The Perfect Storm is coming....

[Cideous]

Last night I was left pondering many of the threads on this board.  Threads about PA's losing jobs to NP's or not being able to interview for "NP" only positions.  Huge numbers of PA's being furloughed or simply flat out fired.  We all know that NP's have been beating us like a cheap drum legislatively for years, and we also know that since CV-19 appeared they have stepped up their legislative game immensely.  Meeting with the president!? Mercy.  PA's have been left in the, "Hey governments!  What about us!?" mode.  Disturbing and somewhat pathetic.  NP's at this time are done educating the public and legislators about who they are and what they do, they have moved on to passing autonomy laws while we keep screaming...what about us?  

Someone in this profession has to be the squeaky wheel.  PA's, for as long as I have been one, have always been passively submissive. To the point of being codependent enablers of our abusers.  Admins, docs, corporate overlords and even nurses.  We as a field just seem to "want to fit in and get along".  So what do I see happening in the next 12-18 months if we don't change immediately...?

1.  NP's will get and retain full autonomy in California.  This will decimate jobs for new and new'ish PA's trying to get their foot in the door there.

2.  NP's in Florida will continue to win full autonomy victories pushing aside all requirements for supervision.  PA's will be replaced.

3.  Successful PA's will be those who already have long standing personal relationships with their job, a doc who will fight for them to stay on and those that are willing to take a pay cut.

4.  Texas (TAPA)and a handful of other states will continue to fight against ANY full autonomy parity with NP's and will torpedo any national push to do so resulting in terminal stagnation.

5.  New PA's will begin to look at starting a crossover bridge program that would allow them to leverage their PA degree into an NP degree.  If NP's are paid enough, they will allow it. Similar to the PA-DO bridge.

6.  PA schools will begin to close, starting with the private ungodly expensive ones ending with reduced class size for the good old state school PA programs.  Leaving many PA students stuck with a "DeVry institute of Technology" worthless degree and thousands in debt.

7.  When practices, hospital systems and large medical investor driven medical corporations start to bring back providers, it will be the perfect excuse and time to bring on only NP's citing their lack of required supervision as a main factor.  All previous contracts will be null and void with CV-19 used as their perfect excuse.  The one exception will be those PA's in sub-specialties like surgery that NP's do not have a foothold in.....yet.

8.  Those of us closer to the end will retire while those PA's at the beginning and in the middle will struggle to find jobs, pay their school loan debt and start a life.

9.  Administrators and Corporatists will use CV-19 as an excuse to justify a semi-permanent roll back of salary, benefits, CME money, licensure reimbursement and PTO amounts for those PA's they do hire.  Take it or leave it will be the phrase of the day.  

 

A grim outlook I know, and I take no pleasure in this post.  Can it be averted?  No, but maybe blunted, delayed and slowly if we do everything right starting right now maybe we can claw back some of the ground we have lost.

Recommendations:

a.  Every PA program must immediately start creating politically active PA students.  Require a legislative class to be taught in every PA school on how to get involved in the upcoming fight for our professional lives.

b. Require EVERY PA in this country to join a PA owned, PA ran, Political Action Committee with full PA ONLY lobbying efforts.  No more "volunteer" crap.  If you want to be a PA or stay a PA then you have to contribute.  It's all hands on deck folks and a $100 per year due will not kill any of us but would raise upwards of 14 million per year to lobby with.

c. Our PA only PAC will push for one thing in every state...A form of full measured Autonomy.  No more supervising physician required if certain training parameters are met.  Obviously some fields would be exempt i.e. a PA could not start performing surgery unaccompanied but she/he would not need a "supervising physician" to sign off on him or be registered with the state.

d. PA's PAC would push for full Medicare and Insurance reimbursement.

e. WE CHANGE OUR NAME IMMEDIATELY TO MEDICAL CARE PRACTITIONER!  Arguably the most important change needed and we need it yesterday.

f.  Any state organizations (looking at you TAPA) that do not support this aggressive PRO-PA agenda will loose all funding and backing of the new SuperPac.  Either lead....follow....or get the F out of the way state organizations.  We are DONE apologizing as a Profession.

 

The time for a seismic shift is now.  Not tomorrow or next year....NOW.    If we don't, I believe a great number of PA's waiting for that post furlough phone call to come back to work...will never get it.  Their job will be filled by an NP or just eliminated altogether.

Good luck to us all.

[VeryOldPA]

Cideous , FYI money donated to PACs can not be used  for lobbying expenses.  The funds are restricted for donations to campaign donations to candidates for office. 

[FallenFruit]

So if the future is dim..... and I wanted to go back to school (after being a PA for 4 years, currently unemployed due to COVID, previously in ped card subspecialty), what would you suggest with a PA background? Is RN the only option? What other lateral movement within the field of medicine is there?

[Hope2PA]

1 hour ago, FallenFruit said:

So if the future is dim..... and I wanted to go back to school (after being a PA for 4 years, currently unemployed due to COVID, previously in ped card subspecialty), what would you suggest with a PA background? Is RN the only option? What other lateral movement within the field of medicine is there?

The profession is not dead, it needs reviving, renaming/branding and staged independence. Another option would be to not give up, but instead, really get in the thick of being involved in state and federal advocacy. Demand those that want to hold you back get out of leadership positions and fight for a better future. Joesleff told me to not look back but work toward future. Make no mistake it will take work. 

[bobuddy]

Cideous - I agree with your post.    

I am the current President of KAPA - and have been on the board for 5 years.   In KY we have less than 10% membership to KAPA and struggle to do the basic things - like pay a lobbyist.    This past year, we were finally successful in getting privileges for prescribing controlled medications but only III-V.  We were the last state to get CS prescriptions and it took us over 10 years to accomplish this.     

Eight years ago, our rural private practice joined with a larger corporate clinic in a larger city.    I saw the writing on the wall with our profession at that time and looked into going back to school for the NP.     I could not justify the cost and the time away from the job (making a paycheck) to do exactly what I was already doing.    I chose to join the board of KAPA to see how to make a difference.  

I was furloughed several weeks ago along with about 100 other APP's at our clinic.   There is no time limit on the furlough ending and all other job leads have dried up.    I am even having trouble finding places to work that are in the thick of COVID - they want nurses but not APP's.    At least the NP's can fall back on nursing jobs.   I am at a crossroads of what to do/where to go from here.   I am currently back to researching taking a year off - doing an accelerated second degree BSN and then working as a PA (if I can find a job) while doing online NP degree.      I am 53 years old - too young to retire, too old to go to medical school and take on a ridiculous amount of debt.    

 

[rev ronin]

36 minutes ago, bobuddy said:

Cideous - I agree with your post.    

I am the current President of KAPA - and have been on the board for 5 years.   In KY we have less than 10% membership to KAPA and struggle to do the basic things - like pay a lobbyist.    This past year, we were finally successful in getting privileges for prescribing controlled medications but only III-V.  We were the last state to get CS prescriptions and it took us over 10 years to accomplish this.     

Eight years ago, our rural private practice joined with a larger corporate clinic in a larger city.    I saw the writing on the wall with our profession at that time and looked into going back to school for the NP.     I could not justify the cost and the time away from the job (making a paycheck) to do exactly what I was already doing.    I chose to join the board of KAPA to see how to make a difference.  

I was furloughed several weeks ago along with about 100 other APP's at our clinic.   There is no time limit on the furlough ending and all other job leads have dried up.    I am even having trouble finding places to work that are in the thick of COVID - they want nurses but not APP's.    At least the NP's can fall back on nursing jobs.   I am at a crossroads of what to do/where to go from here.   I am currently back to researching taking a year off - doing an accelerated second degree BSN and then working as a PA (if I can find a job) while doing online NP degree.      I am 53 years old - too young to retire, too old to go to medical school and take on a ridiculous amount of debt.   

To work at all in KY is astounding.  Thank you and the rest of KAPA board for fighting so hard in such a hostile environment; I doubt I would have lasted.

I'd definitely consider relocating before going back to NP school.

[mgriffiths]

1 hour ago, bobuddy said:

I am currently back to researching taking a year off - doing an accelerated second degree BSN and then working as a PA (if I can find a job) while doing online NP degree.

If I were to do that, and it's a possibility that I could see happening, I would 100% pursue CRNA.  My hospital is 100% CRNA, and they work incredibly easy schedules and make double my salary.

But, honestly, if I were to go back to school AGAIN...I would likely leave medicine altogether.  Not because I hate my job, but because I work too hard and as this covid mess has shown, medicine is NOT recession proof.

Edited April 15, 2020 by mgriffiths

[ANESMCR]

56 minutes ago, mgriffiths said:

But, honestly, if I were to go back to school AGAIN...I would likely leave medicine altogether.  Not because I hate my job, but because I work too hard and as this covid mess has shown, medicine is NOT recession proof.

100% agree with this.

[Cideous]

11 hours ago, bobuddy said:

Cideous - I agree with your post.    

I am the current President of KAPA - and have been on the board for 5 years.   In KY we have less than 10% membership to KAPA and struggle to do the basic things - like pay a lobbyist.    This past year, we were finally successful in getting privileges for prescribing controlled medications but only III-V.  We were the last state to get CS prescriptions and it took us over 10 years to accomplish this.     

Eight years ago, our rural private practice joined with a larger corporate clinic in a larger city.    I saw the writing on the wall with our profession at that time and looked into going back to school for the NP.     I could not justify the cost and the time away from the job (making a paycheck) to do exactly what I was already doing.    I chose to join the board of KAPA to see how to make a difference.  

I was furloughed several weeks ago along with about 100 other APP's at our clinic.   There is no time limit on the furlough ending and all other job leads have dried up.    I am even having trouble finding places to work that are in the thick of COVID - they want nurses but not APP's.    At least the NP's can fall back on nursing jobs.   I am at a crossroads of what to do/where to go from here.   I am currently back to researching taking a year off - doing an accelerated second degree BSN and then working as a PA (if I can find a job) while doing online NP degree.      I am 53 years old - too young to retire, too old to go to medical school and take on a ridiculous amount of debt.    

 

I'm very sorry to hear this, but not surprised.  Thank you for posting.

A mandatory membership lobbying organization could raise millions that could directly help a state like KY.

I stand by my post.

[bobuddy]

12 hours ago, rev ronin said:

To work at all in KY is astounding.  Thank you and the rest of KAPA board for fighting so hard in such a hostile environment; I doubt I would have lasted.

I'd definitely consider relocating before going back to NP school.

Yes, KY is a very hostile state to work.    We have the same roadblocks and excuses from our legislators year after year after year.   We obtained a new lobby group this year which helped tremendously but keeping them will be a challenge due to costs.    AAPA has been tremendous in helping us out with funds for the past two years - so very thankful for them and the work they have done.   

We have kicked around mandating KY PA's to belong to KAPA in order to maintain their license - we have run out of ideas to increase membership and combat apathy.   Maybe with many of us being furloughed, PA's will sit up and take notice when they try and find another job.    We get the same complaints from PA's - KAPA has done nothing for me.   We always tell them - YOU are KAPA - whether or not you are a member!    Then we have a conversation about how much lobby groups cost - and their eyes get wide and their jaw drops.     

I love my job and I love my patients.    But, yes, I am also thinking about getting out of medicine.   I am just not sure what is recession proof - besides driving a truck     Who would have thought we would all be losing our jobs in the middle of a healthcare crisis?    So much for being (or feeling) essential......

 

[rev ronin]

9 hours ago, Cideous said:

A mandatory membership lobbying organization

No such thing in the USA.  It'd be a first amendment violation.  If unions can't do it (they can't), then we couldn't make a PA organization who could do that either.

[GetMeOuttaThisMess]

8 hours ago, bobuddy said:

Yes, KY is a very hostile state to work.    We have the same roadblocks and excuses from our legislators year after year after year.   We obtained a new lobby group this year which helped tremendously but keeping them will be a challenge due to costs.    AAPA has been tremendous in helping us out with funds for the past two years - so very thankful for them and the work they have done.   

We have kicked around mandating KY PA's to belong to KAPA in order to maintain their license - we have run out of ideas to increase membership and combat apathy.   Maybe with many of us being furloughed, PA's will sit up and take notice when they try and find another job.    We get the same complaints from PA's - KAPA has done nothing for me.   We always tell them - YOU are KAPA - whether or not you are a member!    Then we have a conversation about how much lobby groups cost - and their eyes get wide and their jaw drops.     

I love my job and I love my patients.    But, yes, I am also thinking about getting out of medicine.   I am just not sure what is recession proof - besides driving a truck     Who would have thought we would all be losing our jobs in the middle of a healthcare crisis?    So much for being (or feeling) essential......

 

I'm not 100% certain on this.  My wife's state dental hygiene dues include a local chapter fee as well which is built in to the overall dues fee and is not optional.  If you don't join the state then you don't have to pay but the two do go hand in hand.

[BayPAC]

one of the best ways to stand out and make our profession well known by the population is to become the ones who can meet people's needs. Perhaps if we had primary care clinics ran by PAs, offering great services for great cost, community's recognition would follow. 

[ohiovolffemtp]

A couple of things I struggle with concerning memberships in state PA organizations:

• Most state organizations want you to be an AAPA member, so that's $295 to start
• I'm licensed in 3 states.  At $125-$175/state, that starts to get expensive.
• If I have to pick 1 state organization, should I pick the state where I live, or the state where I work the most?
• Should I join the state organization in a state where I'm licensed but not currently working?  (in this case KY, because of the restrictions bobuddy mentioned - though I did support their latest lobbying effort).
• How to deal with a state organization that has done a fair bit of good for the PA scope of practice in their state, but has also actively blocked efforts by other PA's to work with state legislators to improve things for PA's in the state.

[mgriffiths]

14 hours ago, BayPAC said:

one of the best ways to stand out and make our profession well known by the population is to become the ones who can meet people's needs. Perhaps if we had primary care clinics ran by PAs, offering great services for great cost, community's recognition would follow. 

Absolutely agree, but the problem with this is evil insurance companies who screw over small clinics and there is little to no legal recourse without going bankrupt in the process.  On top of that with decreased reimbursement and decreased revenue due to paying a physician to "join" the practice takes even more potential income.

[bobuddy]

13 hours ago, ohiovolffemtp said:

A couple of things I struggle with concerning memberships in state PA organizations:

• Most state organizations want you to be an AAPA member, so that's $295 to start
• I'm licensed in 3 states.  At $125-$175/state, that starts to get expensive.
• If I have to pick 1 state organization, should I pick the state where I live, or the state where I work the most?
• Should I join the state organization in a state where I'm licensed but not currently working?  (in this case KY, because of the restrictions bobuddy mentioned - though I did support their latest lobbying effort).
• How to deal with a state organization that has done a fair bit of good for the PA scope of practice in their state, but has also actively blocked efforts by other PA's to work with state legislators to improve things for PA's in the state.

Thank you for your support with KY -very appreciative!   

We do not require AAPA membership to be a part of KAPA - unless you are on the board - then, yes, it is required.    

I am also looking at getting additional licenses since it seems like many jobs  want specific state licenses before they will consider you (looking at locums).    Any thoughts out there as which license is easiest/ most flexible to get?    I have family in CO - but it looks like you need a supervising agreement before you can get a license - so that seems to be a big roadblock for me working there.   Most locums want DEA license also - but since KY has not had privileges  -  I do not have one yet.   We can apply as early as July of this year.   

  

Edited April 16, 2020 by bobuddy
content

[surgblumm]

I disagree with Cideous because I was an early PA and we have worked damn hard to first get into existence, secondly prove ourselves as capable and more than capable providers and lastly Covid-19 is and will continue to be a turning point for the positive for PAs. I am writing my monthly article on malpractice insurance and I am entitling it The Resurrection of the PA Profession. I see a very different profession with many of the entitlements that we have been seeking for years. As far as PAs and state societies: this profession is among the most apathetic and this needs to change. One person or a handful cannot do all of the work of a state worth of PAs. I wrote an article thirteen years ago called; "Apathy--The Malignancy in the Profession." I was shunned by many AAPA leaders as I was hard on the BOD and administration and the schools but it remains a guidepost of where we were then and the fact that it took until five years ago to start making changes. The article was in Advance for Physician Assistants if any are capable of getting this piece. Look up, maintain hope and read my article in two weeks. Bob

[Hope2PA]

2 hours ago, surgblumm said:

I disagree with Cideous because I was an early PA and we have worked damn hard to first get into existence, secondly prove ourselves as capable and more than capable providers and lastly Covid-19 is and will continue to be a turning point for the positive for PAs. I am writing my monthly article on malpractice insurance and I am entitling it The Resurrection of the PA Profession. I see a very different profession with many of the entitlements that we have been seeking for years. As far as PAs and state societies: this profession is among the most apathetic and this needs to change. One person or a handful cannot do all of the work of a state worth of PAs. I wrote an article thirteen years ago called; "Apathy--The Malignancy in the Profession." I was shunned by many AAPA leaders as I was hard on the BOD and administration and the schools but it remains a guidepost of where we were then and the fact that it took until five years ago to start making changes. The article was in Advance for Physician Assistants if any are capable of getting this piece. Look up, maintain hope and read my article in two weeks. Bob

This is more of a question for surgblumm, Bob. For the past 10-15 years you have pressed for title change to Physician Associate. Apparently worked hard promoting the idea. You wrote about PA’s not being equal but sort of subordinate, to collaborate and be on the physicians team(not exact wording). Good for the time, but that was before NP pushed the independence envelope. The discussion of physician Associate vs Medical Care Practitioner as been quite interesting on the forum. Have you or others with experience and knowledge such as yourself thought about how associate is now a much more general term of low level employees and pho’s keeping physician still suggests need for some form of documented physician to practice? If you still see physician associate as a potential “staged” independent practitioner, how will that be explained to legislators that an associate could practice on same level as a Practitioner?  I realize this is probably mute as apparently to many on the board that can’t Understand the need to pull from physician dependence, but maybe I could learn something. 

[Lexapro]

On 4/14/2020 at 8:38 PM, mgriffiths said:

If I were to do that, and it's a possibility that I could see happening, I would 100% pursue CRNA.  My hospital is 100% CRNA, and they work incredibly easy schedules and make double my salary.

But, honestly, if I were to go back to school AGAIN...I would likely leave medicine altogether.  Not because I hate my job, but because I work too hard and as this covid mess has shown, medicine is NOT recession proof.

The problem with going for CRNA is you'd have to a do a 12 month accelerated BSN, then do 1 year ICU RN work, then apply for CRNA school. It might still be worth it, but it's not as direct as becoming an NP.

[rev ronin]

3 minutes ago, Lexapro said:

The problem with going for CRNA is you'd have to a do a 12 month accelerated BSN, then do 1 year ICU RN work, then apply for CRNA school. It might still be worth it, but it's not as direct as becoming an NP.

Isn't there a 1-year PA->AA bridge somewhere anyways?

[Hope2PA]

39 minutes ago, rev ronin said:

Isn't there a 1-year PA->AA bridge somewhere anyways?

Even if there is, AA’s may be having a more difficult time than PA’s. They can only practice in maybe 13 states. I am not sure of AA salaries,  but statement by physicians wanting them is that they are cheaper than CRNA. When AA’s try to get approved, nursing fights, without reservation, writing letters saying they are not qualified and if the state would continue to lift restrictions on CRNA, there would be no shortage. Even with physicians supporting AA legislation, nursing lobbies are stronger and they will do everything and anything to prevent AA’s from practice. PA’s are fighting an uphill battle, appears AA’s are climbing a cliff. 

[Cideous]

1 hour ago, Hope2PA said:

This is more of a question for surgblumm, Bob. For the past 10-15 years you have pressed for title change to Physician Associate. Apparently worked hard promoting the idea. You wrote about PA’s not being equal but sort of subordinate, to collaborate and be on the physicians team(not exact wording). Good for the time, but that was before NP pushed the independence envelope. The discussion of physician Associate vs Medical Care Practitioner as been quite interesting on the forum. Have you or others with experience and knowledge such as yourself thought about how associate is now a much more general term of low level employees and pho’s keeping physician still suggests need for some form of documented physician to practice? If you still see physician associate as a potential “staged” independent practitioner, how will that be explained to legislators that an associate could practice on same level as a Practitioner?  I realize this is probably mute as apparently to many on the board that can’t Understand the need to pull from physician dependence, but maybe I could learn something. 

I would like to co-author this post or at least give it a gigantic thumbs up.

 

And to Bob...You don't have to agree with me, and I look forward to all of your articles.  

[EMEDPA]

1 hour ago, Hope2PA said:

Even if there is, AA’s may be having a more difficult time than PA’s. They can only practice in maybe 13 states. I am not sure of AA salaries,  but statement by physicians wanting them is that they are cheaper than CRNA. When AA’s try to get approved, nursing fights, without reservation, writing letters saying they are not qualified and if the state would continue to lift restrictions on CRNA, there would be no shortage. Even with physicians supporting AA legislation, nursing lobbies are stronger and they will do everything and anything to prevent AA’s from practice. PA’s are fighting an uphill battle, appears AA’s are climbing a cliff. 

 AAs who work for the govt can do so in all 50 states. non-govt employees can work in 18 states at this point.

https://aaaa.memberclicks.net/assets/the aa profession overview final fact sheet 092414.pdf

[Guest Paula]

I'll remain involved in promoting the PA profession but made a decision this week to retire.  I still need to do something so my next career will be starving artist.  I'm looking forward to it.  So far, I think I've "made" $300 in sales and commissions in the last 9 months. I'm rolling in the dough.  But it is fun and enjoyable.  Unfortunately COVID canceled one of the fine art fairs I was to be at in May, and the gallery that will be taking my work is on hold until lockdown is over. The art class I am to start teaching in June is on hold so starving artist will come true.  And our WI governor just announced he is extending the stay at home lockdown until May 26th.  We are all sunk.

[EMEDPA]

1 minute ago, Hope2PA said:

I would love to see AA’s have the ability to practice in every state. Sickening how CRNA, such as Mike MacKinnon spews against AA’s and Anesthesiologists. He has written very demeaning and flat out untruthful articles which are carried over and presented to states that are attempting practice rights.  I think, in  2015 AA’s had rights in 16 states plus DC. So, as I said, it is a very steep hill or cliff to climb with CRNA kicking dirt on them the entire way. I think a PA who then became AA would be kick A$$! If they wanted to be limited to a few states. I guess in a way, they may be a little more at advantage than PA, because at least CRNA aren’t independent, yet. 

They are in many rural states at this point.