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Why I don't support "OTP" legislation by CAPA


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Before someone starts bashing me I will briefly explain. In California, NP's are seeking and pushing for full independent practice that will give them the ability to practice medicine without impedence and even open their own clinics without any barrier. They say that it would help reduce physician shortages in rural areas. What is CAPA doing? Instead of piggybacking with them and demanding the same rights for PA's and more, they are pushing for a MODIFIED OTP. The legislation they want to pass is a step forward but it still wants " mandatory collaboration " with physicians. This is exactly what Virginia, Rhode Island and Texas delegates wanted last year. They wanted the current OTP wording to include that "PA's shall always collaborate with physicians" Of course, it was rejected outright at HOD. Guess now  what is happening in VA and Texas. Physicians there are pushing for less PA practice rights. NP's are pushing PA's out of the hospitals.  Physicians know that PA leaders there are weak and want to appease people. It makes me wonder if CAPA got their advice from Texas and VA delegates.

Below I posted what one poster said in another thread. Whenever I read about CAPA's new "OTP" policy, this comes to my mind. CAPA members don't want to step on physicians toes and don't want to offend them and admins so they want to include "physician collaboration always" in their law. We want to unlink ourselves to them, not somehow be associated with them. We don't want our livelihood to depended on them. This is not OTP. Anyways, the comment from the poster on another thread is:

"PAs do not have the spine to really take on a fight for themselves as the Nursing Profession does to advance or protect its members.  Yet I constantly hear PA lamenting how nurses are taking over and outpacin us. My observation has been that compromise and apologizing for stepping on toes while advocating for the profession is more our professions forte."

Nurses in NY are demanding a strike right now and trying to get what they want. Admins are afraid so they are staying extra hours to see what deal they can come up with. NP's are with them and trying to get some of their piece of pie. while us PA's just stand and look around trying to appease everyone. We are spineless. We are everyone's step child afraid to speak out within the healthcare family.

By the way, I have seen few specialties that are NP led recently. These teams consist of only NP's with no physicians on board, albeit it was in an easy specialty like psychiatry, palliative care and primary care clinics. This itself makes NP's still more valuable to administrators, especially small, rural community hospitals. They can hire a bunch of NP's and have them run the service without having physicians COLLABORATE with them. PA's seeking mandatory collaboration, which will be seen as secondary, since we will still need to have somehow have physicians on board to COLLABORATE with. It does not put us on equal footing with NP's. Isn't that the whole purpose of OTP. We are still settling for less and making us vulnerable to be seen as less by the public. Not acceptable. If the practice wants all PA's with no physicians, that should also be allowed. Of course, when physicians are on board they should be leading the team. It should be up to the practice to only hire PA's and/or NP's and no physicians. if they want to it should be allowed, as long as they are willing to take responsibility for all consequences. That wording or something along that should also be included in this proposal

However,  having collaboration as mandatory does not really benefit us all

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I hear what you're saying but... So should CAPA let this bill die then? Should we not back it at all?

 

If so, we'll be worse off. It's not perfect but a step (no matter how small or large is debatable) forward in my opinion.

 

NPs have been fighting for their independence (and winning) for years. OTP is the first step for PAs towards independence.

 

Do I wish it was outright independence, sure but the OTP bill is all we have giving right now and it's better than what we have now which is "mandatory supervision" with a bunch of other barriers (mandatory chart Co sigs, etc).

 

If we get it passed and not move it forward after then yes it will still suck but even the NPs have to take what they were given. They put a bill for independence EVERY year in California and always get shot down. They probably will get it done this year but we can follow suit. Their independence in my opinion can help us draft a future bill for independence.

 

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1 hour ago, Joelseff said:

I hear what you're saying but... So should CAPA let this bill die then? Should we not back it at all?

 

If so, we'll be worse off. It's not perfect but a step (no matter how small or large is debatable) forward in my opinion.

 

NPs have been fighting for their independence (and winning) for years. OTP is the first step for PAs towards independence.

 

Do I wish it was outright independence, sure but the OTP bill is all we have giving right now and it's better than what we have now which is "mandatory supervision" with a bunch of other barriers (mandatory chart Co sigs, etc).

 

If we get it passed and not move it forward after then yes it will still suck but even the NPs have to take what they were given. They put a bill for independence EVERY year in California and always get shot down. They probably will get it done this year but we can follow suit. Their independence in my opinion can help us draft a future bill for independence.

 

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I agree this is a good step forward but the buck should not stop here. However, CAPA seems to be VERY content with this and they shouldnt be. They should keep pushing

We should put ourselves at least in equal footing with NP's in all phases or else we would ALWAYS be at disadvantage. These days, NP led teams in  some fields like psych, minute clinic, pain management and so on is becoming popular.Admins love it since they don't have to hire physicians to have MANDATORY COLLABORATION and pay additional salary. PA's are getting shut and shoved out the door.   STOP trying to appease people. These people don't feed  us or support our family.  It is okay to break the door down and demand.  I cant wait to run for a position for my state and demand a big change. Go BIG or go bust! 

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I agree and have stated similar feelings on occasion. I am endlessly frustrated with appeasing physicians. however, like it or not, they swing a big political stick. We shouldn't be hat in hand when dealing with them as stakeholders but there is no profit in being antagonistic either.

Polite, persistent forward movement. How do you eat an elephant? One bite at a time.

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One thing people might not realize is how the sausage is made. Bills are killed in committee all the time, before even going for a full vote. This is done though backchannels essentially. You need to craft something that can actually move through committee based on the political capital you think you have. Our PA organizations have much less money and influence than many of the physician and NP organizations. My state has abysmal membership percentage in our local academy. That affects what can be done. There isn't enough money or political capital to get what you are asking for right now.

 

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No matter how bleak the situation looks we cannot give up and keep moving forward. One step at a time but we cannot settle. Physician groups want us to settle. They want to have leash around our necks. NP's want to see that leash around our necks while they roam free and further explore. We need to keep moving until we are at least in equal footing with NPs. Why? NPs can have their own team and always be at advantage when it comes to hiring and even running their own show. We cannot unless we can free ourseleves.

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