What Do We Do Now? In response to recent legislative events in Florida.

[sas5814]

Let me provide a short background story for anyone who isn’t familiar with the recent happenings in Florida:

 

There was legislation was pending, allowing independent practice in primary care for PAs and NPs in Florida under specific rules. To pass legislation, differences in the House and Senate bills have to be reconciled. The simplest thing to do would be to include PAs in the house bill and boom; there would be independent practice for both groups.

 

The Senate bill made the provisions for PAs and NPs, yet when the companion bill was released in the house, it only mentioned NPs. Instead, the bills were reconciled by dropping PAs from the legislation. This happened despite a fantastic effort by FAPA (Florida Academy of PAs), its leadership, and PAs from all over the country.Why did this happen, and what should we do now?

 

 

 

 

I believe we just saw, in its purest form, the political will of NPs. When there were discrepancies that needed to be reconciled in the two bills, they simply did what was best for them, and worked to have everyone but themselves removed from the legislation. Why would they put their agenda at risk to try to include another group? How would that benefit them? Simply put, it wouldn’t. So they did what was best for them. Many people will want to be angry about this and, while I am frustrated we weren’t able to make things go in our favor, we need not be angry with the NPs but, learn from them.

 

They have, for over 20 years, demonstrated a dogged determination, general disregard for the opinions of other stakeholders, and a will to make their profession successful and that deserves respect. So let us stop carrying on about what they are doing and learn from it.

 

What Do We Do Now?

 

I believe there are a few big things we need to do to get our heads screwed on straight, face-forward, and get back to work.

 

1.

We MUST purge our professional DNA of the urge to please and the fear of making any other group unhappy. It seems to be collectively hard-baked into us to worry about what the physicians think. Let me tell you what they think (at the organizational and political level). They believe we are inferior and undeserving of respect. They think we need to be controlled and closely monitored by physicians. They think if we slip our chains, it will cost them money, power, and control. They think they must keep us in our place.

 

2.

Understand what the NPs are doing and how they are doing it. I don’t think they are our political enemies. I also don’t think they are our friends. They have been killing it legislatively for years. There is zero profit for them in adopting us to help with their causes. We are so far behind them; we would only be a liability if they decided to make us part of their efforts. They have left us in the dust, and they know it. Will there be chances to work together for our mutual benefit? Without a doubt. However, recent happenings in Florida should give all of us a clear view of what happens if we are perceived as dead weight. It is every man and woman for themselves.

3.

We need to promote ourselves aggressively and unashamedly without the first care what any other group thinks about our self-promotion. My father used to say, “If you don’t blow your own horn, it doesn’t get blowed (sic),” and he was right.

 

4.

We need to look people in the eye and tell them how amazing we are. We need to say, “we want to help…to do more…and you are stopping us. Why?” Then we don’t settle for pat answers.

 

5.

We should demand to know why they want to keep us from being and doing our best. We need to demand data and proof when people say foolish things like “ people are going to die .” or “ you order too many tests because you don’t know what you are doing .” Physician groups, in particular, love bumper sticker answers that are not answers at all. The current favorite is “they don’t know what we know,” which makes me grind my teeth every single time I hear it. When this happens the speaker needs to be called out and this little bit of pithy sophistry needs to be exposed for what it is…nonsense.

 

In short, we need to learn to look after OUR profession first and without excuse or apology. We have too much to offer and have too many amazing people in this profession to ever put our heads down or be so reluctant to trumpet our capabilities and accomplishments. We are amazing.

[Cideous]

Well written Scott, but nothing....and I mean nothing will ever change or bring us close to getting parity with NP's until we change our name.  

And not to "Associate".  We must have Practitioner in our name somewhere.  When uneducated politicians see Nurse Practitioner vs Physician "Assistant"...it is a full stop for them.  Some can be educated, but we don't have the resources to educate all of them in every state.  It's just shocking that PA's are still questioning this fact and still holding on to our terrible name.  It is straight up killing us.

[sas5814]

You are correct. When you are trying to educate people who don't know much about us the "assistant" is always the elephant in the room. It is a high hurdle to clear.

I don't know any more than anyone else but, based on my ongoing straw poll, we are going to have spent 2 years and a million dollars to move all the was from "assistant" to "associate". It seems we collectively lack the stomach for a bold move. Just a guess.

[dfw6er]

History has taught, time and again, that the NPs are the enemy of the PA profession.  Look at Mississippi back in the 90s (I believe)....they had legislation passed saying MLPs could only prescribe if they had a master's degree.  At the time all the NP programs were masters and only a few PA programs were.  It royally F*&K@% over the PA profession in that state.  

Now look at what they did in Florida.  They don't want any additional competition.  They're positioning themselves to be considered equal to physicians. 

Their lobby is bigger than the PA and physician lobby combined.  They can, and consistently do, outspend all other interest groups.  This bodes very poorly for the PA profession.  I'm quite concerned that the PA profession is already too far behind the NPs to ever catch up.....and will eventually be relegated to low paying positions in areas of the country few wish to live in.  

Time for y'all to get your crap together, kick AAPA and NCCPA in the butt, and collectively take a stand.  I plan to be a PA advocate after finishing residency, but I also realize that, depending on my working circumstances, the decision to employ PAs over NPs may not be mine to make.  Don't let the NPs continue to marginalize your profession. 

[VeryOldPA]

What does the NCCPA have to do with anything?

[Cideous]

8 minutes ago, VeryOldPA said:

What does the NCCPA have to do with anything?

They have been ACTIVELY fighting against our profession for years in the name of "protecting public health".  Go back to last year and you will see many threads about it.

[Cideous]

So my question is now....how long until PA's in Florida are replaced with NP's?  I can see a complete replacement in Urgent Care this year, and all new hires being NP's in Primary care going forward.

[VeryOldPA]

39 minutes ago, Cideous said:

They have been ACTIVELY fighting against our profession for years in the name of "protecting public health. Would you please Go back to last year and you will see many threads about it.

What did I miss? I have been a PA for 42 years and have never once seen the NCCPA actively do anything that could be considered “ Fighting against our profession” either actively or inactively. Would you please provide examples of when this has occurred?  

Edited March 14, 2020 by VeryOldPA

[Cideous]

12 minutes ago, VeryOldPA said:

What did I miss? I have been a PA for 42 years and have never once seen the NCCPA actively do anything that could be considered “ Fighting against our profession” either actively or inactively. Would you please provide examples of when this has occurred?  

You should pay closer attention then...

 

 

https://www.medpagetoday.com/meetingcoverage/aapa/65322

 

 

 

 

LAS VEGAS -- Grassroots efforts to increase physician assistant autonomy are being blocked by the certifying organization for PAs, a charge that ignited a firestorm at the American Academy of PAs conference here on Monday afternoon.

The conflagration began following an AAPA session on recertification, aka Maintenance of Certification.

States trying to advance bills to remove PA license restrictions were "blindsided" by National Commission on Certification of Physicians Assistants (NCCPA) lobbyists who, in some cases, destroyed years of work crafting legislation and educating legislators, charged Cameron Byers, PA-C, president of the Nevada Academy of Physicians Assistants........

 

 

 

Not so countered Dawn Morton- Rias, EdD, PA-C, president and CEO of NCCPA.

"NCCPA is not a membership organization. It is a certifying body ... We have to support initiatives that protect the public interest. To the extent that they are in line with what PAs want that's very nice, but that's secondary," she said. "We have a 40-year history of providing certification and recertification programs that are well-respected and well-accepted, not only by the medical community, but the public as well as the other stakeholders groups."

 

 

 

 

Like I said....working against us.

Edited March 14, 2020 by Cideous

[dfw6er]

18 minutes ago, VeryOldPA said:

What did I miss? I have been a PA for 42 years and have never once seen the NCCPA actively do anything that could be considered “ Fighting against our profession” either actively or inactively. Would you please provide examples of when this has occurred?  

https://www.physicianassistantforum.com/topic/42539-missiles-launched-at-nccpa/

[dfw6er]

The NCCPA is self-serving first and foremost.  

[PAinPenna]

1 hour ago, dfw6er said:

Time for y'all to get your crap together, kick AAPA and NCCPA in the butt, and collectively take a stand.  I plan to be a PA advocate after finishing residency, but I also realize that, depending on my working circumstances, the decision to employ PAs over NPs may not be mine to make.  Don't let the NPs continue to marginalize your profession. 

This may be way off base but here goes- 

The docs I have worked with during my entire career have voiced they prefer working with PAs over NPs . This said- what are the chances of Physicians and PAs working and lobbying TOGETHER to stop the NPs from taking all the jobs in medicine? First step would be to STOP agreeing to train our replacements. Tell your big health care corporation your schedule "does not allow" for an NP to follow you around for a few hours per week when s/he feels like it.  Additionally, what about PR campaigns that educate patients and lawmakers the value of MEDICAL training over nursing training.? Yes- I realize this has been done with all the MD/DO vs NP charts floating around but we can create strength in numbers if we work together to promote MEDICALLY trained providers when it comes to filling positions. Look- I truly believe there is room for all of us (Physicians and PAs) - this does not need to be a turf war that divides us . Make no mistake , I am not saying we should not move forward , change our horrible name, and eliminate stupid legislation like 100% chart countersignature requirements that makes it harder to onboard a PA.  All of this stuff would make it EASIER to hire a PA- So hear my message all you Docs out there-  ADVOCATE for legislation that makes this happen even if you cannot make hiring decisions, enabling our two professions to work collaboratively while keeping NPs from taking our very hard -earned positions. 

[kang1208]

I really felt like we have been "betrayed" and being "thrown under the bus" in a sense after this Florida event. I am afraid it will soon happen to all the states in the US and we will be "supervised by MD/DO AND NPs". Not only there will be little/no jobs for PAs, we may be "extinct" as a profession.

[Cideous]

4 minutes ago, kang1208 said:

I really felt like we have been "betrayed" and being "thrown under the bus" in a sense after this Florida event. I am afraid it will soon happen to all the states in the US and we will be "supervised by MD/DO AND NPs". Not only there will be little/no jobs for PAs, we may be "extinct" as a profession.

Look for California to do this next.  They were VERY close the last few years, but with the current health crisis going on, NP's will finally push it over the finish line in the most populous state.  I have been predicting this and now that FL is moving forward, the NP's in California can point to it when lobbying.  Once Cal goes ...it's game over.

[kang1208]

What can we do now to prevent California from happening the same fate?

[LT_Oneal_PAC]

38 minutes ago, kang1208 said:

What can we do now to prevent California from happening the same fate?

Change the name. Start asking for autonomy now. Get new lobbyist that are willing to push.

[ventana]

FIRE the lobbyist

get FL PA to all send in $25/month each

 

hire a great lobbying firm that DOES NOT WORK FOR ANY OTHER MEDICAL PEOPLE

 

DRILL it into the elected officials what we are

 

yup costs money and time but it is worth it 

[roundabout]

17 hours ago, ventana said:

FIRE the lobbyist

get FL PA to all send in $25/month each

 

hire a great lobbying firm that DOES NOT WORK FOR ANY OTHER MEDICAL PEOPLE

 

DRILL it into the elected officials what we are

 

yup costs money and time but it is worth it 

I agree that this is the best way. You either spend the money now to make a huge push and hire a lobbying firm or sit back and wait and there won’t be anything to push for. 
 

Involvement by PA’s, PA-S and pre-pa’s needs to be talked about too. The amount of people involved is important and there is probably a lot more fire power out there in way of donations, dues, and out right activists than what we are currently tapping into. 

Edited March 15, 2020 by johncfl