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What is going on with the title change investigation?

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We voted on April 1st for title change and then heard about the results in May. It's now August (basically) and I am curious to see what, if any, progress has been made. 

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We've been investigated the idea of a title change for 35 years now.

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I've said D-day for our profession would be in about 5 years....that was 4 years ago.  The funny thing is when it does get here, I think it's going to hit so hard and so fast it will catch everyone by surprise.  I think within 24 months, like a damn breaking, large organizations will stop hiring PA's altogether and move to only NP's.  It's already happening, but when the damn breaks it will be devastating for new and old PA's a like.  

Don't believe me?  Just ask the docs who almost overnight lost their jobs to AP's in Urgent Care.  One company I locum'ed at literally had a Saturday night massacre and fired all but a few doc's (left two supervise) and replaced them with NP's and PA's.  These docs literally all lost their jobs overnight.  I see the same thing happening to PA's simply because the supervision laws now favor NP's in most states.  No other reason then that.

 

Then, when you look back over the last 20 years a very obvious pattern will emerge.  20/20 hindsight will be clear.  Honestly, at this point I think we may have passed a point of no return, especially for the younger PA's out there fighting for jobs with NP's.  With no hope in sight for a name change and no hope in sight for an organized OTP/Autonomy push going forward, our profession very well could already be a dead man walking.

Edited by Cideous

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You point out something that frankly I haven’t thought of, which is PAs being victims of belt tightening directed against physicians. It gets even worse.... in dependent states, PAs and NPs still would need a few physicians around to supervise, and PAs would theoretically be working alongside NPs who were similarly supervised. In independent states, the bean counters would be able to cut back on physicians entirely, and PAs would have to leave with them since there would be nobody around to supervise them. This never quite stood out to me until now, but I have front row seats to this near where I am at, although I don’t want to go into detail for privacy sake. But yeah, being chained to docs is a liability if they are victims of cost cutting as well. Holy cow. 

After arguing with someone on another forum about OTP, I’ve come to conclude that while more useful than the old status quo, it’s fake progress, especially if it’s at the expense of the independent practice that PAs really really need. Essentially, OTP in Michigan means That physicians get the bulk of the benefit by allowing them to supervise many more PAs, and be potentially relieved of responsibilities of direct supervision, as well as liability. So it comes down to the practice now being the level of supervision... who then is the practice? Well, now it’s administration, AND STILL a physician “participator”. 

So sure, OTP is a good stealth step towards independence, but not in light of the fact that it’s not the independence PAs need to spark a dramatic change that will save the profession. OTP in a state with a terrible nurse practice act? Sure why not? OTP in a nurse practitioner independent practice state like mine? STATUS QUO! And a slap in the face compared to your capabilities. By all means, don’t let them spend money to peddle that trash in a place where NPs are independent. And in a place like California? Holy cow, if nurses get independence, and PAs get OTP instead of parity with NP independence, PAs are done... and for the reason you highlighted. 

This is so critical that I would think OTP in California is a false flag by physicians to rein PAs in, or by NPs to keep you guys two steps behind. Don’t settle. If you do you’ll see urgent and primary care (your bread and butter) plucked from you, and the specialties will be your exclusive domain. From there, you’ll be niche providers.

Again... your strongest argument for independence isn’t “NPs bad, not trained good”, but rather “NPs have it, and the world hasn’t ended.” But by all means, keep dissing everything NP, and see where that gets the Pa profession. Let’s have 50 more posts about how PAs are superior between now and next year when NPs in California gain their independence, and all PAs get is to have physicians get to have more PAs under them, and not need to review their charts (see what happens to your liability insurance when they get to offload risk on to you guys, but more importantly, see what happens to their liability insurance). 

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2 minutes ago, PAekgdude said:

WOw this guy gets it.  OTP is a bullshit. Old PA's still trying to find a way to please physicians. It is like getting a slice of the pie with just few permissions. This is stupid!!!!!!!!!!!!   We need to get off that mindset...  

 PA's need independent practice like NP's. Too many loser PA's dont know what OTP is all about and is all for OTP. OTP should allow PA's to hang their own shingles or else NP's woud ALWAYS be preferred over PA's. ALWAYS.  

I am critical of CAPA and california PA leaders. They suck. They still want to please physicians. They are chickens that dont want to go all in. As a result PA's are treated like second class citizens below NP's. Thank you CAPA for your apathy

I can tell you that it is not because NP's advocate more  or are more vocal that they get more rights. It is because they have outstanding  leaders and advocates. PA organizations need to find exceptional leaders and advocates at the top, even if they have to shell out some big bucks. Lets make it happen

Excellent comment in that NP have great leaders that are out to promote their profession. They are not better providers, they do not have the education compared to Physicians and even PAs, but that doesn’t matter at all! They are taking care of themselves, just as any professional leaders should. . It is sickening to see so many PA’s and PA leaders who not only don’t want progress but actually fight against promoting the future of their profession. It astounds me they think status quo is good because they haven’t been impacted..yet!  

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I used to think that name change was the most important first step, but that kind of motion was one best suited for 5 years ago. Right now, what you guys need is just an independent practice state, and name change be damned. Incrementalism isn’t a luxury PAs have right now. The more I thought about it the last few days, the more it seemed logical to just keep the same jerseys if it means you can still win the games. You can be independent with the name “physician assistant”. There really is nothing to be gained by a sneak attack anymore. The only way to make independence happen is to make the kind of noise that lets them know you are coming.

-Illinois just allowed NPs to be independent after 4000 of supervised practice:

https://www.illinoispolicy.org/rauner-signs-bill-expanding-practice-authority-for-certain-nurses/

Thats how NPs compromise... they get what they want, but they just have to wait a little bit as new grads. This is in Illinois... one of the biggest states in the US. That’s the kind of place you’d never expect NPs to be independent, and where physicians are king. Is it as good as just pure independence right out if the gate? No. But it’s better than PAs have it anywhere. Here’s the disconnect between Nps and PAs: Nurses are like “dang, have to wait 4000 hours before I’m free”. PAs are like “I wish we had something like that anywhere.” 

-If PAs have ever dreamed of having an NP as their boss or supervising provider, OTP will be the vehicle that provides it. Here’s how it goes:

1) An NP independent state passes OTP. PAs rejoice because scope is now determined at the practice level. Yay... now you are a step towards being like your independent NP colleagues. PAs still need to contract with a “participating” physician, but now the “practice” is their boss, and they are utilized according to what the practice determines, vs the old way of the SP determining scope. More freedom, right?

2) The practice hires a DNP who has a resume that includes leadership from things like being a charge nurse and unit manager (if you are lucky). The DNP curriculum is geared towards practice management and evidence based practices for the clinic level. Everyone used to make fun of that as fluff instead of providing enhanced clinical skills. 

3) The PAs quit laughing at the DNP degree because now that the “practice” is the boss that PAs report to, and since the DNP is the manager of the “practice”, the DNP is now your supervising provider...... yes, your supervising provider. Or better yet, your supervising practitioner (rolls off the tongue a lot better since it’s an NP that’s doing the supervising. 

4) You answer to an NPs whims. If your opinion runs counter to that of the “practice”, you are akin to arguing with your supervisor. You have now realized that you substituted a supervising physician for a supervising practitioner. Roh roh! Too late suckers. Your states AAPA chapter just went all in to get OTP so you would shut up and leave them alone. There’s no more political capital to fix that mess they created. 

-Forget OTP nonsense. Go to Montana or Alaska and spend a million dollars on lobbying the legislature to make PAs independent. No name change, no OTP, just get on the books as independent providers. That’s your Boston Tea Party. Expect all hell to break loose in the rest of the country, but at least your friends and enemies will know you mean business. There’s no going back, you just need to do it. Burn the ships so everyone knows the only way home is to fight through the jungle. What have PAs got to lose at this point? You are one well intentioned but misplaced OTP push from becoming directly subservient to not only to physicians, but also NPs. Long ago, that was only an academic concept that came up in fanciful threads on these forums (I’ve read them, and everyone was like “there’s no way NPs could be our supervising providers like doctors are”). Don’t keep thinking that. 

Edited by Lightspeed

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3 hours ago, PAekgdude said:

WOw this guy gets it.  OTP is a bullshit. Old PA's still trying to find a way to please physicians. It is like getting a slice of the pie with just few permissions. This is stupid!!!!!!!!!!!!   We need to get off that mindset...  

 PA's need independent practice like NP's. Too many loser PA's dont know what OTP is all about and is all for OTP. OTP should allow PA's to hang their own shingles or else NP's woud ALWAYS be preferred over PA's. ALWAYS.  

I am critical of CAPA and california PA leaders. They suck. They still want to please physicians. They are chickens that dont want to go all in. As a result PA's are treated like second class citizens below NP's. Thank you CAPA for your apathy

I can tell you that it is not because NP's advocate more  or are more vocal that they get more rights. It is because they have outstanding  leaders and advocates. PA organizations need to find exceptional leaders and advocates at the top, even if they have to shell out some big bucks. Lets make it happen

Just FYI, PAekgdude has been removed as a new instantiation of our recurrent troll.  This individual keeps adapting to our scrutiny, but in the end, the brand new account, claiming to have extensive experience as something, hurling insults and stirring pots doesn't ever change its spots.

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4 hours ago, Lightspeed said:

I used to think that name change was the most important first step, but that kind of motion was one best suited for 5 years ago. Right now, what you guys need is just an independent practice state, and name change be damned. Incrementalism isn’t a luxury PAs have right now. The more I thought about it the last few days, the more it seemed logical to just keep the same jerseys if it means you can still win the games. You can be independent with the name “physician assistant”. There really is nothing to be gained by a sneak attack anymore. The only way to make independence happen is to make the kind of noise that lets them know you are coming.

-Illinois just allowed NPs to be independent after 4000 of supervised practice:

https://www.illinoispolicy.org/rauner-signs-bill-expanding-practice-authority-for-certain-nurses/

Thats how NPs compromise... they get what they want, but they just have to wait a little bit as new grads. This is in Illinois... one of the biggest states in the US. That’s the kind of place you’d never expect NPs to be independent, and where physicians are king. Is it as good as just pure independence right out if the gate? No. But it’s better than PAs have it anywhere. Here’s the disconnect between Nps and PAs: Nurses are like “dang, have to wait 4000 hours before I’m free”. PAs are like “I wish we had something like that anywhere.” 

-If PAs have ever dreamed of having an NP as their boss or supervising provider, OTP will be the vehicle that provides it. Here’s how it goes:

1) An NP independent state passes OTP. PAs rejoice because scope is now determined at the practice level. Yay... now you are a step towards being like your independent NP colleagues. PAs still need to contract with a “participating” physician, but now the “practice” is their boss, and they are utilized according to what the practice determines, vs the old way of the SP determining scope. More freedom, right?

2) The practice hires a DNP who has a resume that includes leadership from things like being a charge nurse and unit manager (if you are lucky). The DNP curriculum is geared towards practice management and evidence based practices for the clinic level. Everyone used to make fun of that as fluff instead of providing enhanced clinical skills. 

3) The PAs quit laughing at the DNP degree because now that the “practice” is the boss that PAs report to, and since the DNP is the manager of the “practice”, the DNP is now your supervising provider...... yes, your supervising provider. Or better yet, your supervising practitioner (rolls off the tongue a lot better since it’s an NP that’s doing the supervising. 

4) You answer to an NPs whims. If your opinion runs counter to that of the “practice”, you are akin to arguing with your supervisor. You have now realized that you substituted a supervising physician for a supervising practitioner. Roh roh! Too late suckers. Your states AAPA chapter just went all in to get OTP so you would shut up and leave them alone. There’s no more political capital to fix that mess they created. 

-Forget OTP nonsense. Go to Montana or Alaska and spend a million dollars on lobbying the legislature to make PAs independent. No name change, no OTP, just get on the books as independent providers. That’s your Boston Tea Party. Expect all hell to break loose in the rest of the country, but at least your friends and enemies will know you mean business. There’s no going back, you just need to do it. Burn the ships so everyone knows the only way home is to fight through the jungle. What have PAs got to lose at this point? You are one well intentioned but misplaced OTP push from becoming directly subservient to not only to physicians, but also NPs. Long ago, that was only an academic concept that came up in fanciful threads on these forums (I’ve read them, and everyone was like “there’s no way NPs could be our supervising providers like doctors are”). Don’t keep thinking that. 

You are likely spot on with your comments. The only problem with no title change is the legislature  needed to pass laws have said they cant see expounding independence to assistants. While you and most NPs are respectful of PAs, there are newly minted NPs who will and have,  openly told patients that PAs are not like NPs and docs, they are  assistants. The title is an anchor to the profession,  

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7 hours ago, Lightspeed said:

I used to think that name change was the most important first step, but that kind of motion was one best suited for 5 years ago. Right now, what you guys need is just an independent practice state, and name change be damned. Incrementalism isn’t a luxury PAs have right now. The more I thought about it the last few days, the more it seemed logical to just keep the same jerseys if it means you can still win the games. You can be independent with the name “physician assistant”. There really is nothing to be gained by a sneak attack anymore. The only way to make independence happen is to make the kind of noise that lets them know you are coming. 

-Forget OTP nonsense. Go to Montana or Alaska and spend a million dollars on lobbying the legislature to make PAs independent. No name change, no OTP, just get on the books as independent providers. That’s your Boston Tea Party. Expect all hell to break loose in the rest of the country, but at least your friends and enemies will know you mean business. There’s no going back, you just need to do it. Burn the ships so everyone knows the only way home is to fight through the jungle. What have PAs got to lose at this point? You are one well intentioned but misplaced OTP push from becoming directly subservient to not only to physicians, but also NPs. Long ago, that was only an academic concept that came up in fanciful threads on these forums (I’ve read them, and everyone was like “there’s no way NPs could be our supervising providers like doctors are”). Don’t keep thinking that. 

This post is turning into another OTP/independence one, but I suppose name change and OTP/independence are interconnected.

Maybe it's just in my neck of the woods of an NP independent state, but attending physicians are still required to admit and oversee any patient care in the hospital setting. Has anyone seen any hospital systems that allow independent NPs to act as the attending? How do you think this will change as PAs pursue OTP or independence and NPs continue their independence lobbying? 

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8 hours ago, Lightspeed said:

I don’t know.... he says I “get it”. How bad can he really be? LOL!

He liked one of my posts at one point, too, I think, or maybe that was his last attempt.  We have enough strong feelings from people who care about more than just political discourse (you know, like actually helping patients?) to need artificial outrage for comic relief.

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23 hours ago, Sed said:

This post is turning into another OTP/independence one, but I suppose name change and OTP/independence are interconnected.

It is all interconnected and in an oft confusing way. I like to think I'm fairly plugged in but the number of different groups working for and against these issues is mind boggling.

At its base name change, to me, is this...... how can we be responsible for ourselves if we are someone else's assistant? Keep in mind most of the groups we have to convince about anything really don't know much about us including the bulk of physicians.

The suggested title change probably won't be released until right before the national conference next year. Then all the key players have to take it home and discuss it. It isn't something to be done quickly and implementation will have to be done over a period of years. 

Edited by sas5814

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New grad here, searching for a job, but keeping up with what I can on topics like these in the mean time.

I think these are good points to be aware of, and I'm curious as to what sorts of progress have been made on the name-change front. I assume there may be other threads about the name-change and I know it would ideally remain "PA."

I know in the UK it's "physician associate," which I assume would not bear any greater weight as far as independence. I feel like many new titles can fit into "PA" (though it can be tricky to brain storm and approve), like "patient/practitioner/provider arbiter."  I'm simply curious about this and would be happy to become an activist for PAs locally.

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On 7/30/2019 at 5:39 PM, Cideous said:

I've said D-day for our profession would be in about 5 years....that was 4 years ago.  The funny thing is when it does get here, I think it's going to hit so hard and so fast it will catch everyone by surprise.  I think within 24 months, like a damn breaking, large organizations will stop hiring PA's altogether and move to only NP's.  It's already happening, but when the damn breaks it will be devastating for new and old PA's a like.  

Don't believe me?  Just ask the docs who almost overnight lost their jobs to AP's in Urgent Care.  One company I locum'ed at literally had a Saturday night massacre and fired all but a few doc's (left to supervise) and replaced them with NP's and PA's.  These docs literally all lost their jobs overnight.  I see the same thing happening to PA's simply because the supervision laws now favor NP's in most states.  No other reason then that.

 

Then, when you look back over the last 20 years a very obvious pattern will emerge.  20/20 hindsight will be clear.  Honestly, at this point I think we may have passed a point of no return, especially for the younger PA's out there fighting for jobs with NP's.  With no hope in sight for a name change and no hope in sight for an organized OTP/Autonomy push going forward, our profession very well could already be a dead man walking.

Damn crazy. You hit the nail on the head with this one. More like within 12 months instead of 24.

Edited by ANESMCR

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2 hours ago, ANESMCR said:

Damn crazy. You hit the nail on the head with this one. More like within 12 months instead of 24.

Yup, and I still stand by that post.  It's more accurate now than even 6 months ago when I wrote it.  I hate it, and I wish it wasn't true.

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9 hours ago, Jovan said:

New grad here, searching for a job, but keeping up with what I can on topics like these in the mean time.

I think these are good points to be aware of, and I'm curious as to what sorts of progress have been made on the name-change front. I assume there may be other threads about the name-change and I know it would ideally remain "PA."

I know in the UK it's "physician associate," which I assume would not bear any greater weight as far as independence. I feel like many new titles can fit into "PA" (though it can be tricky to brain storm and approve), like "patient/practitioner/provider arbiter."  I'm simply curious about this and would be happy to become an activist for PAs locally.

Jovan, as a new PA, maybe you have listened to professors and programs who act like all is well .They care about their own pockets or they would have more frank discussions about importance of being informed and involved with state and national associations . One other title, Medical Care Practitioner, may more accurately describe your profession. However, it appears Physician Associate is often chosen because it’s easy, not because it will be best for your future.  It is a better option than Assistant, but trying to fit new title into PA is pigeon hole mindset. As far as greater independence, legislators look at title and who wields most power or better smoozes them. Which do you honestly think a lay person would assume to be more valued, an Assistant Associate or Practitioner? They have already granted more freedom to Nurse Practitioners, it is a descriptor they can relate to, Practitioner.

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PACali said: Medical Care Practitioner is great MCP, or even if "Certified" is part of the name in CMP Certified Medical Practitioner.  This would be a big win. Associate or assistant both seem overly dependent and under-qualified.  Someone stated somewhere here that Medical Care Practitioner might have a legal hangup.   

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I will be attending PA school in May 2020. I've been trying to do research, but mainly to find out if PA is the career of my choice (totally is), and the difference between PA and NP (for the sake of interviews).

Reading a lot of the comments here has me a little worried. Can someone educate me or point me in the right direction so I can understand this better? What is a good resource to find out state laws for PAs? Will the PA profession crumble? In 10 years? How have you come to that conclusion?

When I become a PA (or whatever the name will be if it changes in the future) what can I do to make sure I protect the profession?

Are all my questions silly?

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5 hours ago, Fegrin said:

I will be attending PA school in May 2020. I've been trying to do research, but mainly to find out if PA is the career of my choice (totally is), and the difference between PA and NP (for the sake of interviews).

Reading a lot of the comments here has me a little worried. Can someone educate me or point me in the right direction so I can understand this better? What is a good resource to find out state laws for PAs? Will the PA profession crumble? In 10 years? How have you come to that conclusion?

When I become a PA (or whatever the name will be if it changes in the future) what can I do to make sure I protect the profession?

Are all my questions silly?

Google.

 

Go to PA school. Don’t be scared off by people on the internet. 

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16 minutes ago, deltawave said:

Google.

 

Go to PA school. Don’t be scared off by people on the internet. 

From someone who just left the profession after graduating in '83, at least as far as direct care is concerned, I think that Cid is closer to being correct than most people give him credit for.  There will always be outlying situations that will hold out till the end but if I were in this situation today, with tuition/debt costs being what they are, I wouldn't repeat the same path.  Regardless of title, until the playing field is level, I think the ship is sinking.

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13 hours ago, Fegrin said:

I will be attending PA school in May 2020. I've been trying to do research, but mainly to find out if PA is the career of my choice (totally is), and the difference between PA and NP (for the sake of interviews).

Reading a lot of the comments here has me a little worried. Can someone educate me or point me in the right direction so I can understand this better? What is a good resource to find out state laws for PAs? Will the PA profession crumble? In 10 years? How have you come to that conclusion?

When I become a PA (or whatever the name will be if it changes in the future) what can I do to make sure I protect the profession?

Are all my questions silly?

There have been a lot of thought-provoking posts on this forum this year that address a lot of your questions. Please give yourself some time to read through these. Otherwise, AAPA is a good start for the information you seek.  

I think I would still go PA today if I had to do it all over again, but I would try harder to reduce my debt, refinance my loans, and reduce my spending earlier than I did given the current economic climate and competition. I still haven't come across a lot of other fields I would enjoy more except for maybe perfusion or CRNA. I didn't really know or understand these until PA school. 

I'm not sure about the longevity of the PA field. I am on the path to early retirement and if PAs fizzle out, I will be fine financially. I don't think the PA field will ever go defunct because I think there will always be a need, especially as medical school gets more expensive and less rewarding, but there is a concern of saturation and competition with NPs. 

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18 hours ago, Fegrin said:

I will be attending PA school in May 2020. I've been trying to do research, but mainly to find out if PA is the career of my choice (totally is), and the difference between PA and NP (for the sake of interviews).

Reading a lot of the comments here has me a little worried. Can someone educate me or point me in the right direction so I can understand this better? What is a good resource to find out state laws for PAs? Will the PA profession crumble? In 10 years? How have you come to that conclusion?

When I become a PA (or whatever the name will be if it changes in the future) what can I do to make sure I protect the profession?

Are all my questions silly?

What is a good resource to find out state laws for PAs?

To find state law, please check your state organization and AAPA. You should be able to find a lot of good resources there. 

Will the PA profession crumble?

It won't crumble, PA is here to stay. Except there will be less job for the PAs compare to the NP. There are jobs out there hire both PAs and NPs and there are jobs only hire NPs. 

what can I do to make sure I protect the profession?

Participate in advocacy for the profession. If you don't have the time, at least pay your dues to your state organization and AAPA. Get your peers to be involve in advocacy. 

Also, I would like to mention that I still see PA students that don't really understand the profession. They think physician are always there  to hold their hands.  They think PA will not get sued, only physician will. They need to understand they will be making important decision as a PA. Patient can get better or get hurt base on your decision. You aren't just an Assistant. You could get sued independently and physician's name will be dropped if clearly not their fault.  

 

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On 12/7/2019 at 4:17 PM, out_foxed said:

PACali said: Medical Care Practitioner is great MCP, or even if "Certified" is part of the name in CMP Certified Medical Practitioner.  This would be a big win. Associate or assistant both seem overly dependent and under-qualified.  Someone stated somewhere here that Medical Care Practitioner might have a legal hangup.   

So far from what I've gathered from people around me, it is almost 50/50 between Medical Care Practitioner Vs Physician Associate. Maybe Associate has a slight edge. Their reason for associate is so we can keep the PA acronym 

I want to ask what is point of keeping the acronym? Is the PA acronym as well known as BMW/IBM? Not where I come from (California). 

Second reason is they think it might be cheaper to change to associate than MCP. Maybe change 3 words vs 1 word is 3X as much "ink" we need to change all the documentation? I don't know if that is true, but I have hard time believe that since we are almost in 2020, everything is digital, you can make a change with a click. 

The whole point of a name change is let the public/administration/legislator know that we practice medicine. We need a name that has "medicine" in it. 

Medical Care Practitioner- We practice medicine and provide medical care.  mic drop moment lol

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I agree with you 100%. I believe Physician Associate is only that close in running because of perceived ease and inability for older folks to see impact or care about future. I am sure there were plenty younger PA’s who voted for it also, but my guess is they were voting like 18 year olds. Doubt they really understand the politics, rather just doing what, in this case, older professor said or mentors tell them is best. What a shame! Now can only hope the final decision rests in hands of those that don’t look for easy way out and can think outside of the box they are putting those silly little letters (PA) in. If anyone that will be doing final vote is reading, PLEASE consider impact 10-15 years down the road. Nothing worthwhile is easy, make the change worthwhile!!

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58 minutes ago, Hope2PA said:

  I am sure there were plenty younger PA’s who voted for it also, but my guess is they were voting like 18 year olds. Doubt they really understand the politics, rather just doing what, in this case, older professor said or mentors tell them is best.

That's how I feel with my students in clinical rotation. They don't really care about the PA politics, but each one of them have over $100,000 loan to pay off. I try to tell them to get involved if they still want to have a job in the future. I also remind them that the Physicians will not watch our back. In a micro level, yes, we get along well with the physicians in the same department but in a macro level between organized medicines is a turf war. 

Regarding the name change, I hope WPP also surveyed the general public. If the general public think "Praxician" is someone they trust and will refer their friend and family as their medical provider, heck i am okay with it. I highly doubt that is the case.

 

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