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Another Example of What We are Up Against

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I have long said Texas is about as medically backwards as it is possible to be. This is the president of the Texas Medical Association. 




This is my initial response. It is a rough first draft as I was just venting my spleen. I will shave off the hard edges and reword a few things before it gets sent:


Dr. Fleeger,


  I read your recent article about APPs working for physicians and it sounded very much like an op-ed piece written by the political arm of TMA. I have grown accustomed to the medical board carrying TMAs water and using it’s bully pulpit to help maintain the financial interests of physicians but, even after 20 years here, I hold hope that someday Texas will drag itself into the current model of healthcare delivery and realize PAs don’t need physicians to control their profession.

  It is because we are professionals that we lead, supervise, educate, and monitor the other members of our health care team. They do not know what we know." This particular piece of sophistry has been trotted out in various forms over the years starting with “people are going to die!” when I first started working on healthcare issue on behalf of PAs in Texas. Only the words have changed and it still isn’t true. It is verbal voodoo that takes the nefarious position that anyone that doesn’t agree is ignorant because they don’t know what you know. 

  Patients benefit when everyone is working at the top of their license. The current model of state mandated supervision is antiquated. It takes a very lazy “they are all the same” position on any provider that isn’t a physician. It creates unnecessary administrative burden and financial costs that is ultimately bourne by the payors which are the patients and the businesses and people who pay for insurance. 

  As NPs achieve independence and PAs are working to modernize their professional practices nationally physicians are becoming more and more afraid and it shows in articles such as yours. Physicians already abdicated their control of healthcare by choosing to become employees. Now the beads of sweat form as they see their control over another profession slipping away. It will come. You can resist, probably for a long time, but in the end healthcare delivery will modernize despite your best efforts at freezing progress. 

  It is time for physicians to get comfortable in their own skin. Stop the panicked missives and dire warnings that have never come true. Look at data. PA practice has been studied multitudes of times and found to have comperable, and sometimes better, outcomes than physicians when working in their scope of practice. I have heard all the anecdotes about PAs. I can match them one for one with physician anecdotes, generally with worse outcomes, because of the wide latitude physicians enjoy, but that isn’t data and that isn’t the measure of either profession. Do you want physicians judged by the neurosurgeon who managed to paralyse and kill several patients a few years back in Dallas? Of course not and PAs don’t deserve to be judged by the worst among them. 

If someone snapped their fingers and made every NP and PA in the country independent of physician supervision tomorrow what would change? The short answer is nothing. We all have profession standards to meet. We all have rules and regulation in abundance that govern what we do. We are all credentialled by employers and insurers. Absolutely nothing would change in the most practical sense. Physicians would be relieved of the legal burden of supervision. Organizations would save the average $12,000 annual cost of supervising APPS. Multiply that by the number of APPs in Texas and you see real cost savings. 

 Let us begin a real conversation about healthcare delivery. Eliminate the fear, ego, politics, and greed that seems to be grist for the conversational mill. Lets figure out how everyone collaborates to provide the greatest access to the best care at the lowest cost. Nobody is arguing physicians are the highest trained health care providers. The argument is about control, power, and money. Lets stop.

Edited by sas5814
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LOL sounds like he is trying to coin a new term with "non-physician providers (NPP's)".  And for the record jackass, we no longer work "for you", physicians gave up their ownership over medicine in the 90's and early 2000's.  We, like you, now work for corporate overlords.  Get use to it.


Scott.....well written, good response.  Not that he will read it, but I wouldn't change a thing.

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yea but I live here. I'm treated pretty well an paid pretty well and generally, as long as you remian the physicians faithful lackey the rules aren't too nebulous.

I have said we will get OTP here right after Puerto Rico and American Somoa. 

Its a battle of attrition and they are all old.

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The Bible Belt of angry old white men continues. 

Born and raised in Texas. PA School in Texas. Moved away 20 yrs ago.

We didn't even have licenses when I graduated in 1992, No Rx privileges when I left in 1999.

Surprised I could even work as a WOMAN in a professional field dominated in Texas on the Board by angry old white males who think the MD stands of Medical Deity.

I feel for you Scott - and my other colleagues in Texas - it will take a true Revolution to get the Texas Medical Board to remove heads from orifices and join medicine in the 21st Century. 

I thought Mississippi was the last hold out of medical idiocy. 

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