The Future

[KpsPac]

Aside from obtaining OTP is all states, what do you think is the top 3 issues PAs will be facing post-COVID?  

[rev ronin]

Too many programs/Job saturation/loss of earning power

Self-Determination at the national and state levels

... and I'm having a hard time settling on a third.  OTP solves a LOT of issues.

[LT_Oneal_PAC]

Agree with @rev ronin

OTP answers a lot of problems. Self-determination and policing. Direct payment. Scope of practice to our level of education and training, independent of someone else's training.

 Outside of those tenets my concerns for our future immediate time post-covid would be (no specific order)

1) Job saturation

- Too many of us for too few jobs, but if we don't increase numbers then they WILL be filled by NPs who our churning out grads at double our rate. 

Solution:  I think we should continue with our current numbers, but increase requirements for new programs and programs that lose accreditation. Established programs grandfather in. New requirements could have faculty:student ratios, student to clinic site ratios, etc. Keep old programs happy, slow the expansion. Bad programs that get on probation have to meet higher guidelines of new programs, which should keep them in line. 

2) Job loss/re-hire

- When the hiring freeze and lay offs are done and people are being hired again, we need to be the provider of choice. 

Solution: Advocate to make the COVID changes permanent. Establish that this isn't the first or last pandemic we will face. We are the best APC to handle  this type of crisis due to our generalist training, and the fact we have as much training as the NPs in their "specialty areas." Why aren't we always the APC of choice? Administrative burden. Title change plays into getting this done as we need optics on our side, which is why I think we should get title change done prior to COVID being resolved. 

3) Recognition of our brand

- We need to encourage doctorates and help PA contribute to medicine and the system not just as money making cogs. DO NOT make them mandatory for clinical practice, but we need to put them into the educational hierarchy. Why? We need researchers developing new techniques, with our name on it. We need PAs becoming administrators to promote within hospitals and healthcare systems. We need to have the clinical clout to take chief and director positions, develop protocols and guidelines. We need people taking high level government jobs at CMS, within the VA, in the military (all heavily value degrees for promotion). We need more people becoming experts and giving lectures on HippoEd, developing FOaMEd, talking on NBC, (god help me) having their own stupid talk show. We need more people with tenure at universities. 

Solution: Establish a universal blueprint of what a PA doctorate look likes and have ARC-PA accredit them. Maybe even have multiple blueprints for clinical, admin, education. Maybe even develop a Phd research track. Phd in Medical Sciences. PT has both a clinical and Phd doctorate. No reason we can't too. 

 

Finally, title change. This is always an issue though. 

[EMEDPA]

11 hours ago, KpsPac said:

Aside from obtaining OTP is all states, what do you think is the top 3 issues PAs will be facing post-COVID?  

The above answers are good. We need OTP/FPAR.

My additional thoughts:

1. Job competition vs NPs and non-specialist physicians(for example fp docs wanting to work in em)

2. requirement to up our educational chops. We need doctorates, not because it will make us better providers, but because everyone else is getting them. Ditto CAQs/specialty board exams and/or residency requirements. we have discussed this before. Docs went from minimal requirements to more formal educational structures, training, and exams. 

3. Assistant needs to go. It drags us down with every person we meet, from patients to legislators.  Physician Associate or Medical Care Practitioner are both significantly better than physician assistant. 

[b2020]

With the growing number of PAs, do you think there would be more of a market for bridge programs?

Im curious on the future of health professional education with many programs having to go online. 

[mgriffiths]

11 hours ago, b2020 said:

With the growing number of PAs, do you think there would be more of a market for bridge programs?

I think there is already a strong market, it's just that the market hasn't provided a quality option (that I'm aware of).

 

11 hours ago, b2020 said:

Im curious on the future of health professional education with many programs having to go online. 

Depending on how the online education is completed, I absolutely, 100% believe this can provide a quality education.  Much of my didactic year could have been completed as self-study or online, but of course hands-on physical exam learning and similar curricula could not.

[turnedintoamartian]

Could everyone chime in on OTP vs FPA for me? It seems like the distinction may be more federal versus state based?

It seems like hammering out OTP nationally combined with name change really takes care of most of my concerns.

[KpsPac]

@turnedintoamartian

FPAR (Full Practice Authority and Responsibility) was the original name (see PAFT site), but was changed to OTP (Optimal Team Practice) by the AAPA task force when they adopted the resolution. 

Some believe that FPAR better represents what is trying to be accomplished versus OTP, which can be considered non-specific. 

[PACali]

Full practice authority and responsibility in primary care. 

I know there are many EMPAs practices solo but I think we should focus our energy to push FPAR in primary care. It is more feasible for PAs to practice independently in primary care at this time, just simply follow the NP model. My prediction is there will be COVID21, COIVD23 etc. More opportunities will be in virtual medicine. To be ahead of all these new changes, we as a professoin needs to be in the driver seat not the passengers. I think having FPAR in prmary care will give us more control in our own destiny. 

 

[rev ronin]

8 hours ago, mgriffiths said:

I think there is already a strong market, it's just that the market hasn't provided a quality option (that I'm aware of).

 

Depending on how the online education is completed, I absolutely, 100% believe this can provide a quality education.  Much of my didactic year could have been completed as self-study or online, but of course hands-on physical exam learning and similar curricula could not.

I think the key way to solve the 'bridge' program is to count PA school as "medical school" for the purposes of the WHO 3-year minimum.  Adding a two year PA->MD bridge (one didactic which might be online, one more year of clerkships) makes a whole lot more sense, if for no other reason that PAs working in other practices CAN BILL WHILE THEY LEARN, where med students cannot. Then, let bridged PAs sit for USMLE, and compete for residencies based on their performance and merit AND fill "assistant physician" slots in the states that have such a critter.

[EMEDPA]

2 hours ago, rev ronin said:

I think the key way to solve the 'bridge' program is to count PA school as "medical school" for the purposes of the WHO 3-year minimum.  Adding a two year PA->MD bridge (one didactic which might be online, one more year of clerkships) makes a whole lot more sense, if for no other reason that PAs working in other practices CAN BILL WHILE THEY LEARN, where med students cannot. Then, let bridged PAs sit for USMLE, and compete for residencies based on their performance and merit AND fill "assistant physician" slots in the states that have such a critter.

yes. I would still go back. 

[mgriffiths]

2 hours ago, rev ronin said:

I think the key way to solve the 'bridge' program is to count PA school as "medical school" for the purposes of the WHO 3-year minimum.  Adding a two year PA->MD bridge (one didactic which might be online, one more year of clerkships) makes a whole lot more sense, if for no other reason that PAs working in other practices CAN BILL WHILE THEY LEARN, where med students cannot. Then, let bridged PAs sit for USMLE, and compete for residencies based on their performance and merit AND fill "assistant physician" slots in the states that have such a critter.

I would do this.

[GetMeOuttaThisMess]

I might even come back to give this a shot.


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[Cideous]

3 hours ago, GetMeOuttaThisMess said:

I might even come back to give this a shot.


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No you won't.  Your out of the game and I am right behind you.

[RadAssPA]

Residencies in specialties/subspecialties with CAQ's. Mandatory/increased membership dues at National and state level with money going to PAC's.

[GetMeOuttaThisMess]

11 hours ago, Cideous said:

No you won't.  Your out of the game and I am right behind you.

I actually think that I would for a couple of reasons.

1)  boredom

2)  I want the degree for my own personal satisfaction/achievement

3)  I'd utilize it to try for EM academia for a couple of years

[ShakaHoo]

I always thought the competition versus APRN's was a joke, and unnecessary panic.

More than ever I am starting to buy into this.  

1) They can work without physician supervision in my state.

2)  There are MANY job descriptions now specifying they would like an APRN only (I assume for reason 1 list above).

3)  In worker's compensation in my particular state, the commissioner states an APRN does not require a physician co-signature, and can see a patient an unlimited number of times consecutively.  If you are a PA, all notes require co-signature, and a PA cannot see a patient more than ONCE in a row, or the visit will not be reimbursed.  

4)  In times like this (COVID) they are asking APRN's to work as RN's and they are able to stay employed.  PA's are simply being furloughed or let-go all together.  

 

I thought with our more diverse training, surgical training, suturing skills, etc... we would be overall more desirable.  It is quickly moving in the other direction, and actually causing me some anxiety that I will ultimately be replaced by an APRN.  

[Cideous]

21 minutes ago, ShakaHoo said:

I always thought the competition versus APRN's was a joke, and unnecessary panic.

More than ever I am starting to buy into this.  

1) They can work without physician supervision in my state.

2)  There are MANY job descriptions now specifying they would like an APRN only (I assume for reason 1 list above).

3)  In worker's compensation in my particular state, the commissioner states an APRN does not require a physician co-signature, and can see a patient an unlimited number of times consecutively.  If you are a PA, all notes require co-signature, and a PA cannot see a patient more than ONCE in a row, or the visit will not be reimbursed.  

4)  In times like this (COVID) they are asking APRN's to work as RN's and they are able to stay employed.  PA's are simply being furloughed or let-go all together.  

 

I thought with our more diverse training, surgical training, suturing skills, etc... we would be overall more desirable.  It is quickly moving in the other direction, and actually causing me some anxiety that I will ultimately be replaced by an APRN.  

 

Trying very hard not to sound like an ass here and I am glad to finally see some PA's waking up to this.  I have been beating the drums, kicking over chairs and screaming at the top of the tower about everything you list.  I just hope others wake up and see this before it is too late, although it may be already.

[VictorOfHungerGames]

2 hours ago, Cideous said:

 

Trying very hard not to sound like an ass here and I am glad to finally see some PA's waking up to this.  I have been beating the drums, kicking over chairs and screaming at the top of the tower about everything you list.  I just hope others wake up and see this before it is too late, although it may be already.

So what would this mean for the future of PA? 

[Cideous]

1 hour ago, VictorOfHungerGames said:

So what would this mean for the future of PA? 

It means when you as a profession fall so far behind another legislatively who does what you do and is competing with jobs doing what you do....you don't get hired, they do.  As I have said here for years, we have been at critical mass for awhile and I have often sighted NP's getting autonomy in California as the final breaking point, but what just happened in Florida changed my mind.  I think that was the breaking point.

 

My question now, and something that keeps me up at night is...How many PA's are going to be brought back from furlough or hired post pandemic?  Could 25%-40% of us be left out when admins do what we all know they are going to do?  Downsize, make providers do more with less, offer jobs with lower salaries but most of all ......hire an AP with less red tape?  That would be an NP.  

Once this pandemic ends....I am going to be watching with morbid fascination to see what percentage of PA's who were working before, now can't find a job.

Edited April 29, 2020 by Cideous

[surgblumm]

Building on the momentum of the temporary changes brought by Covid-19.

Get new legislation in all fifty states based upon the PA response to the call for healthcare providers.

Finalize a name change that is most accepted by our PA polls.

[PAinPenna]

2 hours ago, VictorOfHungerGames said:

So what would this mean for the future of PA? 

I’m quite hopeful the pandemic highlighted how versatile PAs are . In my institution the weekly featured  “heroes on the front line “ have consistently been PAs who have been redeployed from specialties to areas of need , and the articles do point out  how adaptable and well-trained PAs are . 

.
So far - no NPs. It’s refreshing for us to finally get a bit of the spotlight . . 

[Hope2PA]

Think I’ve mentioned this twice. A hospital in an independent NP/APRN state laid off many APP’s due to finances a few years back. As they rehires, what was once at least half PA, half NP , became closer to 3/4 NP. Yet, rumor has it that PA will remain PA, changing the assistant to associate still doesn’t take out the presumed need for physician oversight forever. As a PA, the profession will not be seen anymore than it currently is, Not a Doctor and not a Practitioner. Local news has a Q/A with various Physician, NP, PT etc. not ever PA. Again, Assistant or Associate, still physician helper. Not that PA can’t get laws passed, but the fact is It is the law makers that decide future practice rights. They do not take the time to know or care what your education is. They look at a title which suggests need for physician oversight, then no matter what “you are lesser”. There are to many PAs that want to remain just that, a physician helper. Feel there has been fair amount of increased interest in the future, but is it enough to make AAPA and HOD vote for something other than easy way out. I ask, in another thread for an explanation as to why Physician Associate is still the choice? With an answer other than it’s easier, cheaper, faster. Ten plus years ago there was push for Associate, that was before NPs had gained so much independence. Is it really the best choice. I know their has been gone over  and over, but have heard no other reason than the initials, the ease and because it keeps the profession associated with physicians. Physicians who no longer care. In my specialty office, they will be hiring a new APP, I’ve been told it will be a brand spanking new NP, with no related experience. It is the physician saying It’s better in future due to paperwork.   Just makes me sick!!! Thus my rant! 
Get a real Title that shows at least equality to NP and fight for OTP/FPA! 

[Joelseff]

I think the key way to solve the 'bridge' program is to count PA school as "medical school" for the purposes of the WHO 3-year minimum.  Adding a two year PA->MD bridge (one didactic which might be online, one more year of clerkships) makes a whole lot more sense, if for no other reason that PAs working in other practices CAN BILL WHILE THEY LEARN, where med students cannot. Then, let bridged PAs sit for USMLE, and compete for residencies based on their performance and merit AND fill "assistant physician" slots in the states that have such a critter.

My only qualm about expanding PA to Doc bridge programs is that the product will no longer be a PA but a Doc... If this became the norm or at least a significant number of us did this wouldn't the PA profession be losing members/supporters? I'm not necessarily saying PA to Docs dont support us, I know some do like Prima and others but let's face it, they have more incentive to support docs than PAs...

 

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[sas5814]

On 4/25/2020 at 7:35 PM, b2020 said:

With the growing number of PAs, do you think there would be more of a market for bridge programs?

Im curious on the future of health professional education with many programs having to go online. 

Do you mean PA to MD bridge programs? The market would have to answer that question and the market would ask "what is the advantage?". There is already a shortage of residency matches so what would the upside of creating more unmatched generalists? I see value in a bridge program or 3. I'm just not sure the greater world will (and I know the physicians won't).