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If not OTP/FPAR, what?


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I am astonished at how many PAs are not aware of OTP/FPAR and the modernization it brings. Where is the breakdown? State? National? We all know PAs have apathy,  but if items flow from top down, where is the mismatch? 

And, still so many still disagree with the tenants, preferring to be yoked to a physician. 

GOD FORBID (I actually say that as a Prayer!) OTP/FPAR does not happen. What is to become of us?   Would we slowly go towards extinction? Would it happen once we are all replaced by NPs? Will be be regulated to low paying positions (I saw a PA who is taking $20/hr since being laid off)?

 

(BTW full disclosure: Sold my practice in TX and moved back to NC. I have been looking for a position while trying to open another practice. I have been told NO to collaboration by 10 ((YES, ten)) physicians who are currently collaborating with numerous NPs. The jobs for PAs are sparse, even in NC. NPs have all but taken over in my neck of the woods.) 

I am not really trying to be defeatist. As anyone can tell you, I am a believer  and advocate of FPAR and hope this passes quickly, but even NC is behind on the idea. 

Let's talk about this doomsday scenario, shall we? 

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1. pharmaceutical companies hire legions of reps to literally go from practice to practice telling them- constantly about meds.  To keep it at the front of their mind.  No physician - or CEO is going to on their own to research "optimus maximus practice, or optimal..team?  sounds expensive".  

2. the name.  From our point of view, it sounds great- helps the patient!  good clinical practice!  helps deliver quality care!  Unfortunately, the main (and really only topic) on the CEO's mind (and they are the ones who make the decisions) is money.  Watch shark tank.  Thats how they think.  How would you sell this acronym to a guy who just wants to keep his business, grow his business- and if you use more than a couple sentences, you're out.  Docs- "I just see patients".  NP's- I just see patients.  PA's- "Weellll, first...".  any time a sentence starts with "well..." you've lost the listener already.

 

On one hand, we are idealists.  But realistically, we are being outsold, because no one is selling us, as a whole.  betamax was better than vhs, but died, and everyone had vhs.  Tesla had some better ideas than edison, but edison sold it better.  This may be the worlds best idea in the world, but without good PR, no one gives a hoot.  

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While our representative organizations have spent untold man hours and money on social issues while doing nothing that actually helped assure the survival of the profession much less its growth we have fallen farther behind in all the ways we have discussed over and over in years past. (And I will be mercilessly pilloried for even suggesting we have spent too much time on social issues.)

Here are my predictions. The end point of 2 years work and a million dollars spent we will be physician associates. It will be a meaningless change.

The NCCPA is already hearing cash registers ring and will create numerous CAQs which will further reduce our lateral mobility and opportunities for employment. Since there is no mechanism to effect them we will rail about it but nothing will change.

PAs will continue to be un-aware and apathetic until they personally feel some pain. That has been happening for a few years but there is a balance point. I don't think enough will become active in the nuts and bolts of the profession before the scale has tipped too far towards destruction of the profession. By the time we develop some political nards our numbers will be too small to matter.

In 5 to 10 years we will be a shadow of a profession with our members being almost exclusively in the surgical fields. The decline in demand will result in there being fewer and fewer schools which will further erode our numbers.  This process will continue until we cease to exist.

After I retire in 5 years I'll tell my grandkids I used to be a PA. It will be something like saying I used to be a barrel maker or a town crier.

I could be wrong.... maybe I'll change my mind after a couple more cups of coffee.

 

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Doomsday scenario?

well, I’m an RN, so I’ll just get my NP. Begrudgingly.

I don’t think we’ll ever really die. I mean, AAs still haven’t died with way more restrictions than we do and just 17 states, but will become a shell of our former selves only working at the most rura of hospitals where they can’t recruit others or level one trauma centers where there is a physician around every corner.

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5 hours ago, ventana said:

PA-->NP bridge.........

LOL I posted an entire thread about this a while back and got eviscerated here for even suggesting it.  That was before:

1.  PA's Lost Florida to NP's

2.  PA's Lost California to NP's

3.  NP's were honored in the White House for their Covid work and recognized nationally.

 

 

No one listened and here we are.  So I have some new advice....start making plans for a post PA life.

1.  Get out of debt.  If you have a job you can tolerate....bust ass and get out of debt.  

2.  Make good low risk investments.

3.  Don't spend big money on things like expensive cars

 

We are just a few years away from being peeled away out of the job market in all areas except the jobs even NP's won't take.

It's very depressing.

 

Edited by Cideous
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2 hours ago, Cideous said:

LOL I posted an entire thread about this a while back and got eviscerated here for even suggesting it.  That was before:

1.  PA's Lost Florida to NP's

2.  PA's Lost California to NP's

3.  NP's were honored in the White House for their Covid work and recognized nationally.

 

 

No one listened and here we are.  So I have some new advice....start making plans for a post PA life.

1.  Get out of debt.  If you have a job you can tolerate....bust ass and get out of debt.  

2.  Make good low risk investments.

3.  Don't spend big money on things like expensive cars

 

We are just a few years away from being peeled away out of the job market in all areas except the jobs even NP's won't take.

It's very depressing.

 

Could not agree more. There seems to be a notion amongst PAs that “we are satisfied, we don’t want any change” when the NPs are always “hungry” and that’s how they get to where they are today. Its “evolve or get extinct”. Unfortunately at this rate, our profession will be taken over by NPs in more and more states, just a matter of time.

Time for plan B after PA life...

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I'm so glad to see ppl actually talking about this, It seemed that no one wanted to acknowledge this a few years back.

I don't think it has to be so dire, but in order to reverse the trend, PAs have to get to work:

1) getting independent 

2) unionizing

Nurses have the power, and they have control over their lives, salaries, schedules, etc because they have a UNION. I brought this idea up a bunch of years ago and no one liked the odea. But without it - yeah, we will be utterly marginalized in the world of medicine.

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2 hours ago, kittryn said:

I'm so glad to see ppl actually talking about this, It seemed that no one wanted to acknowledge this a few years back.

I don't think it has to be so dire, but in order to reverse the trend, PAs have to get to work:

1) getting independent 

2) unionizing

Nurses have the power, and they have control over their lives, salaries, schedules, etc because they have a UNION. I brought this idea up a bunch of years ago and no one liked the odea. But without it - yeah, we will be utterly marginalized in the world of medicine.

While I agree with you please know this....NOTHING is going to change until we rid ourselves of our terrible name.  Absolutely nothing.  And changing to "Associate" will do more harm than good.

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14 hours ago, Cideous said:

While I agree with you please know this....NOTHING is going to change until we rid ourselves of our terrible name.  Absolutely nothing.  And changing to "Associate" will do more harm than good.

I hear you, and I agree. I saw a name in the paramedic topic thread, "assistant physician". That's better! Or "associate physician"!

But this issue has been around FOR-E.V.E.R!! I graduated in 2006, and it's been around at least that long. And nothing's happened.

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3 minutes ago, kittryn said:

I hear you, and I agree. I saw a name in the paramedic topic thread, "assistant physician". That's better! Or "associate physician"!

But this issue has been around FOR-E.V.E.R!! I graduated in 2006, and it's been around at least that long. And nothing's happened.

when I graduated in 96 the common wisdom was that we would be Physician Associates within 10 years and have multiple PA to MD/DO bridge programs. So here we are in 2020. One bridge program in one location(and I would still do it if I was single in my 50s) , and a likely change to Physician Associate in the next few years. I see Associate as an improvement over assistant. It keeps the PA letters, which is important to a lot of folks. I would prefer Clinical Associate or Medical Practitioner, but I honestly don't think either will happen. I do think whatever we are called, we will get more and more independence each year, following in the mold of Michigan and North Dakota. I don't think the profession will go away, but I think we will end up with 2 classes of PAs(or whatever name wins): Those who want to work as "assistants to physicians" and those who want to flex their independence. There is room in the world for both. 

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18 hours ago, kittryn said:

I hear you, and I agree. I saw a name in the paramedic topic thread, "assistant physician". That's better! Or "associate physician"!

This would be proper grammar according to my English professor mother; Much like Assistant/Associate Professor.  This was brought up in the 90s in one of the now defunct PA journals. 

Unfortunately, due to our profession’s apathy and not holding our organizational staff accountable, we are now faced with a profession already legally called and accepted as “assistant physician” in a few states. 

 

As far as unionizing, that comes with a different set of issues. We would best benefit by encouraging others to join their state org and hold them accountable.

Being vocal with the board and HOD members, and holding them accountable for votes and interaction with the medical boards are at our current disposal. Yet, people would rather complain on social media, be key board warriors than join or truly get involved. 

Edited by KpsPac
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On 11/1/2020 at 6:30 AM, KpsPac said:

"....we are now faced with a profession already legally called and accepted as “assistant physician” in a few states."

What profession is that? What do they do (scope of practice) and how are they licensed?

Too bad we missed the boat on that one. Thanks for the info.

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8 hours ago, kittryn said:

What profession is that? What do they do (scope of practice) and how are they licensed?

Too bad we missed the boat on that one. Thanks for the info.

 

2 hours ago, ANESMCR said:

MD’s that can’t match for residency. There was a thread on it but can’t find it.

https://assistantphysicianassociation.com

 

 

Literally scraping the bottom of the barrel.

https://www.aafp.org/news/practice-professional-issues/20181109asstphys.html

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