Talk of the Nation: NPR

[Guest hubbardtim48]

[h=4]http://www.npr.org/programs/talk-of-the-nation/

Then Click on: Prognosis Worsens For Shortages In Primary Care to listen.[/h]

[joanna.nola]

I'd like to hear feedback on this radio show.

 

Although I think it's great that we are getting our name out there, I thought the rep from AAPA wasn't as strong an advocate as she could have been. The host seemed ill-informed about what PAs are and how we are trained and while "highly trained" was thrown around in reference to doctors, when she got the chance to highlight our education she made it sound rather ho-hum.

 

Maybe I'm being too picky here. (And maybe I already really disliked Talk of the Nation and the idiot host). I'm curious what others thought of the coverage.

[cinntsp]

I'd like to hear feedback on this radio show.

 

Although I think it's great that we are getting our name out there, I thought the rep from AAPA wasn't as strong an advocate as she could have been. The host seemed ill-informed about what PAs are and how we are trained and while "highly trained" was thrown around in reference to doctors, when she got the chance to highlight our education she made it sound rather ho-hum.

 

Maybe I'm being too picky here. (And maybe I already really disliked Talk of the Nation and the idiot host). I'm curious what others thought of the coverage.

 

You are spot on with your opinion. A couple of my classmates and I said the same thing. It's unfortunate that these situations aren't taken more seriously or at least better prepared for. Every chance to advocate for the profession should be used to its fullest.

[burnpac]

Here is the actual transcript as some might have difficulty locating the interview as this page changes daily.

 

http://www.npr.org/2012/08/07/158370069/the-prognosis-for-the-shortage-in-primary-care

 

The PA representative is Ann Davis, PA-C, one of the smartest and savviest lobbyists working at the AAPA on state legislative affairs. I got my start in leadership on Ann's GAC committee in California in 1991. She has worked tirelessly on behalf of the profession her entire career, and many states owe her a debt of gratitude for help in achieving their legislative goals. We certainly do in California.

[Guest Paula]

I read the transcript and agree with Joanna Nola. I felt the answers were weak and PA's were described as "assistants" who only coordinate care and don't need a high level of training. Read the answer about the PA who sutures all day, or the coordination of care for nephrologists and helping grandma. She did not correct the moderator who interchanged physician's assistant and physician assistant. Good grief, correct the ('s) please. Anyway, I was disappointed greatly. It actually made me feel kind of sick to be thought of as an assistant that is a generalist who can coordinate care for the physician. The answer on the turf issues was politically correct and demeaning to PA's. Some PA's come out of school with huge debt, so the salary answer was short-sighted, and I felt Ms. Davis didn't think we deserve to be paid well because we are PA's. Ms. Davis missed a huge opportunity to truly advocate for PA's.

[EMEDPA]

Ms. Davis missed a huge opportunity to truly advocate for PA's.

Steve-thanks for posting the transcipt.

while I appreciate everything she has done for the profession in the past, this was a great opportunity to get good and credible information about pa's out there to a huge audience at no cost to the aapa. it's their perfect PR campaign and they didn't take full advantage of it. if you want to call us assistants at least don't call us physician's assistants or allow others to do so and don't simplify the description of our jobs so that we sound like hand maidens to docs. I still don't know why these types of pa's are highlighted and not the ones the aapa seems so proud of in the journals but won't discuss when the rubber hits the road: folks practicing solo rural primary care or commanding medical units overseas, etc. these are the ones we want folks to know about, not the ones who do scheduling for doctors and help out by doing their suturing. this type of thing just reinforces every bad stereotype about pa's we are trying to do away with. how about highlighting the fact that this year's army flight surgeon of the year was a pa?

really not a big fan of this line: "primary care requires the physician's full talent and training."

oh really? so all the pa's working in rural and underserved areas are doing their patients a disservice because no physician is there holding their hands?

she then goes on to say that we extend a physician's ability to take care of patients. maybe some pa's do this but most I know see pts themselves and the doc knows nothing about individual cases, they just sign the charts and in many states don't even do that. we are an advantage to the system because we do the same work for less with the ability(not the requirement) to consult physicians as needed.

so as not to sound entirely negative, I did appreciate her mentioning the new funding for veterans to become pa's.

overall I would give her performance a C+/B-. I am pleased that the interview occurred, I just think it could have been done better. I do applaud the aapa's effort to get her on the show and get people talking about pa's. They say "the only bad press is no press" so hopefully this interview is a step in the right direction for the PR folks at the aapa.

[burnpac]

Here's the deal. As a veteran of scores of print, TV and radio interviews, as a guest, you don't get to control the agenda or the questions. You do get the opportunity to turn questions and give the answer that you want to give with the appropriate opening. We don't know if this interview was recorded live, or if the best part of Ann's answers ended up on the cutting room floor editted by someone whose agenda is somewhat different from ours. I have known Ann personally for 20 years, and I can assure you that she is an able representative of the profession in any venue from the practice site to the White House.

 

The use of "physician's assistant" is unfortunate, and irks me too. However, the time to discuss this with a host is off the air. It serves no purpose to get combative with folks who buy ink in a 55 gallon barrel. I can assure you that I (and Ann too) never miss an opportunity to respectfully correct media folks on the inappropriate use of this term, and when I do background off the record interviews, I discuss the proper reference to PAs respectfully and assertively on the front end. This is very important to PAs, but the average American could care less; what they care about is what we can do for them.

 

Ann works for the AAPA, and the party line is that PAs practice medicine in teams led by physicians. We do extend the scope and reach of our physician colleagues as part of our core utility in the health care system. Even the PA working "independently" in Podunk USA. There are many days that I don't talk with my SP while managing significantly ill hospital patients. That comes from the trust that I have earned through our long working relationship. However, I never forget that he is ultimately responsible for the patient under our care. This reality won't change until regulations governing PAs changes significantly.

[cinntsp]

 

Ann works for the AAPA, and the party line is that PAs practice medicine in teams led by physicians.

 

The interview unfortunately didn't do anything to give the impression that PAs practice medicine. Coordinating care between grandma and the doc and suturing all day seems appropriate for PAs, not being highly trained and all.

[EMEDPA]

The interview unfortunately didn't do anything to give the impression that PAs practice medicine.

One of the longest running aruments on sdn between pa's and docs/residents is whether or not pa's practice medicine.....of course we do. it's right on the license: "emedpa, pa-c is granted this license to practice medicine in the state of xyz".

[joanna.nola]

I agree with many folks above. Reading the transcript is even worse. In the ENTIRE interview she never mentions that we practice medicine. If you heard this interview or read it, and had no idea what a PA was, you'd walk away either scratching your head or thinking that PAs are like glorified human sewing machines, who move from patient to patient to suture their lacs (after a doc or maybe a nurse has evaluated them). Easy peasy. Next to no training needed.

 

It's possible, like Stephen Hanson said, that the good parts of the interview ended up on the cutting room floor. Although, given that there were folks calling in, this had to be live, at least in its original broadcast. But even then, it is a rooky mistake to not push your agenda when you are the interviewee, and I realize Ann Davis is no rooky. IN my pre-PA work I also had to do interviews and after one news outlet burned me, I learned carefully to stay on message. MY message. That meant giving MY answer, regardless what *their* question was.

 

He gave her so many chances to explain what PAs actually do and how they are actually trained, and she did not grab any of them. If I were her, I'd have a pre-planned script a little like this:

* We are highly trained in the medical model. Our curriculum is very intensive and similar to medical school, and in clinical rotations PA students often rotate with medical students in all the areas of general medicine.

* We practice medicine in a team approach with doctors and other health care professionals. We conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, first assist in surgery, give medical orders and write prescriptions.

*We work in every area of medicine, including academic medicine, where experienced PAs teach PA students and residents.

*We always work with a supervising physician, but the nature of that "supervision" can look different depending on the scenario. A new graduate is more like a first year resident, who might need to "staff" almost every case with their SP, like an intern staffs cases with an attending. With more experience, PAs work more autonomously, but always have a physician they can turn to if additional input is needed. That's the beauty of the team approach. Some PAs work in rural areas where their "supervising" physician is many towns over, still, they can reach him/her if needed.

 

What I wrote may not be perfect, but we need to come up with a better, concise, clear description that paints an accurate picture for the public. We should practice saying this description, if needed (in my previous life, I certainly prepared before an interview).

 

Straight out of the gate, from the host's first question, she could have made several of the points above, instead she focused on how PAs "extend" and "coordinate care" (I've highlighted it below). And while she doesn't explain what a PA does, she does say that we can't do everything a doctor does, certainly not a primary care doc with all his "talent and training."

 

GJELTEN: So we've been talking about this shortage of doctors as primary care providers. To what extent can physician assistants help fill that demand, and have we seen an up tick in the demand for physician assistants as a result of the doctor shortage?

DAVIS: You know, we really have. And I guess whenever we think about a scarce resource, there's sort of three ways to think about that. You can increase supply, which you talked about a minute ago, of physicians. You can use the scarce resource more wisely, or you can actually reduce demand. And I think the second two are where PAs are particularly critical.

We can certainly help to extend the reach of physicians by that team practice that we really look toward, that is not everything that a physician would do, certainly a primary care requires the physician's full talent and training. So PAs, as part of a physician-PA team, really can extend the reach of physicians.

 

And then in terms of decreasing demand, if the PAs are available to do some health promotion, some exquisite coordination of care so that you decrease readmissions and that sort of thing, that helps address the physician shortage also.

 

GJELTEN: Where are some places physician assistants are working right now? I know that there's a big increase in minute clinics. Are they staffed by physician assistants? And where are some of the other places you see physician assistants being used effectively?

DAVIS: Certainly, we're really trying to find PAs go where the patients are. So your reference to retail clinics is certainly a good one, and we like those particularly when they're well-integrated with other health systems so the patient can receive seamless care, wherever they're being seen.

We certainly see a lot of PAs that are working in specialties are particularly underserved, as well as primary care, for example nephrology. So patients that have chronic kidney disease, the nephrologists can certainly be more effective if there's a PA there, too, to do some of the coordination of care, making sure that the grandma and the patient and the vascular surgeon are all on the same wavelength in terms of what needs to happen for the patient.

 

 

I can't help but see her approach is a conscious choice by the AAPA to deemphasize our training and the fact that we practice medicine, perhaps to try to keep the doctors happy? If so, I don't think this strategy is working. Time to shake off the inferiority complex and take a different tact. We are not doctors, but we are highly trained in our own right, continue to learn on the job like doctors do (and this is where so much of medicine is learned, if nothing else, can't we explain this to the public?), and we offer excellent care. Not just coordination, not just extension, but actual health care. We are part of the team that is the future of American medicine. And we are a critical member of that team. It's high time we recognized and promoted it.

[EMEDPA]

 

I can't help but see her approach is a conscious choice by the AAPA to deemphasize our training and the fact that we practice medicine, perhaps to try to keep the doctors happy? If so, I don't think this strategy is working. Time to shake off the inferiority complex and take a different tact. We are not doctors, but we are highly trained in our own right, continue to learn on the job like doctors do (and this is where so much of medicine is learned, if nothing else, can't we explain this to the public?), and we offer excellent care. Not just coordination, not just extension, but actual health care. We are part of the team that is the future of American medicine. And we are a critical member of that team. It's high time we recognized and promoted it.

 

exactly. this is my main beef with the aapa. even given the chance the spread good info about pa's for free they fall back on "we help doctors" which minimizes the work we actually do. talk about our background, talk about our training, talk about pa's in the trenches doing good work. STOP TALKING ABOUT US AS HANDMAIDENS TO DOCTORS WHOSE ONLY PURPOSE IS TO GET THEM HOME IN TIME FOR DINNER!

[Guest Paula]

One of the longest running aruments on sdn between pa's and docs/residents is whether or not pa's practice medicine.....of course we do. it's right on the license: "emedpa, pa-c is granted this license to practice medicine in the state of xyz".

 

And that is why today I practiced medicine in my little po-dunk clinic on the rez. No doctor here today. Today I diagnosed new onset diabetes, prostatitis, HTN, proteinuria in one patient who hasn't seen a doctor since 2003; diagnosed new case of genital herpes; I&D'd an abscess; diagnosed herpangina; otitis media; URI's, folliculitis, shoulder bursitis; dental pain with cracked tooth; sutured a lac; counseled someone on smoking cessation;refilled numerous medications, trouble-shot several medical issues via phone calls, supervised the healthy start nurses with their projects, dx ectopic pregnancy (without an US) by clinical exam and labs, sent pt. to ER and was found to be correct in my diagnosis.......

 

All without an MD here. Did I practice medicine? H*ll yes! Did I extend the reach of the MD? NO...he was not here!!!! I did not assist. I delivered high quality care with my high level of training and talent. I deserve recognition and promotion as do all of you! (Promotion meaning collaborative or independent practice with an appropriate professional title...not advertising promotion!!)

[burnpac]

exactly. this is my main beef with the aapa. even given the chance the spread good info about pa's for free they fall back on "we help doctors" which minimizes the work we actually do. talk about our background, talk about our training, talk about pa's in the trenches doing good work. STOP TALKING ABOUT US AS HANDMAIDENS TO DOCTORS WHOSE ONLY PURPOSE IS TO GET THEM HOME IN TIME FOR DINNER!

 

Show me one example of the above in AAPA news releases and PR materials.

[burnpac]

And that is why today I practiced medicine in my little po-dunk clinic on the rez. No doctor here today. Today I diagnosed new onset diabetes, prostatitis, HTN, proteinuria in one patient who hasn't seen a doctor since 2003; diagnosed new case of genital herpes; I&D'd an abscess; diagnosed herpangina; otitis media; URI's, folliculitis, shoulder bursitis; dental pain with cracked tooth; sutured a lac; counseled someone on smoking cessation;refilled numerous medications, trouble-shot several medical issues via phone calls, supervised the healthy start nurses with their projects, dx ectopic pregnancy (without an US) by clinical exam and labs, sent pt. to ER and was found to be correct in my diagnosis.......

 

All without an MD here. Did I practice medicine? H*ll yes! Did I extend the reach of the MD? NO...he was not here!!!! I did not assist. I delivered high quality care with my high level of training and talent. I deserve recognition and promotion as do all of you! (Promotion meaning collaborative or independent practice with an appropriate professional title...not advertising promotion!!)

 

Paula-

 

Many PAs share your experience, and I assume that you have a SP, who is supervising your practice of medicine consistent with your state regulations and your delegation of services agreement. If not, don't be surprised at what happens when a medical board investigator arrives at your clinic, either routine or after a patient makes a complaint. Make sure your ducks are in a row.

 

Here is supervision in my world. As all PA / NP medical orders in the EHR are routed to the SP for signature after the fact (PA orders are valid from the get go and don't require cosignature prior to implementation). My SP has just discovered Ctrl-A. He highlights hundreds of orders all at one time and clicks OK..... :-) I don't care. I have a paper trail one mile wide that I'm being supervised consistent with State regulations. I like that security and it doesn't interfere with my practice of medicine one iota, or increase his burden of supervision. It has actually diminished his administrative burden of supervision significantly with the implementation of CPOE. That is the promise of the EHR.

[Guest Paula]

Burnpac: I keep the ducks in a row! I keep up on my state laws. My SP is not required to sign anything, but signs everything. He signs all the NP's stuff, too and all after the fact. I keep him informed of any patients that require a second set of eyes. We don't have EHR yet, so the signing of charts and orders is extremely burdensome for us and in my opinion, dangerous. It can take weeks before labs and notes are put in the charts. I'm a bit of a type A so I spend inordinate amounts of time looking for labs and notes to review what has been done by the NP and MD, and often times, end up following up on all the stuff that has been buried in the pile and forgotten about. It is always a good reminder though from colleagues to think about lawsuits, etc. I dictate and document with that in mind, and the transcriptionist has complained that my notes are too long. I was beckoned into my SP's office with that complaint and I discussed with him that I could not in good conscience dictate shorter notes just for her carpal tunnel problem. He told me my notes were very good, and I continue to do complete notes, although we did come up with a template so she did not have to re-transcribe every normal HEENT, heart and lung exam, etc.

 

BTW: AAPA has updated some of their literature and there is one called "What is a PA". It does a decent job of describing us and actually states that studies have shown that PA's give high quality and equal care as that of a physician. Now if only Ms. Davis had used that piece for her crib sheet. It was updated Feb. 2012. I encourage everyone to check it out on AAPA web site.

[EMEDPA]

Show me one example of the above in AAPA news releases and PR materials.

 

"PAs help alleviate some of the routine work for physicians to help maximize office hours and treat more patients"

 

SOURCE: http://www.aapa.org/the_pa_profession/quick_facts/resources/item.aspx?id=3838

 

PA's do more than "routine work" which frees up physicians to see sicker patients...

sure we all have sp's(in my state sp= "sponsoring physician") but we don't all work side by side with them or even see them on a regular basis. my interaction with my sp is an occasional email or note in my box maybe once/month. we almost never work together(maybe 2-3 x/yr).

PA's are saving the healthcare system money by giving physician level care for 1/2 the price. I appreciate having the ability to call someone for a consult but the truth of the matter is that it is never my sp but a specialist in another field. the vast majority of the time(>90%) if I don't know something they don't either and they just tell me to call the specialist I would have called in the first place..after that happens a bunch of times I stop asking them and go right to the source...

 

what really needs to be spread around is this info(also from aapa but buried in the history of the profession section):

 

The PA profession was created to improve and expand healthcare. In the mid-1960s, physicians and educators recognized there was a shortage of primary care physicians. To remedy this, Dr. Eugene Stead of the Duke University Medical Center put together the first class of PAs in 1965. He selected Navy corpsmen who had received considerable medical training during their military service.

Dr. Stead based the curriculum of the PA program on his knowledge of the fast-track training of doctors during World War II. The first PA class graduated from the Duke University PA program on Oct. 6, 1967.

The PA concept was lauded early on and gained acceptance and backing federally as early as the 1970s as a creative solution to physician shortages.

 

source:

http://www.aapa.org/the_pa_profession/history.aspx

[andersenpa]

This is, from my perspective, and indefensible interview.

Steve, I appreciate you coming to this forum and bear the brunt of our ire at the AAPA. You'll have to remain the face of the AAPA at the forum given your history, so know that my comments aren't necessarily directed at YOU but at the organization you headed.

 

I have only read the transcript so perhaps things came across differently in the audio.

 

Ms Davis had multiple opportunities to do more than give a feeble description of our training and work. As you know, there are many PAs out there who feel that their role in medicine, the level of medicine they practice, and the amount of responsibility they bear...is undercut. Whether we fall back on the concept of supervision or not, we must not dance around the fact that we practice medicine. When people as me what PAs do, I say, we practice medicine. The "...with supervision" qualifier is not necessary to describe what we do, and as you can tell, it distracts from the level of care we provide. Maybe that's just personal philosophy, but I think most autonomous PAs would agree.

 

The most egregious insult was against primary care PAs. I’ll be damned if PAs aren’t providing physician level care. I see it in my world all the time from the PAs and NPs that refer pts to us for stress testing and end up w/ CABG/etc. So to tell the world of radio listeners, many of whom may have PAs or NPs as their PCPs, that “primary care requires the physician's full talent and training”, was indelibly damaging.

 

In my opinion she failed PAs nationwide. To say that Ms Davis was offering the AAPA talking points is understandable/consistent with her role at the AAPA, makes it no less outrageous. She "dissed" the work of thousands of PAs. She should ask herself who she is representing, PAs or the AAPA.

I don't know her. You do. She may be a great friend or have long term years of service. None of that matters, because when the time came to REPRESENT the profession, she failed. She represented the message she was asked to give, not the reality of PA practice. Or....perhaps she is out of touch with what rank and file PAs are actually doing in the US (PRACTICING MEDICINE). Who knows.

 

Her fallback descriptives are awful:

 

Nurses and clerical staff can act as coordinators of care. PAs practice medicine.

Debakey forceps “extend the reach of physicians”. PAs practice medicine.

Docs, nurses, MPHs can all promote health awareness. It’s not the forefront of what PAs “do”, or what should define us. PAs practice medicine.

 

Why is Ms Davis so afraid to state what PAs do (practice medicine) and instead seek to magnify our lowest common denominators (retail clinics), technical functions (suture monkeys, emphasizing work that “didn't really require really advanced training”), or peripheral roles (coordinating grandma’s HD)?????

 

We could go further to talk about her claim that PA pay is “fine”, since I know many primary care PAs who exceed the productivity of their physician colleagues, with bare minimum “supervision” (chart review), who are getting hosed on compensation. We need to move away from the idea that “what physicians have to go through” and their “debt” should determine their salary. By that rationale we should all show our mortgages and debts to out employers to determine our salary. Sounds stupid, because it is. But I know the AAPA doesn’t have the guts or the incentive to pick up that fight.

 

PAs have been howling for a national voice in PR. Here it was, served up on a platter. And once again the AAPA failed us. Their priorities may be their undoing.

[joanna.nola]

The AAPA puts out great material, like what Paula, EMEDPA, and others reference. On their website and publications, they have good information. But that website is for US (PA's). I seriously doubt the public or doctors are trolling it too frequently. What matters is what we actually say in venues like a radio interview--places the public can learn about us. So that is why I think it was a *conscious* decision to downplay what might be seen as offensive to doctors. The fact that she never said *we practice medicine* (with supervision or any other qualifier), makes me think that the AAPA has made a decision to not use this phrase. I can imagine her prep for the interview w/ other leadership in the AAPA ("emphasize the coordination we provide." "emphasize the extension of doctors." "DO NOT SAY WE PRACTICE MEDICINE.") Unfortunately, all this tip-towing around made for a very confusing portrayal of what we actually do. People don't know what extension, coordination or any of that means. They might think that we are actually doctor's administrative assistants.

 

Many more experienced PAs on this forum are asking the same questions about the AAPA's priorities.

 

I joined AAPA in school; I have a few more months as a member, cause I'm a recent grad. I think organization is exteremely important, so I'd like to remain a member. But I worry that it isn't the strong advocate we need. But is there any other option?????

[burnpac]

"PAs help alleviate some of the routine work for physicians to help maximize office hours and treat more patients"

 

SOURCE: http://www.aapa.org/the_pa_profession/quick_facts/resources/item.aspx?id=3838

 

PA's do more than "routine work" which frees up physicians to see sicker patients...

sure we all have sp's(in my state sp= "sponsoring physician") but we don't all work side by side with them or even see them on a regular basis. my interaction with my sp is an occasional email or note in my box maybe once/month. we almost never work together(maybe 2-3 x/yr).

PA's are saving the healthcare system money by giving physician level care for 1/2 the price. I appreciate having the ability to call someone for a consult but the truth of the matter is that it is never my sp but a specialist in another field. the vast majority of the time(>90%) if I don't know something they don't either and they just tell me to call the specialist I would have called in the first place..after that happens a bunch of times I stop asking them and go right to the source...

 

what really needs to be spread around is this info(also from aapa but buried in the history of the profession section):

 

The PA profession was created to improve and expand healthcare. In the mid-1960s, physicians and educators recognized there was a shortage of primary care physicians. To remedy this, Dr. Eugene Stead of the Duke University Medical Center put together the first class of PAs in 1965. He selected Navy corpsmen who had received considerable medical training during their military service.

Dr. Stead based the curriculum of the PA program on his knowledge of the fast-track training of doctors during World War II. The first PA class graduated from the Duke University PA program on Oct. 6, 1967.

The PA concept was lauded early on and gained acceptance and backing federally as early as the 1970s as a creative solution to physician shortages.

 

source:

http://www.aapa.org/the_pa_profession/history.aspx

 

This is a far cry from your original statement. It is in fact true in my situation, and I'm proud of the role that I play in my surgical practice. I first assist on the most complicated reconstructive cases. I perform many of the surgeries as lead surgeon with a tech when my SP dictates and doesn't even bother to scrub. Together, I work to take the brunt of the administrative BS of surgery and medicine so that he can focus on operating and consulting. We go home together at the same late hour every night. Of course PAs do more than "routine work" in every practice.

 

Just a note about your statement regarding the cost to the system. Who benefits from the cost savings of PAs? In most instances, it is our physician colleagues and not the system, unless we are employed by the government. My situation is different in that my SP is my business partner, and he allows me bill consults and first assist directly from my corporation with no cut for him. I get reimbursed at prevailing rates, hardly a "savings" to the health care system.

 

You need to lighten up and allow that all of our contributions to the practice of medicine are valuable and unique to the infinite variety of practice environments in which we find ourselves.

[burnpac]

AndersenPA -- While I'll concede that this may have been less than her finest hour (with all the caveats of what actually happens in a media interview), I can think of no more intelligent and effective advocate for the profession than Ann Davis, PA-C.

 

If I were to go into battle at any level, from local government to the White House, she would be my first pick everytime without question or reservation. Her record on the legislative front over 20 years speaks for itself. Ask any state or specialty GAC chair and they will back me up.

[burnpac]

Burnpac: I keep the ducks in a row! I keep up on my state laws. My SP is not required to sign anything, but signs everything. He signs all the NP's stuff, too and all after the fact. I keep him informed of any patients that require a second set of eyes. We don't have EHR yet, so the signing of charts and orders is extremely burdensome for us and in my opinion, dangerous. It can take weeks before labs and notes are put in the charts. I'm a bit of a type A so I spend inordinate amounts of time looking for labs and notes to review what has been done by the NP and MD, and often times, end up following up on all the stuff that has been buried in the pile and forgotten about. It is always a good reminder though from colleagues to think about lawsuits, etc. I dictate and document with that in mind, and the transcriptionist has complained that my notes are too long. I was beckoned into my SP's office with that complaint and I discussed with him that I could not in good conscience dictate shorter notes just for her carpal tunnel problem. He told me my notes were very good, and I continue to do complete notes, although we did come up with a template so she did not have to re-transcribe every normal HEENT, heart and lung exam, etc.

 

BTW: AAPA has updated some of their literature and there is one called "What is a PA". It does a decent job of describing us and actually states that studies have shown that PA's give high quality and equal care as that of a physician. Now if only Ms. Davis had used that piece for her crib sheet. It was updated Feb. 2012. I encourage everyone to check it out on AAPA web site.

 

Glad to hear it Paula. I have no doubt that you practice stellar medicine, but know first hand how challenging a situation like yours can be to keep it between the regulatory lines.

 

Check out DrChrono.com. We have been using this for six months in our practice and we love it. You can retire your transcriptionist as it has medical grade, adaptive dictation built in. Allows for electronic supervisorial sign off prn.

 

I carry my iPad everywhere now as between this software and loading Cerner on Citrix Receiver, I haven't looked at a paper chart in or outpatient for months.

[joanna.nola]

Burnpac, I know you are forced to represent the AAPA here and that may be unfair, but still, I find it interesting that you are defending Ms. Davis' long record, but not actually addressing what she said. You state that Ann Davis is a great advocate for our profession (and she may very well be, I'm not questioning that), but what AndersenPA (and I) bring up, is that she chose specifically to present the profession as extenders and coordinators (not practicers of medicine). She downplayed our training. This did not seem like jitters during a radio show, this seemed like a conscious decision. I've highlighted, in a previous post, where she uses this language again and again. This repetition suggests that she went into this interview intending to give that message. I (and others) are wondering if this is a strategy of the AAPA. As a member, I think I deserve to know. Because that is not the impression I get from the website and elsewhere, where PAs *are* presented as medical practitioners. I realize you are no longer in leadership and are also being put on the spot in this forum, but if you continue to defend her record, I think you should also speak to what she's said in this interview and what it means for the AAPA, who she was acting in official capacity as a representative.

[burnpac]

Joanna - I have known Ann Davis for a long time and consider her a stellar individual and exceptional leader. She has been a mentor of mine my entire career. Some of the comments in the interview are unfortunate and not representative of how I know that Ann feels about these issues. You and others can disparage her all you want; but don't expect me to participate. Due to my respect for her, and having been in the same situation, I will give her the benefit of the doubt every time. My apologies if that doesn't meet the approval of folks on this forum.

 

BTW, I'm not "forced" to represent the AAPA or anything or anyone else. My opinions and observations are exactly that; mine. They are based on my experience as a professional PA, and as a leader, over a four decade career. Please take whatever I say with a healthy grain of salt.... :-)

 

If you want to know the official AAPA position on this or any other issue, contact President Delaney. He currently speaks for the AAPA as their official spokesperson.

[cinntsp]

I joined AAPA in school; I have a few more months as a member, cause I'm a recent grad. I think organization is exteremely important, so I'd like to remain a member. But I worry that it isn't the strong advocate we need. But is there any other option?????

 

I was originally not going to join because I don't feel they are advocating for the profession in some of the areas they should be(or at least not to the degree that they should be). I've become consistently disappointed over the past couple of years as a pre-PA and now a PA student as these types of situations repeatedly crop up and knowing that I'm investing tons of time and $$$ only to be terribly misrepresented(imo). Eventually I came to the conclusion that if I don't want to be an assistant that does coordination of care and the occasional suturing for the next 40 years, I'll need to pay my membership fee and try to change where the AAPA is headed. I gave them my $75 a couple weeks ago and I'm hoping it'll be enough to build my soap box.

[Guest Paula]

Glad to hear it Paula. I have no doubt that you practice stellar medicine, but know first hand how challenging a situation like yours can be to keep it between the regulatory lines.

 

Check out DrChrono.com. We have been using this for six months in our practice and we love it. You can retire your transcriptionist as it has medical grade, adaptive dictation built in. Allows for electronic supervisorial sign off prn.

 

I carry my iPad everywhere now as between this software and loading Cerner on Citrix Receiver, I haven't looked at a paper chart in or outpatient for months.

 

Oh, no! We cannot retire our transcriptionist for the sake of joining the 21st century. (Tongue in Cheek)! She would be unemployed and no where else to work in the depressed Upper Peninsula. We will be implementing Indian Health Service EHR in the next 6-12 months, red-tape permitting.