or that we are qualified to make decisions on our own, but we can ask for help when needed. 

[sas5814]

Collaboration is at the heart of OTP. It changes us from dependent to team member. 

 

Great changes are afoot. Soon self regulation with PA majority boards. Direct pay from Medicare instead of billing through the physician. Title change. It is an exciting time.

[ProSpectre]

All good points. I definitely understand the importance of language and how it shapes perception; that's exactly why I've been vocally pro-title change. We just need to keep the momentum up on changes like this so that they can continue to snowball into the larger changes of OTP that will break down regulatory barriers to PA practice. 

And I agree Scott, it is a very exciting time for the profession; I don't think I could have picked a better time to join the ranks. 

[vb315]

A little off-topic, but I saw a pt this week (on rotations), who  had her occupation listed as "Physician Assistant" on her demographic form. I was making small talk and asked her about it, and it turns out she's an MA....not a PA. Her uncle is a family doc and she works at his clinic where she assists him, thus she called herself a Physician Assistant....words definitely matter.

[corpsman89]

11 minutes ago, vb315 said:

A little off-topic, but I saw a pt this week (on rotations), who  had her occupation listed as "Physician Assistant" on her demographic form. I was making small talk and asked her about it, and it turns out she's an MA....not a PA. Her uncle is a family doc and she works at his clinic where she assists him, thus she called herself a Physician Assistant....words definitely matter.

Wow. But you're right it's pretty easy to get MA and PA mixed up. Basically, they mean the same thing, and I would argue that Physician Assistant is actually a better title for MAs because they legitimately assist the physician. 

[sas5814]

In Texas is it mandated in statute that to refer to yourself as a Physician Assistant you have to be a grad of a PA program and licensed by the PA board.

When I was on the BOD of a hospital district I was the chair of the BOD credentials committee and there was a graduate of an OR tech training program who was renewing his credentials as a PA with the hospital as a PA and I stomped the brakes on that most tic. He ended up leaving the area. Fun aside he was working for an ortho surgeon who spent 6 years in prison for Medicare fraud and drug dealing who got a full unrestricted license after he finished his tour of duty with the state. It was like a little medical-criminal enterprise.

[vb315]

Saw a job-posting today for a Family Med PA/NP and this was the overview:

"May provides general medical and/or surgical care and treatment to patients in a medical setting (office, telemedicine, hospital, Urgent Care, LTC, or Clinic) in collaboration with physician(s) for APRNs where dictated, or under the supervision of the physician(s) for a Physician’s Assistant.

*sigh*

[ProSpectre]

3 hours ago, vb315 said:

Saw a job-posting today for a Family Med PA/NP and this was the overview:

"May provides general medical and/or surgical care and treatment to patients in a medical setting (office, telemedicine, hospital, Urgent Care, LTC, or Clinic) in collaboration with physician(s) for APRNs where dictated, or under the supervision of the physician(s) for a Physician’s Assistant.

*sigh*

What state was this in? 

I definitely feel like the profession is making progress, but seeing things like this make me wonder if it's one step forward and two steps back. 

[sas5814]

I think what we are seeing is the first steps in what will develop major momentum. We need one or 2 states to go full OTP and the rest will start to go. Getting big changes started is tough but then it tends to pick up speed. States that currently aren't in favor of OTP or drag their feet will find themselves buried in NPs and the PAs will leave for greener pastures. It builds on itself.

[Hope2PA]

On ‎5‎/‎28‎/‎2018 at 12:30 AM, EMEDPA said:

it's more a PR thing. now the official state regs don't list PAs as requiring "supervision", but working in collaboration with physicians. words matter. this is a good change. in my state certified PAs are sponsored, not supervised.

Both collaboration and sponsored are an improvement over supervision.  Good step toward OTP, looking forward to eliminating the extra steps in paperwork required for to work as PA vs. NP in those 22+ states.  Not being associated with the current title will also help with legislation.  When a lot of bills are being reviewed, giving a Physician Assistant OTP   will take a lot more work explaining and educating than a more direct title such as Medical Practitioner. 

[PAinPenna]

I work for a large health system in Pennsylvania, 

Every Advanced Practitioner job ad is broken down as below: 

JOB TITLE: Nurse Practitioner Physician Assistant Urgent Care

The successful Physician Assistant candidate will work under the responsibility and supervision of the physician and require completion of an ARC-PA approved physician assistant program, NCCPA certification or eligibility and Pennsylvania State licensure.  Six months of primary care, emergency medicine, urgent care or critical care experience is required.

 

The successful Nurse Practitioner candidate will work in collaboration with the physician and have a certificate of completion from an approved program for Nurse Practitioners, be eligible for or hold current national certification that allows NP to work with the patient populations and location settings associated with this position (adults and children one year and older ). Must be eligible for licensure by the Pennsylvania State Board of Nursing.  Six months of primary care, emergency medicine, urgent care or critical care experience is required.

 

[Hope2PA]

3 hours ago, ProSpectre said:

What state was this in? 

I definitely feel like the profession is making progress, but seeing things like this make me wonder if it's one step forward and two steps back. 

This is why the title has to be totally revamped.  Keeping PA will take a life time to change from the idea of physician assistant even if it stands for physician associate.  Being an associate still doesn't suggest one ability to practice and made decisions without direct oversight. That would truly be one step forward, two steps back, as there wouldn't likely be another chance to really make a change. If physician associate is choice, because of perceived difficulties or lack of gumption, to change some letters,  it may be less likely to move toward self regulating boards that SAS5814 mentioned. 

[vb315]

7 hours ago, ProSpectre said:

What state was this in? 

I definitely feel like the profession is making progress, but seeing things like this make me wonder if it's one step forward and two steps back. 

This was in Ohio.

[Michigander]

On 5/30/2018 at 2:32 PM, corpsman89 said:

Wow. But you're right it's pretty easy to get MA and PA mixed up. Basically, they mean the same thing, and I would argue that Physician Assistant is actually a better title for MAs because they legitimately assist the physician. 

Still a little off the original topic, I was a participant in the Bureau of Labor Statistics this year and gave my occupation as PA. They asked for my daily duties including "assisting the physician". I refused to pick that one and said "there is no physician at work to assist". I work in one of the states that has switched to "collaboration". I like "collaboration" much better and it is more descriptive of our relationship.