Is It Time To Ditch OTP?

[sas5814]

and call it what it is.... Full Practice Authority and Responsibility?

A bit of history as I understand it and anyone who was actually in the middle of these events please correct any of my misstatements.

Brain Sady, then a board member of PAs For Tomorrow, wrote a white paper on FPAR (for the sake of discussion) and PAFT began advancing the idea. After a bit of wrangling and the traditional resistance to any such bold idea, AAPA got on board and took the idea and ran with it. Somewhere along the line, the decision was made that FPAR sounded too aggressive and the language was changed to Optimal Team Practice. The concept didn't change just the name.

Fast forward to now. We have made some advancements but there is a lot of confusion about what OTP is and isn't. The title is working in opposition to the desired outcome. It is confusing and, perhaps, it is time to be clear about what we are trying to accomplish.

So is it time to continue the work but change the name? We want to be responsible for ourselves in practice and self-regulation. That is a brief summary of the goal. So why are we softening the words to try not to excite groups we know are going to work against us (or at the very least resist us)?

We are making bold changes and they deserve an accurate and bold title.

[Cideous]

Gawd yes.  Why?  It's what NP's have done, and like it or not they are our competition.  They skipped an OTP like waste of time completely.  They went straight to automomy and have it in what, 33ish states?  Hanging our hat on limited liability for our docs is just kind of pathetic at this point.

Having said that, it ALL starts with a name change and NOT to "Associate".  Public perception is everything.  We have better training than NP's and yet the public perceives them as superior to us because of our stupid outdated name.

[Joelseff]

Yes... Hell yes

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[sas5814]

I think we have historically spent all our energy trying to pacify physicians. It seems to be ingrained into us. I don't think we need to be intentionally antagonistic. I think we need to tell them what we are doing, tell them we understand they don't agree, and then go on with our business.

We need to stop spening so much time and money and energy on the physicians and work on getting alliances and sponsorships with large entities and organizations...just like the NPs did. That would multiply our political clout and increase our financial means to prosecute our agenda.

[LT_Oneal_PAC]

I would be all over it. OTP is great. If all it is implemented exactly as intended, like it was in North Dakota, I’d be pretty happy. The problem is it’s chosen as the place to start negotiations, which it shouldn’t be. We get to regulate ourselves, we our responsible for ourselves, we practice to our education and experience. Full stop.

[lemurcatta]

Everyone has such varied and strong opinions on the title such that any eventual final proposal is highly likely to only appeal to less than a majority, meaning it will disappoint the majority of people. I think that portends a poor result of the entire title investigation process. There will be no change at all if people aren’t willing to be somewhat flexible. It’s like if your preferred candidate in whatever party doesn’t become the nominee, refusing to support your party’s actual nominee is really just a vote for the status quo or the opponent. 
 

Right now I don’t see the title changing. Literally everyone I talk to has a different opinion. It’s dead in the water unless we can figure out how to be ok with a personally less than ideal result. Like, don’t let perfect be the enemy of better. 

[Joelseff]

Let's clarify... This thread is about the title of OTP not our professional title...

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[Cideous]

1 minute ago, Joelseff said:

Let's clarify... This thread is about the title of OTP not our professional title...

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The two are intimately intertwined.  We would never and I mean NEVER achieve any sort of practice autonomy as "Assistants" or "Associates".  This thread is about skipping OTP for autonomy which is exactly what NP's did and rather successfully I might add.  That would not have happened if they had either assistant or associate in their name.  No way.

[Joelseff]

The two are intimately intertwined.  We would never and I mean NEVER achieve any sort of practice autonomy as "Assistants" or "Associates".  This thread is about skipping OTP for autonomy which is exactly what NP's did and rather successfully I might add.  That would not have happened if they had either assistant or associate in their name.  No way.

I agree but this thread may devolve into another title thread which has been discussed in several other threads. That is all I wanted to avoid.

 

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[Hope2PA]

2 hours ago, lemurcatta said:

Everyone has such varied and strong opinions on the title such that any eventual final proposal is highly likely to only appeal to less than a majority, meaning it will disappoint the majority of people. I think that portends a poor result of the entire title investigation process. There will be no change at all if people aren’t willing to be somewhat flexible. It’s like if your preferred candidate in whatever party doesn’t become the nominee, refusing to support your party’s actual nominee is really just a vote for the status quo or the opponent. 
 

Right now I don’t see the title changing. Literally everyone I talk to has a different opinion. It’s dead in the water unless we can figure out how to be ok with a personally less than ideal result. Like, don’t let perfect be the enemy of better. 

Sad part is anyone supporting better over what may be best option only because they think it would be easier. Or worse wanting to stay assistant.  Many NP’s do not agree with the changes made to continually move the profession for independence, especially because of inconsistent education and poor clinical experience. Yet, they would not do anything to hinder their profession. It is shameful how PA’s fight against progression. Yes, some PA’s will be unhappy one way or another, but in the end result should be about what is BEST in the next 5-10 years, not because you want the easy road or because it has worked so far, it is no longer working in many areas! . Not just title, but also independence. 

[lemurcatta]

3 hours ago, Hope2PA said:

Sad part is anyone supporting better over what may be best option only because they think it would be easier. Or worse wanting to stay assistant.  Many NP’s do not agree with the changes made to continually move the profession for independence, especially because of inconsistent education and poor clinical experience. Yet, they would not do anything to hinder their profession. It is shameful how PA’s fight against progression. Yes, some PA’s will be unhappy one way or another, but in the end result should be about what is BEST in the next 5-10 years, not because you want the easy road or because it has worked so far, it is no longer working in many areas! . Not just title, but also independence. 

This attitude, whether about OTP, the title, or any other issue, is not one that wins. Its about consensus building and compromise, which is actually much much harder than the spouting off hard line positions on the internet. Say what you want about the NPs but they are a totally separate profession than us and we have our own historical baggage, political and inter-professional relationships to contend with. The people getting things done for PAs are doing it incrementally, in very hard fought and hard won negotiations with many different stakeholders in rooms late at night well past after they finish working their real jobs. They are volunteers who serve in state academies that are vastly underfunded compared to NP organizations. I've seen in in person now for two years. Everybody has their opinions on what to push for but few bother to join their state chapter, pay membership dues, or run for positions on the board. And more importantly, no one takes the time to understand how difficult it is to move from idea to passable legislation. Literally the only time we hear from our constituents is when they need help with something (usually involving license renewal) and half the time they aren't even members. 

 

[sas5814]

9 hours ago, lemurcatta said:

Everybody has their opinions on what to push for but few bother to join their state chapter, pay membership dues, or run for positions on the board.

I made this point in another forum, including the statement that everyone can do something if they want to help, and I was shouted down for "public shaming". Some days I want to bang my forehead on a wall....

[True Anomaly]

The NPs obtained the ability to be directly reimbursed for their services in 1997 with the change in Medicare law.  That's what started the snowball downhill for their independence

I've said it before and I'll say it again- until we ALSO have this ability, the road to OTP/FPAR/whatever autonomous/independence term you wish to use will be a much harder one to travel.

It becomes a much easier case when you completely control your own financial future.  

The NPs laid out the playbook already.  There's no sense in rewriting it- follow what they have done already

[ventana]

When is the lawsuit for restraint of trade?   It is obvious the courts are different then they used to be and seemingly where everything ends up anyways.  
 

we need some individual to start it rolling.  
 

 

 

I would take independence and a name change to just about anything besides our current.  
 

 

[Cideous]

48 minutes ago, ventana said:

 

I would take independence and a name change to just about anything besides our current.  
 

 

100% agree.  It's time to stop nibbling around the edges.

 

I have a feeling this thread is going to go into many pages and go for a long long time.

[VeryOldPA]

Ventana, 

Just whom are you proposing be sued. Who is restraining trade?

[Guest Paula]

YES, FPAR instead off OTP.  Optimal Team Practice is already seen as a move for independence by physician organizations, so we may as well call it that.  In WI the floor vote is tomorrow for our OTP vote and we had to compromise with the state physician organization because they thought they could tell all the legislators to vote no and it would be  a done deal.  Nope.  The leader of the health committee was on our side and forced them to come to the table, but we had to add a few words in, and they wouldn't let us title protect Physician Associate. .  They are scared of PAs and I say we continue to flex our muscles and go for FPAR.   

[VeryOldPA]

Changing the title of the policy from OTP back to FPAR is, as the old tried and true political adage  says, “Like putting lipstick on a pig. At the end of the day it’s still a pig”  Call it anything you want - unless the policy itself is not rewritten nothing changes.

[PA-C]

14 hours ago, Paula said:

 and they wouldn't let us title protect Physician Associate. .

Good thing they don’t know about Praxician  also I hope even more now that Physician Associate is NOT the title that’s presented to us as the best “new” name for our profession this spring.

[PAinPenna]

In Pa we are getting pushback from the state medical society just to not have our charts co-signed 

Meanwhile , the NPs are halfway there to Independent Practice 

 

I really really hate to say this , but I may need to look into a PA - NP bridge program to stay relevant as a practitioner . 

[sas5814]

This illustrates my point. Let us call this movement what it is, tell the physicians we understand they don't agree, and get on with it.

 

Also let's stop trying to get the physicians permission and start developing relationships with business leaders, hospital organizations, insurers and sell what we have to offer. The physicians are never going to do anything but oppose us and yet we continually worry about upsetting them. It is a long dysfunctional relationship we have outgrown.

[GetMeOuttaThisMess]

1 hour ago, sas5814 said:

This illustrates my point. Let us call this movement what it is, tell the physicians we understand they don't agree, and get on with it.

 

Also let's stop trying to get the physicians permission and start developing relationships with business leaders, hospital organizations, insurers and sell what we have to offer. The physicians are never going to do anything but oppose us and yet we continually worry about upsetting them. It is a long dysfunctional relationship we have outgrown.

The physicians can't control themselves, and lost their ability to dictate when they gave in to the business/insurance side.

[Cideous]

I could honestly care less about docs anymore.  They surrendered their role in medicine to their corporate overlords and the insurance industry.  Lock stock and barrel they are now no more than employees.  Employees we compete with for jobs.  Time to stop asking permission and start greasing the pockets of lawmakers just like NP's have done.  21 states NP's have full practice authority......21 out of 50.  We have 0.  Nadda....zip.  

Let that sink in.

[PolakPA]

If most states are struggling to even get OTP passed would transitioning the agenda to FPAR further alienate law makers? What catalyst would be needed to start the fire? I’m sure a name change would be an enormous factor. 

[Hope2PA]

I don’t see FPA as alienating  lawmakers more PA’s fear alienating physicians who BTW are no longer ones responsible for hiring you, often don’t get extra $$$ from you like they did in private practice, so don’t want to be responsible.   Yes, lawmakers have a VERY hard time getting past the physician assistant. May be slightly better with associate, but still suggests you need a physician. The fire needs to come from PA’s actually wanting it enough to financially support state(if society is working for progression, not trying to restrain).  Also supporting AAPA and special interest groups Both financially and by writing letters demanding change for a future, not just to pacify current state. It is nothing magic, Just work. Finally, taking time to write or meet every state lawmaker in your area and present them with the facts on PA vs. NP education and training. I go back to the one I used, Emory univ in Atlanta, top rated for both NP and PA, yet education and requirements are drastically different. This is especially true in states with NP FPA. Law makers are not stupid, just uninformed and writing bills takes time and $$$.