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AOA Warning on PA "Independence"

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Curious to hear thoughts on this.

The American Osteopathic Association has put out a statement warning of the "dangers" of non-physicians (i.e. PAs and NPs) gaining increased independent-practice rights. They mention the AAPA directly (as well as the AANP), and bring up one of the tenets of OTP without fully explaining what it means, the implications, or how it's different than true independent practice (no surprise there).

They also cherry pick a few studies to back up their claims, while ignoring many others that don't support their statement. 

https://www.prnewswire.com/news-releases/expanding-independent-practice-rights-for-non-physicians-means-not-all-patients-can-see-doctors-300740501.html

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Well, look who's calling the kettle black.  Maybe the DO's are concerned because we lack the manipulation of body parts to do a body good.

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hummm

 

turf war that we are actually figthing organized medicine (doc's)   about time....

 

great job AAPA - steps forward are HUGE and I appreciate it!!

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Sounds a lot like the arguments that were used against DO licensure a half century ago.

If you ask me, it's pretty arrogant coming from someone who couldn't get into an allopathic med school.

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I saw this on LinkedIn a couple days ago. Some PAs and NPs had started defending our respective professions in the comments section and when I went back to it the next day all the comments had mysteriously vanished. ? I hope AAPA will be responding to their statement directly to set the record straight. 

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Although I did not read the Linkedin comments, I have seen quite a few on various sites discussing MD/DO, NP, PA, plus numerous articles and publications describing the similarities and differences of each profession.  What concerns me is that MD/DO, and most definitely NP’s, are fluffing their education and experience, PA’s seldom comment or expand  beyond what is "commonly thought" about the profession and actual education/experience. 

MD/DO say; it takes 4 years plus 3 years residency, in the article it said 12,000-16,000 clinical hours. Actually, MD can be achieved in 3 years if full time year round, with average of 155 graduate hours.  With required 18 months clinical rotation which can be as little as 2,800 clinical hours. …..(also take time to look up 2018 ACGME requirements, especially pages 18 on, it may surprise you how much or little is actually required).

I apologize to any NP out there in advance, there are many great ones. For the moderators, I am not intending to "bash" anyone,  just discuss promotion of PA.

NP say; it takes 3 years post BSN, they seldom list the required 500 (sure many have more) clinical hours.  Actually, If full vs. part time, NP can be achieved in 1 full year with an average of 50 graduate hours.

PA say; 2-2.5 years with required 2,000 clinical hours (I don’t know of any who did that few, my experience is closer to 2,500).  Actually, PA fail to include that 2-2.5 is full-time, year round with an average of 112 graduate hours.

In reality, PA has 2/3 education of MD and NP has 1/2  the education of PA. If MD/DO and PA counted years like NP’s count 3 years, it would take MD/DO nearly 10 years and PA 7 years to complete their respective graduate programs. 

Has this information ever been published for general public?  If so, I have missed it.  We should be professional and not belittle each other.  Yet Nursing does not hesitate to “fluff” their education and experience to further promote the profession. They are not specifically attacking PA, however h they are not concerned if people believe their 3 year part time program is more education than PA or close to MD 4 year. Why shouldn’t PA’s at least get the facts out there?

Thank you to AAPA for finally working to promote OTP and get rid of the awful title.

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The most troubling thing I run across is circular logic related to "experience." The haters always note the thousands of hours docs gain in residency. My follow up question is always, "Ok, with experience being the king, who would you rather care for you - a doc right out of residency, or a PA with 10 years of experience?"

The other thing that always struck me as odd was that they did not (that I am aware of) lengthen any of the residencies way back when they put work hour restrictions in place for residents. People currently graduating from residencies are likely seeing on the order of 30% fewer patients during their residency than the previous generation. This being the case, and if experience is king, 3 year residencies probably should have become 4 years residencies. 

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14 hours ago, Hope2PA said:

Although I did not read the Linkedin comments, I have seen quite a few on various sites discussing MD/DO, NP, PA, plus numerous articles and publications describing the similarities and differences of each profession.  What concerns me is that MD/DO, and most definitely NP’s, are fluffing their education and experience, PA’s seldom comment or expand  beyond what is "commonly thought" about the profession and actual education/experience. 

MD/DO say; it takes 4 years plus 3 years residency, in the article it said 12,000-16,000 clinical hours. Actually, MD can be achieved in 3 years if full time year round, with average of 155 graduate hours.  With required 18 months clinical rotation which can be as little as 2,800 clinical hours. …..(also take time to look up 2018 ACGME requirements, especially pages 18 on, it may surprise you how much or little is actually required).

I apologize to any NP out there in advance, there are many great ones. For the moderators, I am not intending to "bash" anyone,  just discuss promotion of PA.

NP say; it takes 3 years post BSN, they seldom list the required 500 (sure many have more) clinical hours.  Actually, If full vs. part time, NP can be achieved in 1 full year with an average of 50 graduate hours.

PA say; 2-2.5 years with required 2,000 clinical hours (I don’t know of any who did that few, my experience is closer to 2,500).  Actually, PA fail to include that 2-2.5 is full-time, year round with an average of 112 graduate hours.

In reality, PA has 2/3 education of MD and NP has 1/2  the education of PA. If MD/DO and PA counted years like NP’s count 3 years, it would take MD/DO nearly 10 years and PA 7 years to complete their respective graduate programs. 

Has this information ever been published for general public?  If so, I have missed it.  We should be professional and not belittle each other.  Yet Nursing does not hesitate to “fluff” their education and experience to further promote the profession. They are not specifically attacking PA, however h they are not concerned if people believe their 3 year part time program is more education than PA or close to MD 4 year. Why shouldn’t PA’s at least get the facts out there?

Thank you to AAPA for finally working to promote OTP and get rid of the awful title.

 

2 hours ago, SHU-CH said:

The most troubling thing I run across is circular logic related to "experience." The haters always note the thousands of hours docs gain in residency. My follow up question is always, "Ok, with experience being the king, who would you rather care for you - a doc right out of residency, or a PA with 10 years of experience?"

The other thing that always struck me as odd was that they did not (that I am aware of) lengthen any of the residencies way back when they put work hour restrictions in place for residents. People currently graduating from residencies are likely seeing on the order of 30% fewer patients during their residency than the previous generation. This being the case, and if experience is king, 3 year residencies probably should have become 4 years residencies. 

SSSSSSHHHHHHHH!!!!  Careful - you are both using too much logic and clear thinking.

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On 11/2/2018 at 9:11 AM, SHU-CH said:

The most troubling thing I run across is circular logic related to "experience." The haters always note the thousands of hours docs gain in residency. My follow up question is always, "Ok, with experience being the king, who would you rather care for you - a doc right out of residency, or a PA with 10 years of experience?"

The other thing that always struck me as odd was that they did not (that I am aware of) lengthen any of the residencies way back when they put work hour restrictions in place for residents. People currently graduating from residencies are likely seeing on the order of 30% fewer patients during their residency than the previous generation. This being the case, and if experience is king, 3 year residencies probably should have become 4 years residencies. 

I am supportive of a lot of what people want in this thread, but experience is different than training.  I can't work in a practice and assist a surgeon who does appy's for 15 years and then sit for the general surgery boards even though I have a MD after my name.   Formal training with specific training and didactic requirements are important.  This is why I think PA residencies are vital, especially if some body comes together and creates formal training requirements for them.

Edited by lkth487
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I could get behind 1 year residencies for all PAs for more continuity. The issue is funding them and them actually being treated as residents, which are students paid to learn versus half paid PAs who are getting limited teaching and half the salary for their first year.

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2 hours ago, newton9686 said:

I could get behind 1 year residencies for all PAs for more continuity. The issue is funding them and them actually being treated as residents, which are students paid to learn versus half paid PAs who are getting limited teaching and half the salary for their first year.

This will be the norm within 5 years.  The market is moving this direction at break neck speed.  If I was getting out of PA school now I would not even apply for a job without doing a residency.  Just go do it and get it out of the way.  

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2 hours ago, Cideous said:

This will be the norm within 5 years.  The market is moving this direction at break neck speed.  If I was getting out of PA school now I would not even apply for a job without doing a residency.  Just go do it and get it out of the way.  

Yup, residency and doctorate. Gonna need em to keep up in a competitive jobs market. 

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Crazy thing is that this defeats the entire premise of how we came into existence to begin with. Shorter, cheaper training than physicians to provide primary care services. Yes, I’m a dinosaur.

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7 minutes ago, GetMeOuttaThisMess said:

Crazy thing is that this defeats the entire premise of how we came into existence to begin with. Shorter, cheaper training than physicians to provide primary care services. Yes, I’m a dinosaur.

the premise also revolved around starting with experienced medical providers, not scribes, transporters, and CNAs. My class had many paramedics, resp therapists, RNs, LPNs, etc. If we had stayed with that we wouldn't be in the situation we are in now...

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6 hours ago, EMEDPA said:

the premise also revolved around starting with experienced medical providers, not scribes, transporters, and CNAs. My class had many paramedics, resp therapists, RNs, LPNs, etc. If we had stayed with that we wouldn't be in the situation we are in now...

If we had stayed with that then the profession probably wouldn't be growing at the speed it is either though (whether that growth is seen as a positive or a negative is another question).

Although GPA has become more important in admissions, I'd wager that it's not just an issue of those types of applicants being passed over in favor of medical assistants and CNAs with high GPAs, but rather that there simply aren't the numbers applicants with that kind of experience to fill classes (doubly so with all of the new programs opening). 

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7 hours ago, GetMeOuttaThisMess said:

Crazy thing is that this defeats the entire premise of how we came into existence to begin with. Shorter, cheaper training than physicians to provide primary care services. Yes, I’m a dinosaur.

 2 years of PA school +1 to 1.5 years of PA residency + online DMS degree is still shorter and cheaper than becoming a Physician. Considering we are moving toward OTP, I think this is necessary. My medical director went through 8 years of training: 4 years medical school + 4 years of EM residency. He also got a MPH (not online).  

Edited by PACali

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14 minutes ago, PACali said:

 2 years of PA school +1 to 1.5 years of PA residency + online DMS degree is still shorter and cheaper than becoming a Physician. Considering we are moving toward OTP, I think this is necessary. My medical director went through 8 years of training: 4 years medical school + 4 years of EM residency. He also got a MPH (not online).  

If it's worth it to you, then be my guest.  It wouldn't have been that way for me.  EMEDPA and I, as well as others dating back to the 80's & early 90's, probably would've bypassed this route for medical school, or maybe made some other selection (CRNA?).  At the time that I got out, the other thread detailing doing scut work, that WAS the norm back then in many situations.  Things change over time.

Here's the one thought that some need to consider.  I'm making just as much in a cush setting as many others working their tail off.  All I've got is an old school BS and I maybe had $10K worth of loans when I got out which were paid off in a year.  Even allowing for the time value of money, the outlay of cash today to perform the same duties for a similar wage that I'm qualified to do, and am doing, just doesn't make sense to me.

Edited by GetMeOuttaThisMess
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22 hours ago, EMEDPA said:

the premise also revolved around starting with experienced medical providers, not scribes, transporters, and CNAs. My class had many paramedics, resp therapists, RNs, LPNs, etc. If we had stayed with that we wouldn't be in the situation we are in now...

This opinion is very firmly held by many. I'm still waiting for the data to show it is anything other than an opinion, though.

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Ahhhh the sacred alter of data even when faced with questions that seems intuitive. Don't get me wrong I have made the data argument many times about any number of things but there is a common sense factor to some things.

For instance if I said 16 is a better age to issue driver's licenses than 4 because 16 year olds are better equipped for the task would you want data? data has a value when something needs to be proven. Common sense will often suffice.

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The appeal to ignorance logical fallacy doesn't really work in this scenario. Data would be helpful because the answer isn't clear. We didn't ask if unicorns exist...

 

Related image

Edited by HanSolo
Edited to include this image lest we forget where "expert opinion" falls on the hierarchy of evidence.

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Do you have data to prove unicorns don't exist? Trust me I know all the logical fallacy points and have used them myself. There is a significant difference between arriving at a "truth" based on no data and having a belief based on experience.

 

Lots of things I believed to be intuitively true turned out not to be. Then there is the weight of evidence. Both sides of the "PAs are inferior to physicians" argument have lots of data. None of it drives a stake through the heart of the argument and settles it.

My point is people with solid expert experience in a subject matter can have credible opinions. People who disagree then , all too often, start banging the "evidence" bell.

Edited by sas5814
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Asking if there is data to support that assertion is valid in this case though, as it would have implications for our profession as a whole. It's no different than asking for data when physician groups state that PAs provide inferior care than physicians (I'm sure many of them would argue that they have that belief based on experience).

If prior patient care experience is the main determinant of the quality of a PA (even if just for the first five years of practice), then the current PA school admissions practices should be diluting the profession with substandard PAs since the trend over the last 10+ years has been less PCE and higher GPAs (the annual PAEA reports show this).

I've heard anecdotal accounts from experienced members of this forum that argue both ways -- some say that they have worked with early career PAs with very little prior experience that are rock stars, and others state that those with prior experience are always the best out of the gate. We can't change policy based on anecdotal experience though. 

 

There was this study (https://www.ncbi.nlm.nih.gov/pubmed/27228045) that looked at prior experience and clinical year outcomes, and the study "did not support the hypothesis that healthcare experience is associated with improved clinical year outcomes." It would be interesting to see a similar study that looked at first few years of practice rather than just the clinical year. 

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yea my opinion is you can't make a strong argument either way though people with prior medical experience seem to have an easier time is school. I know great PAs that had virtually no prior experience and people who worked in health care in some capacity for a long time I wouldn't trust to put ointment on a shaving cut.

I'm military trained (one of the last all Army classes) and we used to argue about what kind of military medical experience made better PAs. We had everything from medics to SF medics to pharmacy techs to OR techs and others. Looking back on the group I graduated with over almost 30 years I see no correlation. Smart hard working people who continue to educate themselves and seek self improvement do well regardless of origins.

Edited by sas5814
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48 minutes ago, ProSpectre said:

There was this study (https://www.ncbi.nlm.nih.gov/pubmed/27228045) that looked at prior experience and clinical year outcomes, and the study "did not support the hypothesis that healthcare experience is associated with improved clinical year outcomes." It would be interesting to see a similar study that looked at first few years of practice rather than just the clinical year. 

Agree- I would like to see a study that examines first year competence as determined by collaborating physicians based on a set criteria for what determines "good" (# of bounce backs, frequency of needing to be bailed out, med errors, etc) examined solely based on years and intensity of prior experience. My N= probably around 200-250 now for PA students precepted is that 95% of the time intensive/high level experience(Paramedic/RN/Resp therapist) > gpa or pance score as a marker for ability to actually practice safely and effectively with minimal oversight. I know many folks who struggled through PA school in the didactic year, shined in clinicals, and can run circles around the 4.0/700 pance former scribes out there.

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