What is going on with the title change investigation?

[deltawave]

3 hours ago, ProSpectre said:

 

As much flak as the survey got, I think WPP is really doing their due diligence and it will be interesting to see the final results in May. 

I certainly hope so. May can't come fast enough.

I remain optimistic.

Edited December 23, 2019 by deltawave

[Hope2PA]

On 12/11/2019 at 8:41 AM, Sed said:

This.

When asked what PA stands for by patients, a common follow-up question is, "So when do you finish your training and become a doctor?" I can see PAssociate being similar while also still limiting us politically.

We need something clear and easy to understand that will also instill confidence if we are to advance to independence.

I am on the fence about MCP since I think it is vague and puts us on par with NPs but as the medically trained equivalent. I do not want to be on par with NPs and we are not the medically trained equivalent of NPs. PAs receive unique medical training to practice as generalists and specialists. That is unique to all of the three practitioners since MDs do specific residencies and NPs choose tracks. PAs can go into virtually any field. MDs and NPs can't do that without additional training or certification. I am reaching for the stars and hoping for a name that is completely unique to us and puts us in our own category of medical provider, not just keep us in the APP/"mid-level" category next to NPs and "below" MDs. I don't think that name is Clinicist, and Praxician seems to be a hard sell to folks. I am interested to see what the public thinks and if WPP has anything else up their sleeve.

“NP track” doesn’t mean much except psych and CRNA.  Nursing boards have said Family med NP’s have ability to be hospitalists, ER, surg,wry, dermatology....you name it. Basically if they think they can, and they get a job, they can do nearly whatever they want. I know a family Medi NP, direct entry, has said that after 50 grad hours, research on history of nursing and 650 clinical, she and her colleagues can do anything except possibly peds, definitely no psych and CRNA. Said she can apply for jobs in any other area. So the old thinking of they’ can’t do anything other than specific area is long gone. Open your eyes and look around. Em Med NP may only be able to do Em Med, but family med NP can do EM med. Family med NP can do anything a PA does, except they can do much of options independently.

[ProSpectre]

7 hours ago, deltawave said:

I certainly hope so. May can't come fast enough.

I remain optimistic.

I do too.

The AAPA Facebook post where I posted the link from earlier today has mostly negative comments about the title change though. There's the standard mix of indifference & apathy, along with a few of the same old tired arguments about why we should stick with what we've got. The lack of vision is disheartening. 

[sas5814]

7 hours ago, ProSpectre said:

I do too.

The AAPA Facebook post where I posted the link from earlier today has mostly negative comments about the title change though. There's the standard mix of indifference & apathy, along with a few of the same old tired arguments about why we should stick with what we've got. The lack of vision is disheartening. 

Yes it is. My particular teeth-grinding posts are from older PAs (and I am one) who say "I got along just fine for 120 years on physician assistant. It never held me back." *facepalm*

yes you also got along without many of the medical marvels we enjoy today. Thanks for laying the groundwork but its time for the people who have to live in this profession for the next 30 years or so to do what it takes to remain competative.

[Cideous]

17 minutes ago, sas5814 said:

Yes it is. My particular teeth-grinding posts are from older PAs (and I am one) who say "I got along just fine for 120 years on physician assistant. It never held me back." *facepalm*

yes you also got along without many of the medical marvels we enjoy today. Thanks for laying the groundwork but its time for the people who have to live in this profession for the next 30 years or so to do what it takes to remain competative.

EXACTLY!

[SedRate]

15 hours ago, Hope2PA said:

“NP track” doesn’t mean much except psych and CRNA.  Nursing boards have said Family med NP’s have ability to be hospitalists, ER, surg,wry, dermatology....you name it. Basically if they think they can, and they get a job, they can do nearly whatever they want. I know a family Medi NP, direct entry, has said that after 50 grad hours, research on history of nursing and 650 clinical, she and her colleagues can do anything except possibly peds, definitely no psych and CRNA. Said she can apply for jobs in any other area. So the old thinking of they’ can’t do anything other than specific area is long gone. Open your eyes and look around. Em Med NP may only be able to do Em Med, but family med NP can do EM med. Family med NP can do anything a PA does, except they can do much of options independently.

CRNA is an entirely different field altogether and so they are not NPs at all, they are CRNAs. Please do not confuse them in this discussion about NPs. 

I'm not an expert on NP practice rights or certification by any means, and so I would welcome insight into where it is said that any NP can practice in any NP field. Please don't be patronizing. To my understanding, FNP tracks do not allow for acute care, ACNP does not allow for family med, and surgical positions require additional surgical training. Since I am not up to speed, according to you, would you mind sharing links to where the nursing boards say that NPs can practice in any field regardless of certification and training? I wouldn't take what one NP says as an overarching law. (It's interesting how many people don't know their own state laws, PAs and NPs included, by yet operate in whatever capacity they think is appropriate. Unfortunately, that doesn't automatically make it legal.) 

[sillycibin]

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 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.

NP programs are flooding the market with new NPs who only require 1/3 the clinical training we do and therefore only need to put together a third as many site rotations which are becoming difficult to secure.  There are many online NP programs.  And they have a huge lobbying organization that continues to get them more autonomy and plenty of states with independent practice and many with simple collaborative agreements.  While we continue to flail around with this Optimal Team Practice garbage that was appropriate maybe 10 years ago and arrives now already outdated.  The growth of new PAs and NPs getting churned out has been on a ridiculous growth trajectory for 15 years and shows no sign of stopping and we are already spewing out over 2 APs per 1 doctor each year.

[Hope2PA]

On 12/24/2019 at 1:45 PM, Sed said:

CRNA is an entirely different field altogether and so they are not NPs at all, they are CRNAs. Please do not confuse them in this discussion about NPs. 

I'm not an expert on NP practice rights or certification by any means, and so I would welcome insight into where it is said that any NP can practice in any NP field. Please don't be patronizing. To my understanding, FNP tracks do not allow for acute care, ACNP does not allow for family med, and surgical positions require additional surgical training. Since I am not up to speed, according to you, would you mind sharing links to where the nursing boards say that NPs can practice in any field regardless of certification and training? I wouldn't take what one NP says as an overarching law. (It's interesting how many people don't know their own state laws, PAs and NPs included, by yet operate in whatever capacity they think is appropriate. Unfortunately, that doesn't automatically make it legal.) 

I do understand CRNA is different, as is Psych. Also, I am not basing info on one individual, just stated what one told me recently. I am personally aware of FNP’s working in ER, derm, priamary care, urgent care, surg and hospitalist. The article below may not be the best, but gives you an idea. It depends on what sub specialties the state nursing board says a FNP can legally work in. Lucky for some FNP’s they work in states with freedom to do whatever they can get a job in. A recent local incident of hiring a fairly new

FNP in oncology vs PA, who had prior radiation therapy experience and few years oncology. The director of clinic, who I knew socially,  didn’t want to deal with PA paperwork. I was unfortunate enough to have a few interactions with the NP who severely lacked necessary knowledge. I finally refused to deal with her again. I have talked with with a good derm FNP who spent 10 yrs with physicians prior to opening own office. She is basically cosmetic. Maybe you are not in one of the states that allow FNP to work in pretty much any setting, don’t expect it to stay that way. https://midlevelu.com/blog/can-fnps-work-hospital-and-specialty-settings

[EMEDPA]

I have also seen FNPs on the west coast doing EM, Ortho, surgery, critical care, IR, etc

Some states(notably TX) do not allow this. 

[SedRate]

14 hours ago, Hope2PA said:

I do understand CRNA is different, as is Psych. Also, I am not basing info on one individual, just stated what one told me recently. I am personally aware of FNP’s working in ER, derm, priamary care, urgent care, surg and hospitalist. The article below may not be the best, but gives you an idea. It depends on what sub specialties the state nursing board says a FNP can legally work in. Lucky for some FNP’s they work in states with freedom to do whatever they can get a job in. A recent local incident of hiring a fairly new

FNP in oncology vs PA, who had prior radiation therapy experience and few years oncology. The director of clinic, who I knew socially,  didn’t want to deal with PA paperwork. I was unfortunate enough to have a few interactions with the NP who severely lacked necessary knowledge. I finally refused to deal with her again. I have talked with with a good derm FNP who spent 10 yrs with physicians prior to opening own office. She is basically cosmetic. Maybe you are not in one of the states that allow FNP to work in pretty much any setting, don’t expect it to stay that way. https://midlevelu.com/blog/can-fnps-work-hospital-and-specialty-settings

 

13 hours ago, EMEDPA said:

I have also seen FNPs on the west coast doing EM, Ortho, surgery, critical care, IR, etc

Some states(notably TX) do not allow this. 

Thank you both for explaining. I have not appreciated this insidious infiltration yet but then again, I haven't cared enough to keep track of what others are doing with their licenses. As a PA in a primarily inpatient surgical setting throughout my career, the majority of NPs I've encountered seem to practice advanced nursing in their respective field of certification. For the FNPs expanding to other fields, at least from what I've seen, they still require physician supervision at the hospital admin level. I do know of an NP whose husband is an orthopedic surgeon. She worked with him initially before opening up her own outpatient cosmetic clinic. These kind of setups (and the direct entry degrees and that most rotations are personally set up and the low required hours of "clinicals" compared to PA and the working during their certification and observational/review papers quoting other observational/review nurse papers and etc etc etc) are what bother me and raise concern of quality control. I have spoken with some physicians who have the similar concerns and will not hire NPs unless they have quality experience. But as you and others have mentioned, the reduced admin oversight may change that. When this topic comes up, I take it upon myself to educate those around me on PA vs NP training. Most are surprised to hear some of the limitations in NP training and surprised to hear what "PA supervision" actually means.

[SedRate]

I should add that the main hospitalist group contracted with the hospital I used to work at only hired physicians up until last year when they hired their first NP. I remember them complaining about having to do extra work since they also had to see the patient and therefore "check his work." I will have to ask the director why they ended up hiring him after so many years of no PA or NP. However, the NP did work at that hospital for years prior to NP school and also did a few rotations with that group during his clinicals. Another NP also worked as a nurse at that hospital for years prior to NP school and ended up rotating with the cardiologist she now works for. I think these NPs are both some certified in some variation of FNP/adult medicine. 

I'm sure these situations will change as more physician groups get bought out by hospital systems and therefore lose some of their ability to choose who they hire.

[Cideous]

15 hours ago, EMEDPA said:

I have also seen FNPs on the west coast doing EM, Ortho, surgery, critical care, IR, etc

Some states(notably TX) do not allow this. 

Umm, just to clarify, I am in Texas and have seen NP's in every field.  Ortho, Urgent Care, Derm and I worked with an NP who actually did an EM residency here and worked in the ER's here in Fort Worth.

Did I read EMEDPA's post wrong?  Was he referring only to them opening up their own shop?  Because they are everywhere in everything here, at least in DFW.

[EMEDPA]

9 hours ago, Cideous said:

Umm, just to clarify, I am in Texas and have seen NP's in every field.  Ortho, Urgent Care, Derm and I worked with an NP who actually did an EM residency here and worked in the ER's here in Fort Worth.

Did I read EMEDPA's post wrong?  Was he referring only to them opening up their own shop?  Because they are everywhere in everything here, at least in DFW.

I didn't mean NPs couldn't do that stuff, I meant they were limited to practice within a specialty by their cert. An FNP in TX without additional training or certs can not do critical care or surgery as I understand it. Most states don't care what the NP cert is, they let them do it all. 

[Cideous]

3 hours ago, EMEDPA said:

I didn't mean NPs couldn't do that stuff, I meant they were limited to practice within a specialty by their cert. An FNP in TX without additional training or certs can not do critical care or surgery as I understand it. Most states don't care what the NP cert is, they let them do it all. 

I believe that has changed my friend.  The FNP I knew was the one who did ER work and now Urgent Care.

[EMEDPA]

52 minutes ago, Cideous said:

I believe that has changed my friend.  The FNP I knew was the one who did ER work and now Urgent Care.

well crap...

[Kaepora]

CRNAs are not NPs, but they are APRNs.
CNMs are not NPs, but they are APRNs.
CNS are not NPs, but they are APRNs.
PMHNPs, PNPs (both acute and primary care), FNPs, ACNPs, WHNPs, AGPCNPs, etc are all NPs and APRNs.  
DNP is a degree, and does not specifically refer to a NP.  A RN, CRNA or CNM can be a DNP, but not be a NP.  

For the past many decades, FNPs were really the only track/certification on the block so they were found in every specialty.  Most state BONs (really all of them) still allow this.  The National Council of State Boards of Nursing created the Consensus Model for APRN regulation in an attempt to align each NP's licensure, accreditation, certification and education with their population/specialty practice.  This remains a guideline, rather than a legally adopted regulation.  It is still hotly debated (mostly by FNPs) and also remains a point of contention among NP specialty tracks (i.e. psych NPs don't believe FNPs should practice psych, ACNPs don't believe FNPs should be in the hospitals, etc).  The main problem is, however, that FNPs still dominate the NP landscape.  For example, ACNPs only make up about 7% of the NP workforce.  Further, employers largely do not know the difference.  This is changing.  My hospital system now requires the ACNP certification.  It'll take time but it'll happen.  

Generally, it is true though, that if I, an ACNP, wanted to work in psych, I would need to go back and do a PMHNP program to get my psych certification.  So that would be another "x" number of didactic semesters and at least 500 hours of clinical.  If i wanted to get my pediatric NP, same deal.  FNPs "should" do the same, but that hasn't been an option for decades so, even now, they don't see the point.

[Cideous]

5 hours ago, Kaepora said:

FNPs "should" do the same, but that hasn't been an option for decades so, even now, they don't see the point.

 

And they don't.  The real test is simply...will someone in Derm for example, hire them.  The answer is a resounding yes.  So why would they go back and get a cert not needed?  Answer...they don't.

[deltawave]

And.... I wonder if we will hear what they had worked on prior to the pandemic? The May AAPA conference has been cancelled. 

Edited March 23, 2020 by deltawave

[ProSpectre]

Does anybody "in the know" have any idea how the results of the title change investigation will be presented now that the AAPA had to cancel the 2020 conference? Are there any members of the HOD (or anyone else with knowledge on the topic) that can shed light on what the process looks like going forward? 

I sincerely hope the AAPA has a plan for releasing the final results of the investigation and presenting the WPP recommendations for potential new titles.  

[rev ronin]

HOD has been rescheduled to November.  Absent specific guidance, I expect it would be presented then.

[iconic]

How much more time are they going to waste with their investigation? 

[Hope2PA]

13 minutes ago, iconic said:

How much more time are they going to waste with their investigation? 

Would have been nice to have been prepared and started in legislation for 2020-2021 with new title. 

[ProSpectre]

38 minutes ago, rev ronin said:

HOD has been rescheduled to November.  Absent specific guidance, I expect it would be presented then.

That's disappointing. Cancelling the conference was a reasonable move, but I was really hoping they had worked out some method of presenting and discussing the results of the investigation virtually. We need to begin taking action on this sooner rather than later, and we can't start anything on this front until those results are disseminated, discussed, and debated by the HOD. 

[rev ronin]

Email Dave Mittman and ask him--they may have something else planned, but the HOD gets the report-out, so I'm surmising that November is the date that will happen, but to be clear: I have no firsthand or AAPA internal knowledge.  There was an AAPA constituent organization meeting tonight, which I didn't get to, but I was sent a copy of the slides, which were entirely about Covid-19 and AAPA's response.

[Cideous]

Tick tock...Tick tock.

 

Like water under the bridge, us "Assistants" stay the same and nothing gets done.  Year after year after year.......