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

[LT_Oneal_PAC]

1 hour ago, ohiovolffemtp said:

8 beds, but when we're full, we open up 4 rooms used for exams by consultant physicians who come to the CAH on certain days of the week.  Assuming no "family plans", we can room 12 patients (and do so about 1/month).  However, usually during these time we do have "family plans" and have ~15 patients on the board.  Wait times go up, because even with deferred charting, it's hard to get more than 4 patients dispo'd/hour, and only can hit that if there's a fair number of ESI 4's in the mix.

We have 3 regular rooms and two trauma beds. We are actually adjacent to FM clinic, so we open that up when needed, which is pretty much daily. Sounds like we are much slower than you, so I’m not juggling as many ED patients, but we have to cover the floor too and round. It’s horrible having a patient doing poor on bipap on the floor and you have 3-4 ED patients waiting. With 1-2 nurses, one LPN, 2 paramedics who also cover EMS in the hospital.

[ANESMCR]

3 hours ago, mcclane said:

It's a post-MD SDN-like trash forum for people who just now realized they are trapped in a 7+ year pyramid scheme designed to funnel cash into attendings.

Hilarious

[Joelseff]

 

I just clicked on that link and.... [emoji15] Wow.... Just wow.... I thought the huddle was bad...

Sent from my SM-G975U using Tapatalk

[PACali]

On 7/26/2020 at 11:24 AM, ScullyAMA said:

I wanted to jump in on this convo and say how disheartening reading all of this is. I'm also an HM hoping to be PA @HMtoPA. I appreciate you making a point to discern between md & pa.

I have to say, these threads end up on reddit, specifically r/residency (as @ANESMCR pointed out), and on #midlevelrant, and it really has made me think twice, even thrice, about choosing to pursue the PA route. It just seems like there is no solidarity in the PA community, and it makes it easy for NPs and MDs to gang up and even dismiss PAs as a whole. I'm not sure what I'm looking to gain out of saying this, but it stinks to feel this way when I really should be so excited to jump in and get to work.

Go out to meet real people. You can get some good information on the forum but also a lot of distorted, anecdotal information. I mean do you make important life decisions just by reading the social medial? what you see on TV? I hope not. 

 

On 7/26/2020 at 4:27 PM, ScullyAMA said:

 But I think it is worth noting how the rhetoric effects current PAs and PA hopefuls. Who wants to go into a volatile field? Who wants to go into an environment where they know they'll be hated? What I really look for in mentors is consistency, dedication, and reassurance. You know, leadership. And the fact that there is so much infighting is concerning. IDK.

I know there are doctors be hated, nurses as well. It all depends. No one is going to hate you just because you are a PA. I been a PA for 10 years and I enjoy it. Is it always sunshine and rainbow? of course not. You will not find a job like that. Again, my advice is to go out and meet real people. People get nasty behind the keyboards for some reason lol. 

[ScullyAMA]

10 hours ago, PACali said:

Go out to meet real people. You can get some good information on the forum but also a lot of distorted, anecdotal information. 

This is why I think in life (in person or otherwise), we should all be thoughtful in how we speak and behave. I'm excited to get to work (at some point) and am looking forward to some semblance of cohesion and comradarie, somethings that I miss from my military days

[LT_Oneal_PAC]

2 hours ago, ScullyAMA said:

This is why I think in life (in person or otherwise), we should all be thoughtful in how we speak and behave. I'm excited to get to work (at some point) and am looking forward to some semblance of cohesion and comradarie, somethings that I miss from my military days

Yeah, I hate to bust your bubble on that one, but it’s tough to find that again regardless. Took a long time for me to find even a semblance of it.

[EMEDPA]

Took me a while to understand that "happiness at work" is just as important as almost anything else. Certainly more important than money. I could have a job at which I (literally) walked to work for more $/hr than I make now, but I would hate every min of the low acuity BS and lack of fulfillment. fast track type position. 4-5/hr for eternity. 

33 yrs in EM now and I have 4 jobs, all of which would be a great stand-alone job, but doing them all offers a lot of fun variety:

primary job (last 7 years): 5 bed ED. medics across the parking lot for occ back up

part time job(last 13 years): 17 beds. double coverage with doc. we alternate charts. this is the one the "why I love rural EM" thread was created for. 

Per diem 1 (most rural) last 18 months. 7 beds. solo coverage

Per diem 2 5 months. 9 beds. double coverage. alternate charts.

[EMEDPA]

7 hours ago, LT_Oneal_PAC said:

Yeah, I hate to bust your bubble on that one, but it’s tough to find that again regardless. Took a long time for me to find even a semblance of it.

I think part of the secret is bringing it with you. Treat your colleagues with respect. Find your people.  Do things with them outside of work. Build a network of friends wherever you go. I still keep in contact with and see folks from work connections at places I have not worked for years. I think EM draws a certain type of personality, so we bond well. I have never met you face to face , but I am sure we could grab dinner and a drink and have a great conversation from day 1 if you moved to my part of the world. I have met a few folks from the Forum at cme events , Like True Anomaly, Medic25, Boatswain, Kargiver, etc,  and we bonded pretty quickly, despite political differences, etc. 

[TexasPA28]

On 7/26/2020 at 4:03 PM, HMtoPA said:

 

My point isn't that PAs can't or aren't practicing at a high level. But I know EM docs and trauma surgeons with 30-40 years of practice under their belt with more humility than I saw displayed in that post. There's a reason it ended up as a screen grab on Reddit (clue: it sounded a bit ridiculous).

Sorry I'm not going to bow down to the MDs.  I know more than most of them in my field, period.  I can do more than most of them in my field, period.  I have met many, many PAs in fields like EM, primary care, gen surg, vascular surg, anesthesiology who were BETTER than the MDs who were supposedly "supervising" them.

You need to read the bio of the first link that emedpa posted.  That guy is a PA but he's also a *******surgeon.  

Here's a listing of some of his job duties:

Quote

His duties as lead surgeon include performing and teaching the intraoperative evaluation, cardiac dissection and cannulation for perfusion of lung allografts, and performing the en-bloc pneumonectomy.

 

[MediMike]

7 hours ago, TexasPA28 said:

Sorry I'm not going to bow down to the MDs.  I know more than most of them in my field, period.  I can do more than most of them in my field, period.  I have met many, many PAs in fields like EM, primary care, gen surg, vascular surg, anesthesiology who were BETTER than the MDs who were supposedly "supervising" them.

You need to read the bio of the first link that emedpa posted.  That guy is a PA but he's also a ****** surgeon.  

Here's a listing of some of his job duties:

 

What is your field? And where are you finding a bunch of PAs who are in anesthesia and better than the anesthesiologists? And who are these PAs in surgical fields who are supposedly better at performing surgery than... surgeons?

You want to talk N's, I guarantee you that for every PA that is amazing and outstandingly fantastic, on par with their board certified colleagues in their respective specialties, there are a vast number who don't even come close.

Nobody is asking you to bow down to physicians, but to dismiss their expertise in their fields is arrogant and ridiculous.

 

[ventana]

7 hours ago, TexasPA28 said:

Sorry I'm not going to bow down to the MDs.  I know more than most of them in my field, period.  I can do more than most of them in my field, period.  I have met many, many PAs in fields like EM, primary care, gen surg, vascular surg, anesthesiology who were BETTER than the MDs who were supposedly "supervising" them.

You need to read the bio of the first link that emedpa posted.  That guy is a PA but he's also a ***** surgeon.  

Here's a listing of some of his job duties:

 

 

lets tone down the rhetoric

 

 

[LT_Oneal_PAC]

12 hours ago, TexasPA28 said:

Sorry I'm not going to bow down to the MDs.  I know more than most of them in my field, period.  I can do more than most of them in my field, period.  I have met many, many PAs in fields like EM, primary care, gen surg, vascular surg, anesthesiology who were BETTER than the MDs who were supposedly "supervising" them.

You need to read the bio of the first link that emedpa posted.  That guy is a PA but he's also a *******surgeon.  

Here's a listing of some of his job duties:

 

Yeah, buddy. I’m with you that PAs can be just at great, but we don’t have to sacrifice humility. Your message is getting lost in the tone. Plus you’re saying that you’ve met many PAs in anesthesiology, which just can’t be true.

Most MDs I meet in person are excellent, and further, they don’t care about PAs doing whatever they are capable of doing.

[Cideous]

On 4/3/2020 at 4:06 PM, Cideous said:

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.

 

 

 

I posted this back in April...I think it's still relevant and even more so now.  

[Malik144]

2 hours ago, Cideous said:

 

 

 

I posted this back in April...I think it's still relevant and even more so now.  

I would still agree that NP's/ Nurses don't really need our contribution. If you ignore the different models of training as well as the legality of calling a PA a Nurse of any kind. We're still left with 3+ million nurses, governed by their own board and already gaining autonomy without assistance from us. Not to mention the hostility that would probably be very noticeable from experienced PA's, probably doesn't excite them too much.

The lack of medical school residencies as well as the continued number of PA program opening each year, show a 31% rise of PA's accompanied by the normal Physician Shortage. NP's however, have done what Medical schools should have done years ago, they have effectively made becoming a provider non-class restricted. Community colleges were created for that exact purpose, you don't have to be rich or know exactly what you want to do in order to educate yourself. Nurses have used it to beautifully and steadily increase their numbers. The rate of increase for  NP's is estimated at 66% and they're at about 300k, with PA's at 140k and Physicians at 950k.

Although PA numbers are increasing, it can't compete with NP's, and Physicians have been losing this battle for almost a decade at this point. We could essentially call this a war of nutrition, all NP's have to do is wait us all out. Healthcare is a business unfortunately and who would you hire, the experienced PA that needs an SP or an Experienced RN that needs no oversight at the same price. Hell Physicians are so scared that they are writing books that are the equivalent to untold resident caused horror stories, told in the form of NP'S and PA's. (Charming read..... linked below)

https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/ref=sr_1_2?crid=2251VV9GUMU7X&dchild=1&keywords=patients+at+risk&qid=1606251424&sprefix=Patients+a%2Caps%2C155&sr=8-2

AMA and the AANP are basically at war. The AAPA is young and smaller but also too effective to be considered neutral by either. Logistically speaking the only leg Physicians are standing on is that they improve patient care and are more experienced. Stats show that if anything the numbers dictate no change in care, but that PA/NP's are more favored by patients because they listen more.

Physician's ( obviously not all) are too proud to admit it, but they're too expensive to train and haven't definitively proven they are essential to giving positive outcomes. The only people who would benefit from absorbing PA's are Physicians, adding to their numbers and increasing positive Physician trend statistics, effectively making the statistics, "who gives better care the Medical model or the Nursing model." I would imagine this is unlikely too since they still seem to barely tolerate DO's lol.

[Cideous]

4 minutes ago, Malik144 said:

I would still agree that NP's/ Nurses don't really need our contribution. If you ignore the different models of training as well as the legality of calling a PA a Nurse of any kind. We're still left with 3+ million nurses, governed by their own board and already gaining autonomy without assistance from us. Not to mention the hostility that would probably be very noticeable from experienced PA's, probably doesn't excite them too much.

The lack of medical school residencies as well as the continued number of PA program opening each year, show a 31% rise of PA's accompanied by the normal Physician Shortage. NP's however, have done what Medical schools should have done years ago, they have effectively made becoming a provider non-class restricted. Community colleges were created for that exact purpose, you don't have to be rich or know exactly what you want to do in order to educate yourself. Nurses have used it to beautifully and steadily increase their numbers. The rate of increase for  NP's is estimated at 66% and they're at about 300k, with PA's at 140k and Physicians at 950k.

Although PA numbers are increasing, it can't compete with NP's, and Physicians have been losing this battle for almost a decade at this point. We could essentially call this a war of nutrition, all NP's have to do is wait us all out. Healthcare is a business unfortunately and who would you hire, the experienced PA that needs an SP or an Experienced RN that needs no oversight at the same price. Hell Physicians are so scared that they are writing books that are the equivalent to untold resident caused horror stories, told in the form of NP'S and PA's. (Charming read..... linked below)

https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/ref=sr_1_2?crid=2251VV9GUMU7X&dchild=1&keywords=patients+at+risk&qid=1606251424&sprefix=Patients+a%2Caps%2C155&sr=8-2

AMA and the AANP are basically at war. The AAPA is young and smaller but also too effective to be considered neutral by either. Logistically speaking the only leg Physicians are standing on is that they improve patient care and are more experienced. Stats show that if anything the numbers dictate no change in care, but that PA/NP's are more favored by patients because they listen more.

Physician's ( obviously not all) are too proud to admit it, but they're too expensive to train and haven't definitively proven they are essential to giving positive outcomes. The only people who would benefit from absorbing PA's are Physicians, adding to their numbers and increasing positive Physician trend statistics, effectively making the statistics, "who gives better care the Medical model or the Nursing model." I would imagine this is unlikely too since they still seem to barely tolerate DO's lol.

 

What a great response and reply.  Well written and for the most part I agree.