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Ultimately, this isn't our fight: it's board-certified MD/DOs taking on NPs.  Neither one of them has any interest in advancing PA practice. But hey, if you can get AAEM or someone to run ads saying "If you MUST see a non-physician, see a PA who works on a team with board-certified physicians and is trained in the medical model" I'll eat my words.

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14 hours ago, Lightspeed said:

You see the catch with clear eyes. Docs won’t prop you guys up unless they use you as a bat to beat NPs up with. They would turn on PAs the moment they got wind of rumblings for independence. Wife beaters usually beat their kids too. 

Imagine the power of a poster that says “NPs practice independent in half of states, and the sky remains intact. Why can’t we?”

pkeeeeew! Nuclear bomb goes off. 

For anyone applauding this flier from the docs, just realize that the best hope you guys have of keeping from being niche providers is to emulate NPs, not cheer when they get their noses bloodied. 

Guess who isn’t worried about this message from physicians? NPs. Why? Because they already do just fine in the places where we are independent. When they march into California next year and demand and get independence, they will have a map that shows all the existing independent states, and talk about how long they’ve been practicing that way. It’s been tried, it works, it thrives, and outcomes are good. If they are smart they will fly folks in that practice independently to talk about the benefits. This isn’t about supervision, because as many of you folks know, your SPs don’t hover over your work enough to know there’s a problem unless you bring it to them (which is actually you guys supervising yourselves). 

Your trade better have a plan for piggybacking in on NPs work rather than slow clapping the smears. 

 I  do not feel NP’s or PA’s should be totally independent, unless maybe after Many many years of provider experience, not RN experience.  Unfortunately nurse leaders do not agree and have pushed the envelope with disregard to actual patient safety in some states with limited experience required . The sky hasn’t fallen, although there  are very stupid and dangerous  mistakes being made by very cocky insufficiently trained providers. That being said, PA leaders should be smart and follow your suggestion.. Unfortunately, they are so worried about stepping on toes their successors will really be burned. At very least they should advocate for independence based on certain criteria rather than no to any possibility. After MANY years of experience with motivated individual who seeks to continually learn, beyond basic requirements, their is no reason both NP and PA couldn’t be just as proficient as mD or DO and should be given chance to do a great job.

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On 8/3/2019 at 11:04 PM, Lightspeed said:

Imagine the power of a poster that says “NPs practice independent in half of states, and the sky remains intact. Why can’t we?”

Its funny I have been saying this for years. Even when testifying in the legislature I would say "my physician colleagues are going to say >insert hysterical emotional nonsense< and all I ask you is to request data. We are scientists and make decisions based on data. Ask them to show you where the bodies are. Ask them to demonstrate the horrible outcomes they will warn you about. They can't because the data isn't there."

People smarter than me were advocating for PAs and NPs to work together legislatively 15 years ago and, back then, I thought they were nuts. They were just years ahead of their time.

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Physicians need to realize the "midlevel" train has already left the station. Advanced providers are here to stay, no matter how they feel about it. Now they have to decide which model they would like to support:

1. There are PAs, who were "invented" by physicians, trained in the medical model, and have been generally eager to work side by side with physicians.

or

2. There are NPs that by most measures have inferior training (at least out of the gate) are all into calling themselves "doctor," and generally give the middle finger to physicians.

 

We are beyond the point where political crap will change anything. Physicians can support the PA profession, prioritize hiring PAs in their systems, and watch us grow and thrive. The alternative is to watch us go into extinction as the market is flooded by NPs, much like C. diff moving into a vacant colon. 

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1 hour ago, FiremedicMike said:

I'm genuinely curious.. If the internet had existed when DO's made their push to be recognized, do you think the teeth gnashing would have been just like this?

 

Difference is the DO’s did, and now NP’s are Fighting for their future, while PA’s ultimate goal is for restrictive practice at best. Over saturated pharm and dental saw decreased salary before correcting years ago.  PA’s are different because can not compete for jobs, let alone decreased salary in many locations, and it expanding because no matter education, the laws are against them.  Even without internet, eventually, you would notice and start being  concerned.  In some iNP independent states, PA’s  are being turned down, no, not turned down, just not even considered for a job because you have no possibility of independence. Admin doesn’t want to deal with the extra work. Docs can’t wait to have highly educated “assistants” they can pay less and less because you are stuck with no other options and rapidly growing number fighting for low paying job which is better than no job.  

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The AAEM is full of crap and even docs knows famous EM docs like Swaminathan of EM RAP have come out against their rhetoric. Even ACEP is taking a hard stance on this kind of BS. Their proposal of every patient being staffed is not practical, as only 30% of the ER visits today are attended by a board certified EM physician. They can’t practice in rural areas or won’t because the pay is beneath them. They can ask to see an EM physician and I’ll tell them hop on the highway and drive 75 minutes south, pull into the university, check in, wait 6 hours, the resident will see you, and at some point an EM attending will walk by and wave.

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26 minutes ago, LT_Oneal_PAC said:

The AAEM is full of crap and even docs knows famous EM docs like Swaminathan of EM RAP have come out against their rhetoric. Even ACEP is taking a hard stance on this kind of BS. Their proposal of every patient being staffed is not practical, as only 30% of the ER visits today are attended by a board certified EM physician. They can’t practice in rural areas or won’t because the pay is beneath them. They can ask to see an EM physician and I’ll tell them hop on the highway and drive 75 minutes south, pull into the university, check in, wait 6 hours, the resident will see you, and at some point an EM attending will walk by and wave.

yup. wanna see a doc? there may be one here in 24 hours or there might be another PA. oh, and that doc is a new grad FP doc...

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16 minutes ago, EMEDPA said:

yup. wanna see a doc? there may be one here in 24 hours or there might be another PA. oh, and that doc is a new grad FP doc...

Or a doc doing part-time ER work while he works on his GI fellowship...

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On 8/3/2019 at 2:52 PM, Cideous said:

Of course ER docs are behind this.  I don't really disagree with it, but the cats out of the bag already.  They waited too long.  NP's are gonna steam roll them for jobs, just like us.

I don't agree with this.

New Mexico is a complete 100% independent state for NPs, they can literally do anything an MD can do except for brain surgery.  No cosignatures, no chart review, complete 100% autonomy.  NPs can own their clinics with no MD oversight whatsoever.

Yet I see recruiting all the time for MDs.  So I don't think the MDs really have anything to worry about in terms of NPs or PAs.

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I suggest we embrace this totally and carry to its own illogical extreme. Let suggest nobody be allowed to work independently in the ER except board certified ER physicians. FP doc in the ER? Staff all your cases with the ER doc. Then carry it to other specialties. Only board certified physicians can work on their own. Everyone else has to staff everything with a board certified physician.

I could run with this concept for months. Lets lean into it.

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2 hours ago, sas5814 said:

I suggest we embrace this totally and carry to its own illogical extreme. Let suggest nobody be allowed to work independently in the ER except board certified ER physicians. FP doc in the ER? Staff all your cases with the ER doc. Then carry it to other specialties. Only board certified physicians can work on their own. Everyone else has to staff everything with a board certified physician.

I could run with this concept for months. Lets lean into it.

FM physicians shouldn’t be allowed to introduce themselves as doctor in the ED setting. It might confuse patients and believe they are being seen by a BC EM physician.

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Just now, LT_Oneal_PAC said:

FM physicians shouldn’t be allowed to introduce themselves as doctor in the ED setting. It might confuse patients and believe they are being seen by a BC EM physician.

But DNPs can get away with being called "Doctor"?

 

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7 minutes ago, CAdamsPAC said:

But DNPs can get away with being called "Doctor"?

 

It’s a joke. 

But if you want it to be serious I don’t think ANYONE should only use their educational credentials. Not physicians or anyone else. I don’t think doctor should be synonymous with physician in any setting. If we are to take “patient confusion” to it’s logical end point, then everyone should have their credential and specialty identified. I’ve worked plenty of places where podiatrists walk around with “physician” on their badge, but I doubt you want them running your code. The university I work at now has dental residents and medical residents with the exact same badge with “Doctor” on it. They certainly didn’t go to medical school. Yet no one seems to make fuss over these.

 

ETA: and yes, the dentist are in the ED all the time for consults. Never seen one clarify their credentials 

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2 minutes ago, LT_Oneal_PAC said:

It’s a joke. 

But if you want it to be serious I don’t think ANYONE should only use their educational credentials. Not physicians or anyone else. I don’t think doctor should be synonymous with physician in any setting. If we are to take “patient confusion” to it’s logical end point, then everyone should have their credential and specialty identified. I’ve worked plenty of places where podiatrists walk around with “physician” on their badge, but I doubt you want them running your code. The university I work at now has dental residents and medical residents with the exact same badge with “Doctor” on it. They certainly didn’t go to medical school. Yet no one seems to make fuss over these.

I understand sarcasm. In my surgical days we had Dentist completing the  OMF Program on the surgical service for 2 years they were ranked  PGY 1 & 2 and they were strong hitters. I think ID Badges stating "Medical Staff" with their level of training should be the standard. I believe the use of  physician was settled by the SCOTUS when Chiropractors fought  and won to be called Physicians of Chiropractic Medicine. While Doctor remains a nebulous term when heard by patients and families versus professionals. The lay public is often confused and ignorant about who is who in medicine.

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