Merging fields with Nurse Practitioners.....It's time.

[Cideous]

I know...provocative.  But is it?  Just like me suggesting to change our name to Medical Practitioners almost 10 years ago.  Most laughed.  Now most see our name is professionally killing us and know it needs to change.

Merging fields would:

-Instantly cover us in their 30+ state autonomy successes (OTP as laughable as it is can finally die a horrible death), something our leaders have been completely inept at implementing.

-I would happily take their national certification exam in exchange for no more long term certification testing.  I would personally send a letter to the former NCCPA and tell them to kiss my ass.

-NP's would benefit by adding hundreds of thousands to their ranks and we could all finally work together instead of against each other.

 

The question is simply this....do we start working on this merger now while we still have a little strength?  Or do we wait for our field to be absolutely gutted by legislative loss after loss and then crawl to NP's begging for their table scraps.

 

Think about it.

Edited April 3, 2020 by Cideous

[Reality Check 2]

I would go for this ONLY if the degree creep stops.

No more required Doctorates - no more Doctorates are better than you.

Could we have ONE educational oversight body to ensure that training is legitimate and similar in length, depth, breadth of knowledge and skills?

Could we curtail all the new blooming let's make money PA programs that keep cropping up? 

Does this mean that NPs would enter fields they previously have mostly avoided such as Ortho and surgical fields? Would that hurt PAs? 

What about the nursing lobby that smothers PAs now with their vast membership? Would the new alliance sever the NPs from the nursing lobby - since we would all be Practicing Medicine together - not nursing?

I am sure more things will come to mind.....

 

[rev ronin]

Why on earth would the NPs consent to something like that?

[jfmDNP]

Back in the 1960s in California, the state medical association offered DOs the opportunity to obtain their MD degree for a nominal fee of $65 and attending a seminar. The majority of DOs made the switch. This was the states's effort to end the practice of osteopathic medicine in the state. Now DOs continue to thrive in California and all throughout the country, gaining parity with their MD counterparts. As a DNP (and yes, patients, staff and my physician colleagues do refer to me as doctor, with my credentials fully visible on my lab coat/fleece jacket) and having been a preceptor for MD, NP and PA students, I appreciate the history of each profession and the role they play in providing care for millions of Americans to the fullest level of their training and capabilities. 

I definitely appreciate the role of PAs and I believe it is important to embrace that role to its fullest, as I have for my own profession. In regards to the degree of independence of PAs in each state, grassroots movements will certainly help advance that cause. The strength and voice of NP organizations, at the state and national level, have certainly helped us advance and it's only a matter of a few more years that NPs will be independent in every state. 

Regarding taking the NP certification, training is specialty focused (family, pediatrics, adults-geriatrics, women's health, acute care, emergency, mental health). PA training encompasses aspects of all these specialties (just like at the RN level, students rotate in different specialties before doing specialized rotations as NP students). If anything, you might be able to take the family NP certification due to its breadth as PAs. And just to clarify, NPs need to recertify. However, they may decide between retaking the boards each recertification period or present a certain number of CME units in their specialty plus pharmacology units. But regarding merging, should that really be what needs to happen or should the entire PA community continue to work in unison to advance the profession, regardless of the challenges and length of time it may take?

Edited April 4, 2020 by jfmDNP

[sam619]

To be a nurse practitioner you have to be a NURSE, and embody the nursing approach to diagnosis and treatment. 

[iconic]

Too many backward thinking PAs would be against this

[ProSpectre]

I disagree. I'm a new PA, I'm proud of the training I received, and I'm proud of the direction the PA profession is heading. There has been a lot of small, incremental progress over the years, albeit much less than that of NPs. I think that in general, PA training is the stronger model, and I would like to keep the standards of our training high, something that wouldn't be guaranteed if some kind of merger ever happened.

NP programs range from strong brick and mortar programs that require applicants to have RN experience, find rotations for their students, and go well above the minimum clinical hour requirements, to programs with 100% acceptance rates (seriously) that don't require any RN experience, make students find their own rotations, and only require the bare minimum clinical hour requirements. The degree of variability is where the weakness lies. Over the last few years, I have heard quite a few physicians, PAs, and NPs comment on the degraded standards within NP education and the poor product many schools are churning out. When I was in PA school, I even had 3 separate rotation sites tell me they stopped taking NP students altogether due to this recent drop in quality. Physicians often express preference for PAs as well. 

I appreciate the NPs I work with and think many of them are great clinicians, but frankly I would much rather that PAs continue to push for parity with NPs and ride this wave of increased interest in OTP and title change until we get the practice parity PAs deserve. 

[Meddeb]

Thank you, thank you, and thank you for affirming my thoughts, wishes, and vision for the direction we should be moving in. This is truly the path WE as PAs should be taking. Forget about PA vs NP because at the end of the day, we are both Advanced Practice Providers or as you stated, Medical Practitioners. How do we make this happen? How do we facilitate change? I lay awake at night thinking about this movement and how it would change the landscape across the nation. We need to unite on this at every level...

[ANESMCR]

6 hours ago, jfmDNP said:

PA training encompasses aspects of all these specialties (just like at the RN level, students rotate in different specialties before doing specialized rotations as NP students). If anything, you might be able to take the family NP certification due to its breadth as PAs.

 

6 hours ago, jfmDNP said:

And just to clarify, NPs need to recertify. However, they may decide between retaking the boards each recertification period or present a certain number of CME units in their specialty plus pharmacology units. 

Aka don’t need to take national certifying exams anymore, as implied. We are required to have more CME and still retake boards.

 

I’m with Rev. They would never go for this. They want to be called “Doctors”. No. Thanks. I’d rather sink with the ship or claw our way out than sell ourselves as NPs. We’re not, we are statistically higher trained providers on the medical model without the recognition. 

Edited April 4, 2020 by ANESMCR

[DiggySRNA]

As a RN (who was previously a Pre-PA before entering nursing)....and with working alongside a large amount of RNs and NPs...who also witnessed how RN and NP faculty view PAs.....this will never happen. ever. won't even be a thought.

I had to hold my tongue a few times during RN school because yes...My future depended on it.

[jfmDNP]

It's interesting how when you look at other places where medical students and physicians express their discontent, you frequently see posts with sentiments that are strongly against both NPs/PAs. In yet another milieu, you see posts after posts of PAs bashing NPs. You look at similar nursing sites and these sentiments strongly opposing another profession are essentially bare in numbers. The nursing profession has been in existence much longer than that of the PA profession and the founder of modern nursing, Florence Nightingale, used medical statistics in infection control in hospitals and the battlefields, established guidelines for health care reform and influenced the design of modern hospitals. The fact that nurses and APRNs concern themselves just with their profession is one of the reasons it's been as successful as it has been in advocating for themselves. Perhaps it will serve others well should they do the same. 

FYI: 5 more states (New York, New Jersey, Wisconsin, Louisiana and Kentucky) this week alone suspended state regulatory barriers to NP practice. More states will follow suit. 

I personally don't enjoy anecdotes, but alas, here is one. I worked in a practice where I was the only NP and the other non-physician providers were PAs. When one of the physicians was out on vacation, they only wanted me to see their patients; never the PAs. That particular MD seemed to always correct what the PAs were doing. Many times the PAs came to me for patient management advise. But again, this is anecdotal and experience and familiarity are always on your side when diagnosing. I've certainly worked with amazing MDs, NPs and PAs equally. 

And just because you've passed the PANCE, NP or medical boards it doesn't confer mastery, only proficiency. 

Edited April 4, 2020 by jfmDNP

[PAinPenna]

Am I the only one who is truly getting sick of this endless debate ? 
Yes - we are better trained but No - we are not nurses so will never transition to becoming NPs . 
if you want to be an NP - go the most direct route and jump on their bandwagon 

I’ve considered it but for now I’m much too needed in my current role . 
 

We are in the midst of a public health crisis like we’ve never known . Make yourselves useful and quit bitching about NPs all the time . 

Edited April 4, 2020 by PAinPenna

[turnedintoamartian]

We cannot easily merge because of the difference between medicine and nursing. We would have to learn “advanced nursing” or they would have to begin practicing medicine. 
 

They won’t be doing that because their ability to maintain distinct and separate boards is based on them being nurses. This is a big part of their independence in general.

[ANESMCR]

4 hours ago, jfmDNP said:

It's interesting how when you look at other places where medical students and physicians express their discontent, you frequently see posts with sentiments that are strongly against both NPs/PAs. In yet another milieu, you see posts after posts of PAs bashing NPs. You look at similar nursing sites and these sentiments strongly opposing another profession are essentially bare in numbers. The nursing profession has been in existence much longer than that of the PA profession and the founder of modern nursing, Florence Nightingale, used medical statistics in infection control in hospitals and the battlefields, established guidelines for health care reform and influenced the design of modern hospitals. The fact that nurses and APRNs concern themselves just with their profession is one of the reasons it's been as successful as it has been in advocating for themselves. Perhaps it will serve others well should they do the same. 

FYI: 5 more states (New York, New Jersey, Wisconsin, Louisiana and Kentucky) this week alone suspended state regulatory barriers to NP practice. More states will follow suit. 

I personally don't enjoy anecdotes, but alas, here is one. I worked in a practice where I was the only NP and the other non-physician providers were PAs. When one of the physicians was out on vacation, they only wanted me to see their patients; never the PAs. That particular MD seemed to always correct what the PAs were doing. Many times the PAs came to me for patient management advise. But again, this is anecdotal and experience and familiarity are always on your side when diagnosing. I've certainly worked with amazing MDs, NPs and PAs equally. 

And just because you've passed the PANCE, NP or medical boards it doesn't confer mastery, only proficiency. 

Tried giving you the benefit of doubt, believing/hoping you were going to add some sort of valuable insight after so nonchalantly comparing our training to BSN students. But I digress. I don’t find it threatening enough to go discuss it on an NP forum. Thanks...”Doc”.

Edited April 4, 2020 by ANESMCR

[PACali]

The only thing I like about being a NP is their full practice authority and responsibility aka FPAR. Other than that, I have no interest to become a nurse. I don't see any benefit join them other than for their FPAR. I don't think they would want to join us too. I think we are at a very important period of our profession in the mist during covid crisis. We need OTP/FPAR and a name change (Medical Care Practitioner). I think one of the area we need to focus our energy on is primary care. There is no reason we cannot practice independently in those settings. Many PAs are already practically running primary care office, urgent care, or even ED fast track on their own. 

Medical Care Practitioner vs Nurse Practitioner, who are you going to pick?

Edited April 4, 2020 by PACali

[EMEDPA]

2 hours ago, PACali said:

There is no reason we cannot practice independently in those settings. Many PAs are already practically running primary care office, urgent care, or even Main ED  on their own. 

 

fixed that for you.

[PACali]

4 hours ago, EMEDPA said:

fixed that for you.

Thank you. Sorry for the solo EMPAs. You are right, even when I managed main ED pt in an inner city ER, ER Physicians are only there for consultation purposes. No one is there to hold my hand. 

[TexasPA28]

2 hours ago, PACali said:

Thank you. Sorry for the solo EMPAs. You are right, even when I managed main ED pt in an inner city ER, ER Physicians are only there for consultation purposes. No one is there to hold my hand. 

You should tell them to fire the MDs.  MDs cost a shitload of money.  You can replace all of them with PAs and split the difference in the savings.

Mark my words in 20 years there won't be MDs in the ER anymore.  The writing is on the wall.

[PACali]

2 hours ago, TexasPA28 said:

You should tell them to fire the MDs.  MDs cost a shitload of money.  You can replace all of them with PAs and split the difference in the savings.

Mark my words in 20 years there won't be MDs in the ER anymore.  The writing is on the wall.

Main ED have different acuity of patients as well.  I am have no interest in replacing the MDs. They can have all the crashing neonate, difficult airways all they want. I don't see MD going away but I do see we won't need that many of them 20 year from now only IF the PA profession flourish. I am talking about OTP/FPAR and a name change. If our name is still physician's assistant or Physician's associate, there will always be a MD in the room, doesn't matter what specialty. Even in Education, there has to be a Medical director in a PA program.    

Edited April 5, 2020 by PACali

[bobuddy]

I am all for merging with NP's to have a unified profession.    Yes, they are nurses first -and yes, we do medical model training - but in the end, we are all doing the same job.   This arguing about being nurses first/us having medical training is no different than arguing over which school provides better training overall.  Some are better, some are worse.   NP's are just better at untethering themselves from the MD's and we are still stuck floundering in the muck.    There is no point in arguing about whose training is better or worse - because they are getting the jobs and the healthcare administrators (that do the actual hiring) don't seem to care about their training.     Think about it guys - there is no other profession -that I can think of -that LEGALLY tethers their job to a specific individual.  Even the guy at McDonalds making fries can go to his job the next day if the manager gets fired or dies.  Us - on the other hand - not so much.   

What would the NP's get?  They get the chance to have another 140k members to contribute to their PAC - literally overnight.    Many millions of additional dollars in their pocket.    

Many of us - myself included- are finding ourselves on the outside looking in as we get furloughed by our employers.   Private practice is gone and our collaborating physicians are just employees themselves.  They don't have a say in who gets hired anymore.    So this idea of practicing in a "team" is nice in theory but not happening in reality.    I am 53 years old  and have been practicing at the same clinic for 21 years.   All the NP's and PA's were furloughed at my clinic last week - about 100 of us.   My docs had ZERO input to whether or not I stayed working in the clinic.   If they have no voice, then we have no voice.    

Yes, I can go back to school for another three years to become an NP - but I am 53 years old and not wanting to take out loans to do what I have been doing for the past 21 years.    Too young and broke to retire (especially after the pandemic).   As a profession, we are at a crossroad of either making a BIG change  - or not - and watching our profession becoming obsolete.

[Cideous]

4 minutes ago, bobuddy said:

I am all for merging with NP's to have a unified profession.    Yes, they are nurses first -and yes, we do medical model training - but in the end, we are all doing the same job.   This arguing about being nurses first/us having medical training is no different than arguing over which school provides better training overall.  Some are better, some are worse.   NP's are just better at untethering themselves from the MD's and we are still stuck floundering in the muck.    There is no point in arguing about whose training is better or worse - because they are getting the jobs and the healthcare administrators (that do the actual hiring) don't seem to care about their training.     Think about it guys - there is no other profession -that I can think of -that LEGALLY tethers their job to a specific individual.  Even the guy at McDonalds making fries can go to his job the next day if the manager gets fired or dies.  Us - on the other hand - not so much.   

What would the NP's get?  They get the chance to have another 140k members to contribute to their PAC - literally overnight.    Many millions of additional dollars in their pocket.    

Many of us - myself included- are finding ourselves on the outside looking in as we get furloughed by our employers.   Private practice is gone and our collaborating physicians are just employees themselves.  They don't have a say in who gets hired anymore.    So this idea of practicing in a "team" is nice in theory but not happening in reality.    I am 53 years old  and have been practicing at the same clinic for 21 years.   All the NP's and PA's were furloughed at my clinic last week - about 100 of us.   My docs had ZERO input to whether or not I stayed working in the clinic.   If they have no voice, then we have no voice.    

Yes, I can go back to school for another three years to become an NP - but I am 53 years old and not wanting to take out loans to do what I have been doing for the past 21 years.    Too young and broke to retire (especially after the pandemic).   As a profession, we are at a crossroad of either making a BIG change  - or not - and watching our profession becoming obsolete.

^^^ This.

[bobuddy]

So, the question is - how do we make this happen?    Do we do this state by state?    Nationally?    

 

Those of you who do not want to do this - that is fine.   But, lets talk about this for those that would like to pursue  this idea.

This is what I see as a potential merge: 

We are all licensed under the new board - lets use the NP board since they are already apart from the MD's.   We all pay dues to them each year to maintain licensing.   Yes, you can complain all  you want but the level of apathy among the PA's and their state organizations shows us exactly what happens when you choose to be complacent.   If you don't like what the board is doing, you can run for a board position to make changes. 

All schools can stay the same  but they can come together on a more cohesive curriculum - are you a nurse? Fine - do your same nursing education from BSN - to MSN.  If you are in PA school - since we start with a BS anyways - we stay the same.  Then we each sit for the same boards and come out with a APP or MCP title.  

We re-board every 10 years to be on par with MD's - just like PA's do now.    CME is the same as PA's take now ( although I am sure the NP's would fight these).    

The NP's would not have to "specialize" in FP or Womens Health or psychiatry - they would be generalists also.   So, they can float between specialties just like we do.    

No supervision/collaboration tied to any person or profession.   This would be no different than nurses/RT/PT/OT etc.  Yes, we would continue to have people lead us and that we report to ( Attendings, etc) - but this "legally tethered" wording has to go.  If we all came together as a group - we could get this done in a timely fashion - whether at the state level or at the national level.

Anyone that is already working/graduated - automatically grandfathered in

Any additional thoughts?    

Edited April 5, 2020 by bobuddy
content

[TexasPA28]

10 hours ago, PACali said:

Main ED have different acuity of patients as well.  I am have no interest in replacing the MDs. They can have all the crashing neonate, difficult airways all they want. I don't see MD going away but I do see we won't need that many of them 20 year from now only IF the PA profession flourish. I am talking about OTP/FPAR and a name change. If our name is still physician's assistant or Physician's associate, there will always be a MD in the room, doesn't matter what specialty. Even in Education, there has to be a Medical director in a PA program.    

I can do crashing neonates and difficult airways just as well if not better than the MDs can.

PAs have proven time and time again that they can run all the different types of situations that occur in an ER, including major trauma without MD involvement.  Hell there are major ERs in urban Chicago, New York, Los Angeles that are run 100% by PAs RIGHT NOW with no MD involvement.  

The days of ER PAs only working in rural areas is over.  We can run ERs in major level 1 trauma centers with no MD involvement.  We've got the skills.

MDs provide nothing that we cant already do.  All they do is eat up unnecessary paycheck.  Like I said, eventually hospitals are going to figure out that it's stupid to pay ER docs 400k to sit around and do nothing while the PAs are doing all the work, and doing it better than the MDs can.

[bobuddy]

6 minutes ago, TexasPA28 said:

I can do crashing neonates and difficult airways just as well if not better than the MDs can.

PAs have proven time and time again that they can run all the different types of situations that occur in an ER, including major trauma without MD involvement.  Hell there are major ERs in urban Chicago, New York, Los Angeles that are run 100% by PAs RIGHT NOW with no MD involvement.  

The days of ER PAs only working in rural areas is over.  We can run ERs in major level 1 trauma centers with no MD involvement.  We've got the skills.

MDs provide nothing that we cant already do.  All they do is eat up unnecessary paycheck.  Like I said, eventually hospitals are going to figure out that it's stupid to pay ER docs 400k to sit around and do nothing while the PAs are doing all the work, and doing it better than the MDs can.

Excellent points - and I can also state that after 21 years in the FP clinic, I can manage diabetes and hypertension along with the other diseases that we see on a regular basis - just as well as my counterparts.    

However, we are still legally tied to these MD's that you are proposing that the hospitals do away with.    So, asking them to do away with MD's and replace them with us, is not legally possible.     Hence - see my above post.   

Edited April 5, 2020 by bobuddy
content

[jmj11]

On 4/3/2020 at 4:45 PM, rev ronin said:

Why on earth would the NPs consent to something like that?

I agree. Since they have chosen to go ahead of us in promoting their profession, they have nothing to gain, only to loose by merging with us.