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Cideous

Stood in a Sears the other day, it reminded me of our profession...

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Wife and I stopped by a Sears last week while browsing around in the mall.  It was the first time I had been in one in a long time and it was in a word....Sad.  "Everything half off" "Closing soon" signs were everywhere.  I was looking for the sign that said, "Refused to adapt to the changing marketplace, now dying...".  But alas it was nowhere to be found.

Sears reminds me of Physician Assistants.  Whether through arrogance or laziness, we have allowed ourselves in less then 20 years to be caught and passed by NP's both in size and scope.  Yet here we are ....all excited about hiring a firm to "look at the impact of changing our name or OTP"........Not to sound too dickish, but ....wooooooow! Go us!  As NP's FLY past us we are suppose to be excited about starting to think about maybe what it would look like if we began to consider the possibility of maybe not becoming extinct???????    Give me a break.

I am nearing the sunset of my career and granted I bear the scars of 28 years of medicine, but there is one thing I do know.  We are going to be replaced soon and it will not be a slow gradual event.  NP's will continue to pass independent practice type legislation and one day the corporate overlords will simply /delete Physician Assistant from the job posting leaving only Nurse Practitioners on the heading.  

Right now it's 2005, they are Amazon and we are Sears.  I wonder what Sears would have done 13 years ago had they known what the outcome was going to be for them.  Would they have been more aggressive in an effort to save their very existence?  We will never know.  What we do know now though is that they are dead.  They failed to act when they still had time, and because of that impotence,  they are now just another footnote in history.  I would prefer our profession does not become a footnote, but that is where we are headed if we don't at least start by changing our name...not tomorrow not next year...Now.  Trying to implement any kind of independent practice laws will fail the second the word "Assistant" is heard by lawmakers.

 

It's 2005 and we are Sears friends......everything is half off....

Edited by Cideous
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I already see job postings around Colorado that specifically list NP and when I contact the company, they insist they really do mean NP and not PA. These are jobs in FP, urgent care, peds, oncology, specialty clinics, and even some surgical positions. Although I will not that most surgical, EMed, and procedure heavy specialties still seem to prefer PAs. I see a lot of "we want an NP to staff our rural primary Care clinic because they don't need a doctor around to supervise them" When I have taken the time to explain what  flexibility "supervison" actually allows for in most states, I'm usually met with "well that's great but it still seems like more of a hassle than we are looking for". Sigh... This is really not an us (Pa) vs them (np) fight. This should serve as a warning call, even if it's not happening in your state or locale right now. 

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I don't agree

 

But if I did my question to you is "What are you doing to change it?"

 

Are you donating to PAC, or your state board?  are you calling elected reps?  Are you going to sit by the side, or get involved?? 

 

lamenting what could have been does nothing....

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I think it is more like 2 used car salesmen.

One can get you the kia rio right now for 5000. sign here and it's yours.

The other can get you a (better) honda civic for the same price, but you need to talk to the sales manager (SP) first.

people say, sounds like a hassle, I will just buy the kia.

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I'm getting ready to start PA school in the next year so I'm curious what do some of y'all who have much more experience and wisdom recommend for somebody like me who is getting ready to embark into this field. What can I do to make a difference or am I starting a journey on a sinking ship?

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16 minutes ago, JohnnyLAX9 said:

I'm getting ready to start PA school in the next year so I'm curious what do some of y'all who have much more experience and wisdom recommend for somebody like me who is getting ready to embark into this field. What can I do to make a difference or am I starting a journey on a sinking ship?

Sinking ship is an exaggeration. More like a ship in storm (since we're talking about analogies.) Consider doing a residency or fellowship to set yourself apart. One of my upperclassmen did it and one month from finishing she had more job offers than she knew what to do with. 

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31 minutes ago, kingcoffee7 said:

Sinking ship is an exaggeration. More like a ship in storm (since we're talking about analogies.) Consider doing a residency or fellowship to set yourself apart. One of my upperclassmen did it and one month from finishing she had more job offers than she knew what to do with. 

yup, residency, caq, doctorate. do the trifecta. then there is nothing a a DNP has that you don't....

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31 minutes ago, kingcoffee7 said:

Sinking ship is an exaggeration. More like a ship in storm (since we're talking about analogies.) Consider doing a residency or fellowship to set yourself apart. One of my upperclassmen did it and one month from finishing she had more job offers than she knew what to do with. 

This. Residency will set you apart not only from NPs but your classmates. Also join you state PA association as well as AAPA. I know my program has representatives that go to conferences. You could be active in those. 

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50 minutes ago, JohnnyLAX9 said:

I'm getting ready to start PA school in the next year so I'm curious what do some of y'all who have much more experience and wisdom recommend for somebody like me who is getting ready to embark into this field. What can I do to make a difference or am I starting a journey on a sinking ship?

Stay aware and stay involved. The profession is in the early stages of a seismic shift and one of our biggest problems is apathy. My personal guess is about 10% of the PA force knows much of anything about the huge events that drive their professional future and probably 10% of that 10% is participating in the process that is going to move the profession forward.

In addition to staying involved ask your peers at every opportunity if they are aware and involved. I work in a 7 clinic UC that belongs to a major hospital group and exactly 1 of my colleagues has even heard of OTP and she didn't really know what it was. Apathy will kill us.

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11 minutes ago, EMEDPA said:

yup, residency, caq, doctorate. do the trifecta. then there is nothing a a DNP has that you don't....

 

44 minutes ago, kingcoffee7 said:

Sinking ship is an exaggeration. More like a ship in storm (since we're talking about analogies.) Consider doing a residency or fellowship to set yourself apart. One of my upperclassmen did it and one month from finishing she had more job offers than she knew what to do with. 

What if I want to work in Family Medicine? Do you still recommend a residency? I have read around on the page here and it sounds like people are mixed on whether a Family Medicine Residency is valuable for a PA or not. I've worked at a Community Health Center for the past couple of years and really enjoy it. I am hoping to do similar work once I graduate.

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13 minutes ago, JohnnyLAX9 said:

 

What if I want to work in Family Medicine? Do you still recommend a residency? I have read around on the page here and it sounds like people are mixed on whether a Family Medicine Residency is valuable for a PA or not. I've worked at a Community Health Center for the past couple of years and really enjoy it. I am hoping to do similar work once I graduate.

Yes. I worked in that world for 5 years. It is a difficult mixture of family medicine, psychiatry, urgent care, and emergency medicine. It probably won't land you the job because those jobs aren't particularly hard to find if you want one, but it will make it a MUCH easier transition for you. 

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17 minutes ago, JohnnyLAX9 said:

 

What if I want to work in Family Medicine? Do you still recommend a residency? I have read around on the page here and it sounds like people are mixed on whether a Family Medicine Residency is valuable for a PA or not. I've worked at a Community Health Center for the past couple of years and really enjoy it. I am hoping to do similar work once I graduate.

Consider going rural! My school offered to set us up for family medicine and electives. You'll get a lot of exposure and learn a lot. One person in my class did it and said he learned a ton and higjly recommended it. But go into clincal year with an open mind. Half my class went in dead set on a certain specialty only to change. I wouldn't worry to much about it right now. 

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7 minutes ago, kingcoffee7 said:

Consider going rural! My school offered to set us up for family medicine and electives. You'll get a lot of exposure and learn a lot. One person in my class did it and said he learned a ton and higjly recommended it. But go into clincal year with an open mind. Half my class went in dead set on a certain specialty only to change. I wouldn't worry to much about it right now. 

yup, rural also offers the option of loan repayment. a friend of mine who works at a rural ED is getting both state and federal loan repayment for doing so. Having worked urban, suburban, and rural, I can tell you that PAs are generally treated much better in rural environments where they are more needed and appreciated. Go where the docs don't want to go and do the work they don't want to do and you will always have a job. that pretty much means rural, prisons, Indian health service, Alaska, etc.

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^^ This. I worked rural for most of my post-Army career. Pay was great. Cost of living was low. I was treated as a respected colleague. I had people clammoring for my services.

Sadly life happened and now I work for a giant organization in a mid-sized town where I am a voiceless cog in a money making machine run by nurses and bean counters.

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6 minutes ago, sas5814 said:

^^ This. I worked rural for most of my post-Army career. Pay was great. Cost of living was low. I was treated as a respected colleague. I had people clammoring for my services.

Sadly life happened and now I work for a giant organization in a mid-sized town where I am a voiceless cog in a money making machine run by nurses and bean counters.

sorry...I went from cog to 100% rural. 3 rural jobs now, 2 of them solo. job #3 is a coastal vacation destination double coverage position. great crew there. have been offered full time many times. may do it as I get closer to retirement. bought a condo across the street from the hospital with an ocean view for less than 70k and get top dollar wages there. I see anyone I want and typically alternate charts with a doc. almost criched someone there my last shift.

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Rural jobs seem to pay okay and have more opportunity for loan repayment but I will say that I work in an underserved rural clinic and I both get paid poorly and was turned down for both state and federal repayment programs despite our site qualifying and doing the applications correctly. I wasn't counting on the loan repayment so it wasn't a complete surprise.

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7 minutes ago, Colorado said:

Rural jobs seem to pay okay and have more opportunity for loan repayment but I will say that I work in an underserved rural clinic and I both get paid poorly and was turned down for both state and federal repayment programs despite our site qualifying and doing the applications correctly. I wasn't counting on the loan repayment so it wasn't a complete surprise.

sorry to hear that. I know there is a big difference between qualifying and getting approved for loan repayment. the site my friend works at is > 1 hr away from any major metro areas and she works at one of 2 hospitals in a very large rural county.

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5 hours ago, JohnnyLAX9 said:

I'm getting ready to start PA school in the next year so I'm curious what do some of y'all who have much more experience and wisdom recommend for somebody like me who is getting ready to embark into this field. What can I do to make a difference or am I starting a journey on a sinking ship?

Go to medical school (assuming you are young and brilliant like most PA students).

This analogy is grossly flawed.  Sears business model is relatively strong and they have very strong brand loyalty.

What has driven Sears to bankruptcy is their defined pension plan.  They are spending more on retiree pay than employee pay, and that has killed them.

 

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3 hours ago, Boatswain2PA said:

This analogy is grossly flawed.  Sears business model is relatively strong and they have very strong brand loyalty.

I'm really not sure it is.  I HAD brand loyalty.  I tried to buy a large appliance for cash.  I offered to let them upsell me, but they had 20+ models on the floor and only 2 in the warehouse they could give me that day.  They couldn't sell me anything without knowing who I was.  It took forever to get anyone's attention.

All this to say... Sears is WAY worse off than the PA profession is, but the problem in the analogy isn't that Sears is actually OK. :-S

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22 hours ago, EMEDPA said:

yup, residency, caq, doctorate. do the trifecta. then there is nothing a a DNP has that you don't....

Except "Practitioner" in their name...not "Assistant"...

 

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18 hours ago, Boatswain2PA said:

Go to medical school (assuming you are young and brilliant like most PA students).

This analogy is grossly flawed.  Sears business model is relatively strong and they have very strong brand loyalty.

What has driven Sears to bankruptcy is their defined pension plan.  They are spending more on retiree pay than employee pay, and that has killed them.

 

I think you missed the point of the analogy lol.  

Most got it though.  it's 13 year ago and Amazon has just passed Sears (or insert any other lazy slow to adapt retailer who got crushed by Amazon).  Amazon is moving full steam ahead to marketplace dominance.  Sears did little to nothing and got crushed.  Debating their flawed "pension" system was not the point...

 

As for what I do?  I've given a LOT of money over the years to my state org and AAPA.  Yet here we are.  I will bookmark this post and check it in a few years.  I don't want to be right, but I would bet money I will be proven correct unless we as a profession go into crisis mode BEFORE it's too late.  

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I think you make some very good points. I, too, am nearing the end of my career. Some bad cultural decisions were made early on. I understand why those decisions were made as we sprouted out of physician model and nurse practitioners came from a powerful and established nursing platform. But early on, our forefathers bet that physicians would oppose nurses who wanted more autonomy and embrace PAs who said we wanted to work together. But money talks. Nurse Practitioners are more lucrative for hospitals if they don't have the required supervising physician. They have a huge lobby to promote their profession and they play dirty.

After working for my first years in support of the AAPA, I became disillusioned with them for the same reason as some have with Sears. They would not change and they would not listen to the rank-n-file. I left them for 15 years and continued working on my own issues. I met with insurance companies about reimbursement. I created and owned my own clinic and had to fight like hell against many powers to do that. I had to fight to keep PA-owned practices legal in Washington when an attempt was made to close us down (I had no help from PA powers that be).

However, I do sense a final changing climate within the AAPA and PA culture. With Dave Mittman taking the helm next year (and he was always been on our side) I see hope of change. The only questions remain is it too little too late and will it be like Animal Farm, as soon as we get good people in the farmhouse, they become ruined by the same system.

I'm betting that there will be change so I've rejoined the AAPA and am not losing hope.

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