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What is the update on OTP across the states?


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Going through a transition period with my per diem gig (retail medicine) right now and my new CP, an FM MD who decided to go into admin d/t burnout and is licensed in both WA and OR, just told me that PAs need to do something about the current landscape or we will be finding ourselves out of a job due to the NPs, especially as they transition to DNPs. This is not a NP vs PA post but rather a question of where are we currently on OTP? Last I heard one of the Dakota's was successful in this endeavor. My state association in WA is trying again next time. Anyone else have any updates? 

The fact that other professions are noticing should be an eye opener that there is a hole on this boat and it needs fixing.

Edited by MSPAC
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17 hours ago, Lightspeed said:

Washington and Oregon are extremely progressive towards NPs, with some of the best practice environments for them. It’s well beyond them simply having the independence they want... they have the ear of anyone that they want to have. NPs in Oregon, by law, have reimbursement parity with physicians... their equal work for equal pay approach. 

https://www.oregonrn.org/page/670

PAs are roped into that law, but what does that matter if PAs are still required by law under OTP to be affiliated with a facility or a physician that is a “participating physician”? It means “practices” get to pocket the difference, while independent NPs that run their own practices get as much reimbursement as physicians do. 

OTP in Oregon and Washington mean that physicians and practices get to hire a bunch more PAs. But physicians that are needed to “participate” are still expensive. NPs to the rescue. 

OTP is a bureaucrat’s dream. Admin would be your daddy. Admin can be any kind of practice manager. It can even be the new DNP they hire because they have all those fluff classes in practice management and evidence based practice.... the ones that have nothing to do with clinical skills. I’ve said for years that the DNP was all about running the show rather than showing anyone up on the clinical side. I wasn’t sure how nurses were going to capitalize on it, but now I see the light... OTP baby! It’s no longer a physician that’s calling the shots for their supervisee’s... it’s determined at the practice level. Who will be tasked with it on the practice level? DNPs that were nurse supervisors in a former life. Now PAs get to experience the joy that NPs felt when they were RNs and had nurse bosses! This is the kind of unforced error that can only come from within. An NP couldn’t design a better way to take charge, even if given a free hand. 

Don’t push for OTP there or anywhere else. Independence is the only option. OTP is at best a half step forward when you need to take a full step to make it to your NP friend waiting for you with dry feet across the stream. 

Conversation on getting at least one state to be PA independent needs to take place at fever pitch.

Agree.

There is no reason that PAs should be treated any differently than NPs in regards to having the independence to practice. We have been left in the DIRT by NPs and admin has taken note for years and now other providers are as well.

I find it nearly impossible to even get an employer to CONSIDER my applications for a job because "Oh, we are looking for an NP only not a PA" This even goes for jobs listed for "PA or NP" All the hiring managers and administrators that I've encountered recently here in Colorado have a strong, if not singular, preference for NPs only and specifically quote NP's independence and PAs dependence (on SP/CP whatever we are calling it these days) as the reason why. (Yes, I've only been in practice for 2 yrs but I have great patient outcomes and performance reviews and employers aren't stating my lack of experience as the reason but specifically NP preference)

The medical boards get their undies in a wad even discussing OTP with PAs, and definitely kick and whine about independence because MDs are the MEDICAL BOARDS' "Shining Stars". All the while, the nursing boards govern themselves and  promote their "Shining Stars" which are their NPs. We will never be held to this level or promoted by the medical boards in the manner that the nursing boards promote their NPs unless we have some major changes soon. 

Ive gone to AAPA and my state chapters and asked questions, pushed for answers.....no response. So I try to provide education to everyone I meet about PAs, our capabilities, our breadth of practice ("No, we dont need a doctor to hold our damn hands"), and the state laws regarding our practice. 

 

As someone with 6 figures of PA School debt (common these days) and unable to obtain another higher paying job to afford my loans due to NP competition due to lack of our independence....something has to change. Maybe I'll get one of those online NP degrees everyone raves about...... 

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On 7/30/2019 at 7:03 PM, Lightspeed said:

Admin would be your daddy.

Admin already is if you work in any large organization. When physicians sold their souls and became employees they abdicated their control over healthcare and the void was quickly filled by people who think a hospital system can be run like a chain of fast food restaraunts.

OTP matters. Independence isn't going to happen in my lifetime so lets not throw the baby out with the bathwater. If we don't do something very soon we will be extinct as a profession. If you want to go directly to independence we will be dead long before you get any traction.

If my memory serves CAPA was an obstacle in modernizing our practice language in Colorado. I don't remember the nuts and bolts right now but PAFT was pushing for some big changes and CAPA pushed back over fear of making the physicians mad.

Edited by sas5814
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On 7/31/2019 at 12:57 PM, Colorado said:

As someone with 6 figures of PA School debt (common these days) and unable to obtain another higher paying job to afford my loans due to NP competition due to lack of our independence....something has to change. Maybe I'll get one of those online NP degrees everyone raves about...... 

This just breaks my heart.  I have no voice left after screaming this for years to my state leaders, local leaders, friends, family and on these boards.  And yet nothing happens.  I sometimes wonder if PA's have an institutional inferiority complex that makes us as a profession ...suicidal.  I can think of no other reason why our state and national members are not freaking the hell out at where our profession will be in 3-5 years and where people like this poster will be with their school loan debt.  Terrifying.

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Guest Paula
3 hours ago, Cideous said:

This just breaks my heart.  I have no voice left after screaming this for years to my state leaders, local leaders, friends, family and on these boards.  And yet nothing happens.  I sometimes wonder if PA's have an institutional inferiority complex that makes us as a profession ...suicidal.  I can think of no other reason why our state and national members are not freaking the hell out at where our profession will be in 3-5 years and where people like this poster will be with their school loan debt.  Terrifying.

So Cideous are you soon to retire?  If not, run for president of your state organization and be the one who makes the change.  It's too bad your state leaders are not listening.  I fear for the new PA grads and the future of the profession too.

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11 hours ago, Lightspeed said:

The debt I’ve seen PAs come out of school with is tragic. These are folks I personally know. For so long, the mentality for pre PAs has been the same as what you see with some medical, dental, and even POD students, which is “if I can just get into a school, any school, and get through it, I’ll be set.” That might be the case if the field and it’s advocates were rabidly hungry to advance.

It used to be that the advice to a student that struggled was for them to hang in there and keep trying for PA school. There’s no way that is good advice now. If you don’t land PA school the first time through with relatively good stats, throw in the towel and move on. The payday and perks aren’t there anymore when you account for debt. It’s to the point that the only people talking sense are the ones who are like “live like you are making poverty wages and do Dave Ramsey for 5 years or else you won’t make it”, and that’s on top of “pick 2 out of three... location, specialty, wages.” Those are both sound pieces of advice, but it’s not even that rosy anymore. I’d suggest that for many folks, they can now only expect to pick one of the three you want, one that you can tolerate, and forget about a third”. It’s that way for FNP’s too, but those are folks with a decent paying income and typically less debt (although that’s changing too with regard to debt). 

I feel like even physicians and dentists are outside of the golden age of their professions, but they have so much more cushion before they reach the bottom. The opponent isn’t even physicians anymore, it’s administrations and entities. The idea of getting independent practice rights isn’t about setting up shop, shedding the physician overlord, or acting on my own as a sole provider, it’s about being set up to be a valued employee like what physicians are becoming (rather than as support staff like a paralegal). It’s not really as controversial as some folks are making it. It’s just recognizing that the person that goes in and makes a diagnosis ON THEIR OWN and takes on that liability gets treated like they went in and did that work on their own. If a physician reviews every single case, then sure, make them a part of the process. Otherwise, treat the PA like they work on their own merits, not delegated authority. That delegating authority doesn’t see your patients, write your scripts, keep your notes, or pay your bills. You’d be surprised by what that does as far as how the boardroom treats you. Even if we only can bill 85% of what a physician does, that’s 85% more than they would make if you guys weren’t there doing that work. That work doesn’t get done on its own, and a physician is rarely involved. So forget the inferiority complex, you guys are indeed paying the bills, and then some. In all honesty, I don’t think the healthcare system could hold itself up in many places without NPs and PAs taking the haircut on the billing. I know there are primary care practices that literally could not stay afloat without “midlevels” subsidizing the physicians on staff. If they had to staff just with docs, they would have to cut back significantly in other areas to make up for it. Specialties would be ok, sure, but you can’t keep a healthcare system running with specialties.  

^^^ Great post.  Deserves a quote and re-read.

 

Paula, yes I am moving towards retirement in the next 1-2 years at least from FT.  I have been associated with sounding the alarm to an empty firehouse since about 1999.  Crickets.  

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On 7/31/2019 at 10:57 AM, Colorado said:

As someone with 6 figures of PA School debt (common these days) and unable to obtain another higher paying job to afford my loans due to NP competition due to lack of our independence....something has to change. 

Until independence is achieved, unfortunately the high COL in Colorado doesn't help your current situation. Have you considered refinancing your loans and moving to a lower COL area, at least temporarily? Or somewhere that's more PA friendly? Loan pay-off is easy if you put your mind to it. It really is at a $100k+/year PA salary. The key is not getting caught up in the monetary upgrade in your life. Move in with a roommate, drive a cheap gas-efficient car, eat cheaply, bike when you can, reduce your monthly reoccurring costs like cable, cell, etc, and BAM, you've just relieved yourself of $1500/mo. Financial independence won't happen overnight just like PA independence won't. You gotta look at all angles. That $13/mo for TV streaming service, $5/mo for ad-free listening, $60+/mo for cell, $300+/mo for car, $50/mo for gym, etc adds up! 

I know this thread is really about OTP in addition to your debt comment. Just wanted to give you and others some hope while the independence fight ensues. I paid off my $125k+ student loan debt in 4 years while still taking vacations, buying houses, getting married, and buying cars. Could've paid it off sooner had I buckled down sooner, but hindsight's 20/20. PM me for further discussion if you'd like. Good luck!

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I see your points. I'm all for people living how they want, especially after making sacrifices and during for PA school. I lived through it, too. And we could go on all day about how this is better than that. But the point I'm making isn't "Spartan living" as a standard but instead is that if one is temporarily struggling financially and having difficulty finding a job due to lack of competitiveness with NPs in a particular market, one should make grave efforts to reduce spending to help them get through that period and/or make some changes in job locale. I'm not advocating for not exercising or maintaining mental health by getting rid of a $600/year expense such as a gym membership, so please don't make it out to sound like something it's not. But I am advocating for lesser expenses, such as riding a bike, home workouts, going on a hike, etc. For example, I have a $200 home gym of things I bought off Craigslist. It's paid for itself and beyond. You'd be surprised what kind of things you can find for dirt cheap. And you can most definitely "live a little" while still not having $3000/month in living expenses alone. And with that, I'll discontinue diverging from the point of the OP.

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I work with a physician who worked in a hospital in rural Montana that butted up against a reservation. He described the ER as the knife and gun club. He left because it was a horrible job. He said admin LOVED it when a provider came to work and bought a huge expensive house and land because then they were stuck.

Financial freedome gives you a fair amount of mobility

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