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OTP is a must if we're to catch up to our NP colleagues


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OTP is a hot topic no doubt.  When I look at the big picture, I believe it is absolutely needed.  In increasing pockets over the nation, practices and hospitals / institutions / companies, are moving to, or moved to, hiring NPs exclusively over PAs.  I've been seeing job ads where the ad actually states NPs only.  There's different factors with this evolution.  Some physicians in some institutions have begun to ask for extra $ to "supervise" PA(s).  It's cheaper for an institution to have NP vs PA.  NPs have marketed, lobbied, and gotten on certain administration boards and convinced administration why NPs are "better."  I've actually seen this where I work.  This one NP where I work had said untrue things about PA licensure, abilities, and laws and, guess what, surprise, the board of directors and administration took what the NP said at face value and totally believed her.  I had to refute this with state law quotes and educate people.  

This is not a post about "us vs them" ...not at all.  This is about us being pro-active, to evolve to be more marketable, on even par cost to credential and have on staff as NPs, and be unlinked from the subjective and confusing word "supervising" from our profession.  The population is growing faster than doctors can meet the need of and PAs are a highly viable help to this need.  If I have this correct, there are now 20 states that have removed the supervising part of the laws, and this is in line with OTP.  

I've actually talked with PAs, who don't even know what OTP is, who don't know about this evolution of NPs gaining on us, and increasing pockets of NPs being hired exclusively over PAs or the reasons as to why.  

I respectfully implore PAs to read up on OTP and what it's about and to get involved with state laws and help us evolve in a desirable and prosperous way. !:) 

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So here's the thing.  What you will find is that a LOT of *older* PA's want to either keep Physician Assistant or at most move to Physician Associate.  Why?  Because that's the way it's always been an

OTP is a hot topic no doubt.  When I look at the big picture, I believe it is absolutely needed.  In increasing pockets over the nation, practices and hospitals / institutions / companies, are moving

I disagree wholeheartedly that another year should be added, at least for the purpose of residency. Honestly I think no more than 6 months could be added, but thats just opinion. I understand why you

Its (sadly) amusing how many of our colleagues are unaware.The other day on a FB forum a PA first asked what OTP was and then stated she didn't buy into the "made up hysteria" of PAs losing jobs to NPs and us becoming extinct.

So in one sentence she admitted total unawareness of the biggest thing happening in the profession and then making a blanket denial of an issue that is effecting many of our colleagues across the US.

We should all have a basic awareness of the forces driving our professional life and should participate at some level.

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Unfortunately a sad state in society. If it doesn’t and won’t impact me thenI don’t give a darn. Can’t blame this on young people, as in PA issue it appears it is More of the older, not likely to be impacted group that say everything is just fine and don’t change name or at least keep P.A.  Thank goodness for those you that have time and experience  who actually care for the future! Of the profession!! You deserve so much praise!  Will say I have ran across some younger PA’s who have been fed by their programs to think everything is fine, no job concern, PA is great.....but these programs just want to keep$$ rolling.  I have seen experienced PA with 4 years in a specialty who had to move for family health issues, took nearly a year to land job in same specialty and had applied to everything. It is a NP pro state and not one of bigger cities. 

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26 minutes ago, deltawave said:

Is there a list somewhere of these states that categorizes them as PA friendly/neutral/unfriendly? Does the AAPA have a list? I feel like that would be worthwhile.

I don't think there is a comprehensive resource that can categorize each state as "friendly" or "unfriendly", but there are some metrics that can be measured and compared. 

This chart and this table cover the 6 Key Elements of Modern PA Practice (as outlined by the AAPA), which is a pre-OTP measure of "PA friendliness", as it were. It's one way to compare apples to apples for each state, but may not provide the whole picture. 

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the 6 elements are all well and good, but don't often reflect what goes on in a state. WA, for example is MUCH more PA friendly than OR, yet WA has 5 and OR has 6. PAs run ERs solo all over WA. Only 1 ER in OR was PA run, until it was purchased by a larger organization and turned into a 12 hr/day urgent care. 

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A “PA friendly” state may also be one of the indecent for NP making it in reality unfriendly. While a “PA unfriendly with few of the 6 components that is not NP independent could be great location. Especially if hospitals are not dominated by NP managers. Seams likely in areas where NP and PA on same playing field, PA’s can do well, but Shouldn’t think all is ok, that area may be the next going independent, NP aren’t going to stop pushing till all have achieved full independence goal, why should they, it is in best interest of their profession. . 

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18 minutes ago, EMEDPA said:

the 6 elements are all well and good, but don't often reflect what goes on in a state. WA, for example is MUCH more PA friendly than OR, yet WA has 5 and OR has 6. PAs run ERs solo all over WA. Only 1 ER in OR was PA run, until it was purchased by a larger organization and turned into a 12 hr/day urgent care. 

I completely agree, that's why I mentioned that it doesn't provide the whole picture. However, it's hard to quantify how PAs are predominately utilized in a given state since it likely varies so much from practice to practice, and the links I posted are the only way I know of to objectively compare one state to another.

The charts also don't cover salary data, job availability, current legislative efforts, etc, and are basically just a starting point. 

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It is so hard to quantify. I'm in Texas which, for the most part, is fairly PA friendly. We had good prescribing rights and are well utilized across the state.

That said we are totally dominated by the physicians and the Texas Medical Association. So as long as we are good boys and girls and do what we are told they won't hurt us. I suppose is is partially PA friendly because we share a practice act with the NPs so we are all in the same strictly controlled boat together.

I don't know how to parse that against PA friendly or not.

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2 hours ago, Hope2PA said:

A “PA friendly” state may also be one of the indecent for NP making it in reality unfriendly. While a “PA unfriendly with few of the 6 components that is not NP independent could be great location. Especially if hospitals are not dominated by NP managers. Seams likely in areas where NP and PA on same playing field, PA’s can do well, but Shouldn’t think all is ok, that area may be the next going independent, NP aren’t going to stop pushing till all have achieved full independence goal, why should they, it is in best interest of their profession. . 

... what?

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22 minutes ago, deltawave said:

... what?

There are charts AAPA.org indicating how friendly states are based on 6 key elements . My point is no matter how many or few of the 6 points, if the state is also one where NP’s have independence, It is likely going to be less PA friendly than a state where NP do not have independence. HOSpitals or management in general don’t care how friendly they are suppose to be they just want someone that takes less paperwork and don’t require paying a doc to supervise or collaborate. 

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5 hours ago, Hope2PA said:

Will say I have ran across some younger PA’s who have been fed by their programs to think everything is fine, no job concern, PA is great.....but these programs just want to keep$$ rolling.

I don’t doubt this for one second. I’ve not heard of a school that appropriately prepares new grads for the realistic state of the profession. I’m one of the new grads that was somewhat aware of this but still had no clue how terrible it was. The less pragmatic hear nothing but “you can move anywhere in the country and you’ll have a job”, “new grads have an advantage because they are trainable”, “there are 20-1 jobs per PA”, “you can choose any specialty you like”, “you can change specialties whenever you like” etc etc etc. I predict that in the coming year this forum will be overrun with posts about it, rather than “new grad job offer”.

 

The rural Midwest/mountain west is absolutely, undeniably DOMINATED my NPs.  

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22 minutes ago, ANESMCR said:

I don’t doubt this for one second. I’ve not heard of a school that appropriately prepares new grads for the realistic state of the profession. I’m one of the new grads that was somewhat aware of this but still had no clue how terrible it was. The less pragmatic hear nothing but “you can move anywhere in the country and you’ll have a job”, “new grads have an advantage because they are trainable”, “there are 20-1 jobs per PA”, “you can choose any specialty you like”, “you can change specialties whenever you like” etc etc etc. I predict that in the coming year this forum will be overrun with posts about it, rather than “new grad job offer”.

 

The rural Midwest/mountain west is absolutely, undeniably DOMINATED my NPs.  

agree with this. NPs are an issue. Lateral mobility is going away. Yes, you can work in any specialty you want, but you may need to live in BFE to do it. Outside of formal residency programs, most physicians don't want to train PAs. 

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18 minutes ago, EMEDPA said:

agree with this. NPs are an issue. Lateral mobility is going away. Yes, you can work in any specialty you want, but you may need to live in BFE to do it. Outside of formal residency programs, most physicians don't want to train PAs. 

Then to me, it is easier to go to a fellowship/residency program than it is to do battle with the NP lobby. 
 

I am one person. I can only do so much in the battle. I have to make myself as marketable as possible, which will benefit me as well as the profession. Some are against fellowships/residency as it starts to set an unofficial bar for PAs. But with PA medical model training, a title change, OTP, and fellowship training the PA brand can really put a wallop on the nursing lobby. 
 

The deal is this. The PA organizers are trying to tip toe around. Don’t want to bite the hand that feeds (MDs) and don’t want to ruffle feathers of the other “mid-levels” (NPs). Toes will need to get stepped on if we are going to evolve. No one is going to give us anything, we have to fight for it and achieve it ourselves. 

This must be done in stages. Step 1.) get out from under the thumb of the AMA by changing the title (removing “physician”/“assistant”) and achieving OTP. A working relationship as team practitioners with physicians rather than an expressly supervisory/subordinate/assistant relationship. 
I am not in the camp of PA new grads going into independent practice and completely separating from docs, but I am in the camp that it should be an option as one gains experience and has a reliable team. (Much like the new North Dakota OTP legislation; we ought to strive to model that nationwide). 
 

Step 2.) Wage a PR battle the likes of which the world has never seen. Establish that NP is not greater than “insert new title here.” Establish we are team players. Establish we are here to put patients first. Establish we the evolution of physician extenders and we are here to stay. 
 

 

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3 hours ago, EMEDPA said:

agree with above. I am a big fan of postgrad training and doctoral credentials for PAs. CAQ exams/certs as well. 

I think behind the scenes we are making progress on this front. I’ve personally seen a difference in respect and somewhat in pay with a doctorate. Hoping for continued gains with the CAQ-EM. 
 

I do think all these “fellowship” and “residency” programs need some oversight from the NCCPA or another regulatory body. 

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2 minutes ago, BirdDogPA said:

I think behind the scenes we are making progress on this front. I’ve personally seen a difference in respect and somewhat in pay with a doctorate. Hoping for continued gains with the CAQ-EM. 
 

I do think all these “fellowship” and “residency” programs need some oversight from the NCCPA or another regulatory body. 

Ultimately they mean little if you don’t obtain a CAQ. That’s oversight.

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but...but...but...according to some here on the boards, every time I bring up the current over-saturation of PA's and NP's they jump in and say everything is fine.

It's not fine, and it's getting worse by the month.  Every month another few hundred NP's are dumped into the DFW area from their rolling online NP schools...not to mention the 2 PA schools here in DFW.

Sat...ur...a....ted!

 

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3 hours ago, deltawave said:

Ultimately they mean little if you don’t obtain a CAQ. That’s oversight.

many of the programs are part of the association of postgraduate pa programs(appap.org). Most of the EM programs meet the sempa recommendations for residency programs, designed when I was on the board of sempa a few years ago. A few of the em programs also required passage of the caq at the end of the program. 

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I guess my main concerns is ive seen a trend in my area of some of the CMOs starting these “residencies” for APPs that are just a way to get cheep labor. No off service  rotations, minimal didactics... Personally I think these programs should be shut down as they have minimal education value and are focused on corporate profits. 

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Who can adequately add to this topic when the responses all demonstrate the same understand. I don't care if some states are better than other because it demonstrates that we need a national standard. When I was young we added STP to our gas to get better mileage and efficiency, that's what OTP is. We need to be recognized as providers who do mot need the supervision and are not a financial burden. Too many of us have become apathetic because they have a good paying job. Apatha, is a cancer that needs to be excised if we are going to evolve and be on equal ground as NPs.

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9 hours ago, Cideous said:

Every month another few hundred NP's are dumped into the DFW area from their rolling online NP schools...

Yep. And now we have new grad BSN’s going straight to NP, zero experience required. Subsequently accepting lower salaries. Have to pay them less, don’t have to “supervise“ them. It’s a no brainer. 

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My wife is asking the same question right now regarding her professional program where she is a professor.  They are looking at doubling the number of students in the next couple of years at a program that offers a non-BS degree (sound familiar?).  They (staff) already realize that it'll water down the quality of the graduates and impact their reputation as a top-notch program.  Why is this being done?  Silly rabbit, it's all about the $$$.  There is no way that demand for PA services warrants the number of programs/graduates that this state produces.  He@@, I don't even know how many programs there are in the state anymore.  I probably can't count that high since I run out of fingers on one hand too quickly.

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New grad PAs are also settling for lower compensation packages. It doesn’t take long for corporations to recognize this. There ought to be a class on salary negotiations in every PA program. It only takes a couple people to accept a low-ball offer before everyone loses traction. 
 

Ultimately, the responsibility and workload held by a PA/NP demands a salary above board. 

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