New DMSc program in Oregon

[EMEDPA]

5 hours ago, Kaepora said:

What hospital do you work at?  I would like a union that guaranteed me a job...

the nursing union in northern CA has a contract with kaiser that says a PA can only be offered a job if NO NP applied for that position.....so new grad online FNP trumps 20 year PA working in the same specialty. Fact. Not a guaranteed job, but a major roadblock for any non-np to work for KP in that market.

[Boatswain2PA]

It's funny to watch PAs (deservedly) bash on NP education by comparing it to the almost always superior PA education, but then push for independent practice by ignoring the MUCH greater physician education.

NP<<<PA<<<<MD education.  Which is PAs (and especially NPs) should always have some sort of physician supervision.

[EMEDPA]

11 minutes ago, Boatswain2PA said:

 

NP<<<PA<<<<MD education.  Which is PAs (and especially NPs) should always have some sort of physician supervision.

The wrinkle in this discussion(which we have discussed before) is that in many/most cases EM Doc> EM PA> FP doc. many rural facilities staff their ERs with docs who spend most of their time in clinic and "cover the ED" a few times/month. It is 2 am and your family member is a trauma pt. Do you want me(or you) to care for them or some 30 yr old fp doc who has a total of maybe 6 months covering the ER, including their clinical rotations in medschool and residency? Does their superior knowledge of how to work up an abnormal pap smear trump 30 years of ER experience?  So if your answer is you or me , because we can do this, the next question is why should said FP MD have to "supervise us" when they have never put in a chest tube or intubated, etc. I once made a point that EM PAs should supervise these new fp docs( it was not taken well as you can imagine, although all the em docs agreed with me and at that facility paid me more than the new fp docs to cover the er).

I have no problem reporting to an EM (or FP) doc who is more experienced than I am. That is a long list of em docs and a short list of FP docs after 32 years of me working exclusively in em from the street to the community setting to the trauma ctr setting to the solo/rural setting.

[Boatswain2PA]

I'm with you E, but the other end of the "independence" spectrum is the 24 year old new grad PA who worked for 6 months as a CNA.

What's the best fix?  I dunno, but standards should be there to establish a baseline, not a cap.  We need a baseline to prevent the 24 yo new grad from practicing independently.

Edited December 20, 2018 by Boatswain2PA

[PAtoMD]

6 minutes ago, Boatswain2PA said:

I'm with you E, but the other end of the "independence" spectrum is the 24 year old new grad PA who worked for 6 months as a CNA.

What's the best fix?  I dunno, but standards should be there to establish a baseline, not a cap.  We need a baseline to prevent the 24 yo new grad from practicing independently.

The gold standard to practicing independently currently is a residency. I dont really see a way around this. Because if you say 2-3 years of supervised working it still sounds a whole lot like a residency.

Edited December 20, 2018 by PAsPreMed
Spelling

[EMEDPA]

6 minutes ago, Boatswain2PA said:

I'm with you E, but the other end of the "independence" spectrum is the 24 year old new grad PA who worked for 6 months as a CNA.

What's the best fix?  I dunno, but standards should be there to establish a baseline, not a cap.  We need a baseline to prevent the 24 yo new grad from practicing independently.

I agree that both PA and NP should have some kind of internship/postgrad program/fellowship and perhaps pass a specialty exam before being eligible for decreased oversight. No argument there. Maybe a residency and exam or 3-5 years in the same specialty with physician sign off.

[Boatswain2PA]

Just now, EMEDPA said:

I agree that both PA and NP should have some kind of internship/postgrad program/fellowship and perhaps pass a specialty exam before being eligible for decreased oversight. No argument there. Maybe a residency and exam or 3-5 years in the same specialty with physician sign off.

So 3 years of holding a retractor with Doctor Numbnutz in Ortho and suddenly you are independent for FP?

Lots to figure out...and we ain't figured it out yet.

CAQs are the eventual answer I think.

[EMEDPA]

1 minute ago, PAsPreMed said:

The gold standard to practicing independently currently is a residency. I dont really see a way around this. Because if you say 2-3 years of supervised working it still sounds a whole lot like a residency.

there are currently 31 em residencies/fellowships for PAs. Many of these are exactly the same as em physician pgy 1 training alongside physicians. same cases/call/responsibility/off service rotations, etc

I think we are looking at a time in the not so distant future in which PAs will have to do a specialty residency/fellowship and pass an exam to practice in any specialty outside of primary care.

[EMEDPA]

Just now, Boatswain2PA said:

So 3 years of holding a retractor with Doctor Numbnutz in Ortho and suddenly you are independent for FP?

Lots to figure out...and we ain't figured it out yet.

CAQs are the eventual answer I think.

no 3 years with a full fp pt panel working with an fp doc before independent practice in fp.

no one is talking about independent surgical PAs operating alone. .

[Boatswain2PA]

6 minutes ago, PAsPreMed said:

The gold standard to practicing independently currently is a residency. I dont really see a way around this. Because if you say 2-3 years of supervised working it still sounds a whole lot like a residency.

No, it's not.  The focus, or goal, of a residency is learning.  While a resident is moving the meat (IE: performing), their primary job is to learn.  Plus residencies have rotations in important specialties (and subspecialties) that someone "simply" doing the job wont get.

[Cideous]

1 minute ago, EMEDPA said:

there are currently 31 em residencies/fellowships for PAs. Many of these are exactly the same as em physician pgy 1 training alongside physicians. same cases/call/responsibility/off service rotations, etc

I think we are looking at a time in the not so distant future in which PAs will have to do a specialty residency/fellowship and pass an exam to practice in any specialty outside of primary care.

I am quoting this for one reason.  It is 100% correct.  Everyone should read it and believe it.

[PAtoMD]

2 minutes ago, EMEDPA said:

there are currently 31 em residencies/fellowships for PAs. Many of these are exactly the same as em physician pgy 1 training alongside physicians. same cases/call/responsibility/off service rotations, etc

I think we are looking at a time in the not so distant future in which PAs will have to do a specialty residency/fellowship and pass an exam to practice in any specialty outside of primary care.

100% agree. EM residency is exactly what I’ll do if medical school doesn’t work out. Specialization exams for PAs and residencies are in the very near future.

[Boatswain2PA]

14 minutes ago, EMEDPA said:

no 3 years with a full fp pt panel working with an fp doc before independent practice in fp.

no one is talking about independent surgical PAs operating alone. .

So a FP PA can evolve toward no longer being an "Assistant"...what about the surgery PA?  Are we creating a new profession?

 

And for the love of GOD can we please get rid of the damn waiting period between posts for verified posters?  I'm so old, and have such bad ADD, if I dont post quickly I'll forget what the hell I was thinking!

Edited December 20, 2018 by Boatswain2PA

[PAtoMD]

7 minutes ago, Boatswain2PA said:

No, it's not.  The focus, or goal, of a residency is learning.  While a resident is moving the meat (IE: performing), their primary job is to learn.  Plus residencies have rotations in important specialties (and subspecialties) that someone "simply" doing the job wont get.

I think you’re missing the forest for the trees. 

What is, in your opinion, the gold standard of training currently for independent practice rights?

 

edit: to echo your wait time request, I request a reply button so we don’t have to quote each other with each post. A reply button would simply alert the posters we are replying to them.

Edited December 20, 2018 by PAsPreMed

[Boatswain2PA]

6 minutes ago, PAsPreMed said:

What is, in your opinion, the gold standard of training currently for independent practice rights?

Medical school and then residency.  This is the absolutely best (but never perfect) method of ensuring someone with a extensive training and experience is involved (in some way) in the care of every patient.

 

 

 

[PAtoMD]

5 minutes ago, Boatswain2PA said:

Medical school and then residency.  This is the absolutely best (but never perfect) method of ensuring someone with a extensive training and experience is involved (in some way) in the care of every patient.

 

 

 

So where do we disagree then?

[EMEDPA]

23 minutes ago, PAsPreMed said:

100% agree. EM residency is exactly what I’ll do if medical school doesn’t work out. Specialization exams for PAs and residencies are in the very near future.

They are already here. 31 residencies. 1 CAQ exam (offered since 2011).

[PAtoMD]

1 minute ago, EMEDPA said:

They are already here. 31 residencies. 1 CAQ exam (offered since 2011).

Right, I was saying more of required type of deal to practice in specialities like your were saying.

[EMEDPA]

22 minutes ago, Boatswain2PA said:

So a FP PA can evolve toward no longer being an "Assistant"...what about the surgery PA?  Are we creating a new profession?

 

And for the love of GOD can we please get rid of the damn waiting period between posts for verified posters?  I'm so old, and have such bad ADD, if I dont post quickly I'll forget what the hell I was thinking!

surgical PAs are almost by definition "assistants". Outside of the OR though, they could "independently" manage a post op wound clinic or do minor procedures not requiring general anesthesia(complex lac repair, biopsies, etc) or round on the floor on pstop/preop pts, etc. Their surgeon would still be able to say" your job is X and not Y". 

[Boatswain2PA]

10 minutes ago, EMEDPA said:

Outside of the OR though, they could "independently" manage a post op wound clinic or do minor procedures not requiring general anesthesia(complex lac repair, biopsies, etc) or round on the floor on pstop/preop pts, etc. Their surgeon would still be able to say" your job is X and not Y". 

This is fuzzy.  So who becomes responsible for the surgical site infection....the surgeon (and PA) who did the surgery, or the physician ASSOCIATE(??) who saw the patient before surgery (who may not have adequately control blood sugars or didn't notice the off-site cellulitis/pneumonia), or the Physician ASSOCIATE who independently saw the patient post-op with the infection?  I'm sure we both know the surgeon would be held responsible.

If a surgeon could say "your job is x, y, z" then isnt the surgeon supervising?  Which leads me back to the question of "is OTP simply independent practice for family practice PAs ", thus creating a new profession?

Edited December 20, 2018 by Boatswain2PA

[EMEDPA]

8 minutes ago, Boatswain2PA said:

 

If a surgeon could say "your job is x, y, z" then isnt the surgeon supervising?  Which leads me back to the question of "is OTP simply independent practice for family practice" PAs, thus creating a new profession?

I think it will have the most impact on FP and EM(and maybe correctional med and addiction med), especially in rural and underserved settings. It will allow a PA to take a job on an Indian reservation or in a prison where no physician wants to work. It will allow rural fp clinics to stay open if the physician working there dies/retires/loses their license. For you and I it probably won't make much of a difference. I have zero required chart review at my primary job and am treated like another physician at my double coverage job. We literally alternate patients and cool procedures. If my current sponsoring physician left/died/retired I have alternates and would need to do a bit of paperwork. If the em group left though, the hospital could not hire me and the other PAs to stay without a physician on staff(but they could hire an NP).

[Boatswain2PA]

So how do we differentiate between you or I, and that new grad?

[EMEDPA]

4 minutes ago, Boatswain2PA said:

So how do we differentiate between you or I, and that new grad?

As mentioned above, a residency/CAQ or X years experience, physician sign off in your specialty, and passage of the same exam.

I know lots of folks here hate the CAQs. I took the EM CAQ day 1 it was offered. It has gotten me several great jobs, lots of respect, $10/hr more than any other PA I work with, independent procedural sedation privileges(I am considered board certified em by the hospital), and a host of other benefits related to autonomy and scope of practice. I am asked to look at piles of em pa CVs and decide who to interview, etc.  My current SP introduces me to new docs as "the only em boarded PA in the state" (true story).

[Boatswain2PA]

I guess my question should've been asked in regards to OTP.  How does OTP differentiate between you and a new grad regarding need for supervision?

[EMEDPA]

2 minutes ago, Boatswain2PA said:

I guess my question should've been asked in regards to OTP.  How does OTP differentiate between you and a new grad regarding need for supervision?

one off the cornerstones of OTP is "supervision is determined at the practice level". That means the hospital could require 100% chart review for any new grad for 2 years than 50% for 3 years,  and an association with a specific physician etc, while letting me have 0% chart review and no established/required physician collaborator.  Could they let us both run free from day 1? sure, but that would just be stupid. stupid costs lives and therefore money. the floodgates will not open for inexperienced PAs working far above their ability. hospitals just won't allow it. even "independent hospitalist NPs" work on teams. they can't do crazy stuff like 5 attempts on a chest tube and think the chief of the service won't have them fired.