Talk of the Nation: NPR

[burnpac]

We need to take some ownership of the role we have earned in the health care market, based on >40 yrs of excellent, competent medical practice.

 

I could not agree with you more.

 

Thinking about this thread today, I had a epiphany moment regarding how we are framing this discussion, and how off base it was.

 

It seems that we are polarized into the "doctors helper / assistant" vs. the "brain surgeon" dichotomy when this is not the really important issue.

 

I blame many things for this, not the least of which is our education and acculturation as PAs, which for the most part has been obtained in schools of medicine. We are products of that system.

 

We subtly and unconsciously have been trained to revere the specialist, the surgeon, and the pinnacles of our medical profession as the utmost expression of excellence in the practice of medicine. We aspire to what we have been taught is "excellence", and have also been taught to look down on all else. From day one, medical education for physicians and PAs is chock full of peer pressure and pecking orders that reinforce these stereotypes and biases.

 

We see it every day in the surgery suite when we joke about "real surgery", and acculturate our students to the concept of "surgery good", "general practice" bad, among other pressures. It is cynical but very real. We learn to hold in high value procedures, and technically complicated medicine. But is it really what is most important to our health care system?

 

Paula works among a medically underserved population, and I'm confident she serves them well and with compassion. But, what is the most important part of her job? That she can practice independently, diagnose DM and HTN, prescribe medication, set fractures, and suture wounds, or that she can detect medical illiteracy, understand the cultural differences of the population that she serves, assess the social and family safety net, and improve community health by removing the barriers to health that go well beyond medication, and diagnostic and therapeutic intervention?

 

The folks who are making health policy on the state and federal level are not medical people, and don't care one iota what we or any other health profession are called. They only care about three things. How much does it cost? Who is going to pay for it? And what outcomes can we expect (both political and tangible)? As to health care professionals, they care only about what we as PAs can do to help them achieve those goals. To that end has been the driver of health care reform, and talk and legislation surrounding concepts such as accountable care organizations, chronic care management, the medical home, etc., etc.

 

The emphasis is dramatically shifting towards valuing measurable outcomes in our patient populations. Such as how well we manage HTN, DM CVD, and other chronic diseases, with the very big hammer as to financial incentives tied to measurable outcomes determining reimbursement. We already have a healthy does of this on the inpatient side.

 

What will be valued in medicine in the near and long term future is exactly what PAs have in abundance. And that is the expertise both in the practice of medicine, as well as in education, case management, counseling, etc., and many other tasks that we have "traditionally" been trained to look down on as what "doctors helpers" do.

 

One of the main motivators (cynical alert) that drives physicians into specialty practice is money. PAs have followed their physician counterparts for similar reasons. We go where the need and jobs are. Health policy legislative folks are going to force change in the traditional paradigm in a big way in the very near future. It is already happening. General practice specialties, long the bottom of the food chain in medicine, are going to be elevated in the system through the incentive of money (and hopefully to a great extent because it is the right thing to do). This is great news for team practice and general medical subspecialties, and better news for PAs, who have the entire package as the best health care utility player out there for the foreseeable future.

 

So, I perceive the doctors helper vs brain surgeon debate as the wrong debate, and reflects more about us internally than anything that matters to the health care system. Let's think about really valuing the things that matter to the health and well being of our communities (which PAs can deliver in every conceivable way as well as level of the health care system), and we won't have to worry about the future of the profession, ever.

[joanna.nola]

I could not agree with you more.

 

Thinking about this thread today, I had a epiphany moment regarding how we are framing this discussion, and how off base it was.

 

It seems that we are polarized into the "doctors helper / assistant" vs. the "brain surgeon" dichotomy when this is not the really important issue.

 

I blame many things for this, not the least of which is our education and acculturation as PAs, which for the most part has been obtained in schools of medicine. We are products of that system.

 

We subtly and unconsciously have been trained to revere the specialist, the surgeon, and the pinnacles of our medical profession as the utmost expression of excellence in the practice of medicine. We aspire to what we have been taught is "excellence", and have also been taught to look down on all else. From day one, medical education for physicians and PAs is chock full of peer pressure and pecking orders that reinforce these stereotypes and biases.

 

We see it every day in the surgery suite when we joke about "real surgery", and acculturate our students to the concept of "surgery good", "general practice" bad, among other pressures. It is cynical but very real. We learn to hold in high value procedures, and technically complicated medicine. But is it really what is most important to our health care system?

 

Paula works among a medically underserved population, and I'm confident she serves them well and with compassion. But, what is the most important part of her job? That she can practice independently, diagnose DM and HTN, prescribe medication, set fractures, and suture wounds, or that she can detect medical illiteracy, understand the cultural differences of the population that she serves, assess the social and family safety net, and improve community health by removing the barriers to health that go well beyond medication, and diagnostic and therapeutic intervention?

 

The folks who are making health policy on the state and federal level are not medical people, and don't care one iota what we or any other health profession are called. They only care about three things. How much does it cost? Who is going to pay for it? And what outcomes can we expect (both political and tangible)? As to health care professionals, they care only about what we as PAs can do to help them achieve those goals. To that end has been the driver of health care reform, and talk and legislation surrounding concepts such as accountable care organizations, chronic care management, the medical home, etc., etc.

 

The emphasis is dramatically shifting towards valuing measurable outcomes in our patient populations. Such as how well we manage HTN, DM CVD, and other chronic diseases, with the very big hammer as to financial incentives tied to measurable outcomes determining reimbursement. We already have a healthy does of this on the inpatient side.

 

What will be valued in medicine in the near and long term future is exactly what PAs have in abundance. And that is the expertise both in the practice of medicine, as well as in education, case management, counseling, etc., and many other tasks that we have "traditionally" been trained to look down on as what "doctors helpers" do.

 

One of the main motivators (cynical alert) that drives physicians into specialty practice is money. PAs have followed their physician counterparts for similar reasons. We go where the need and jobs are. Health policy legislative folks are going to force change in the traditional paradigm in a big way in the very near future. It is already happening. General practice specialties, long the bottom of the food chain in medicine, are going to be elevated in the system through the incentive of money (and hopefully to a great extent because it is the right thing to do). This is great news for team practice and general medical subspecialties, and better news for PAs, who have the entire package as the best health care utility player out there for the foreseeable future.

 

So, I perceive the doctors helper vs brain surgeon debate as the wrong debate, and reflects more about us internally than anything that matters to the health care system. Let's think about really valuing the things that matter to the health and well being of our communities (which PAs can deliver in every conceivable way as well as level of the health care system), and we won't have to worry about the future of the profession, ever.

 

 

Stephen--I see what you are trying to say here, but you are not getting at the heart of the debate. This is not some fetishization of the All Powerful Specialist. This particular thread actually isn't about surgical PA vs. primary care PA. This isn't about how much specialists get paid, or even directly about policy.

 

Reread the thread. Ann Davis struck a nerve in all of us because of what she said and--more importantly-- what *she did not say.* She did not say that PAs PRACTICE MEDICINE.

 

Does Paula practice medicine? (You did not say that she does.) Your description of her work smacks of condescension, whether you intended it or not. The day Paula described is a similar day for all primary care practitioners, especially in underserved areas, whether they are PAs, MDs, or NPs. Her day sounded exactly like many of my future SP's days, and I'm sure he'll be happy to know that he's practicing medicine (I'll let him know). And when I work there, I won't educate, counsel, or coordinate specialists for his patients. He'll do that. And I'll do the same for my patients. Of course, I'll have a lot more contact with my SP than Paula does, because I'm a new PA. But I will act as my patients' primary care provider, which means (I hope) that I do a lot more than push pills. What you described is not "doctor's helper" stuff (can it be if doctors do it, too? or does it only become doctor's helper stuff when we do it?) It is part and parcel of the practice of primary care medicine. And even though it is something that PAs do well, it is not the only thing we bring to the table. We do all these things in the course of practicing medicine, just like family practice docs. The difference is, family practice docs don't have worry that what they do won't be considered practicing medicine.

[burnpac]

Stephen--I see what you are trying to say here, but you are not getting at the heart of the debate. This is not some fetishization of the All Powerful Specialist. This particular thread actually isn't about surgical PA vs. primary care PA. This isn't about how much specialists get paid, or even directly about policy.

 

Reread the thread. Ann Davis struck a nerve in all of us because of what she said and--more importantly-- what *she did not say.* She did not say that PA's PRACTICE MEDICINE.

 

Does Paula practice medicine? (You did not say that she did.) Your description of her work smacks of condescension, whether you intended it or not. The day Paula described is a similar day for all primary care practitioners, especially in underserved areas, whether they are PAs, MDs, or NPs. Her day sounded exactly like many of my future SP's days, and I'm sure he'll be happy to know that he's practicing medicine (I'll let him know). And when I work there, I won't educate, counsel, or coordinate specialists for his patients. He'll do that. And I'll do the same for my patients. Of course, I'll have a lot more contact with my SP than Paula does, because I'm a new PA. But I will act as my patients' primary care provider, which means (I hope) that I do a lot more than push pills. What you described is not "doctor's helper" stuff (can it be if doctors do it, too? or does it only become doctor's helper stuff when we do it?) It is part and parcel of the practice of primary care medicine. And even though it is something that PAs do well, it is not the only thing we bring to the table. We do all these things in the course of practicing medicine, just like family practice docs. The difference is, family practice docs don't have worry that what they do won't be considered practicing medicine.

 

Joanna - It this is all you got out of what I wrote, then I utterly failed to express my thoughts effectively. Of course Paula practices medicine. I practice medicine. You practice medicine. That is what is meant by practicing independently. It would be nice if your description of what an FP physician does (which would be my description too so don't also accuse me of sarcasm.... :-) ) was universal to physicians and the health care system. Let me know if you feel the same way after you work with ER physicians or surgeons.

 

I have reread the thread many times, and if you think that this is only about whether or not Ann stated that "PAs practice medicine," then you are misinterpreting what is truly being discussed here. However, you and everyone else here taking the time out of their busy day practicing medicine is entitled to their opinion, and I will hang onto mine.

[joanna.nola]

Joanna - It this is all you got out of what I wrote, then I failed to express my thoughts effectively. Of course Paula practices medicine. I practice medicine. You practice medicine. That is what is meant by practicing independently. It would be nice if your description of what an FP physician does (which would be my description too so don't also accuse me of sarcasm.... :-) ) was universal to physicians and the health care system.

 

I did read what you wrote, and I believe I understood it. It would be something interesting to discuss in a different thread. But what you said is not at the heart of the concern on this thread. You say "of course" we practice medicine. That is not what Ann Davis, as a rep of the AAPA, conveyed in her interview. And therein lies the rub.

[DJ Bunnell MSHS PA-C]

I am just coming across this discussion and am genuinely surprised at the tone. I listened to the radio program last week and came across with a completly different impression. I came away with the idea that the US is facing a massive shortage of providers in primary care and that PAs are part of the answer in how to bridge the gap. I would be surprised if the casual listener came across with a different message. We, of course, are a different audience who tend to be on the hunt for the occasionally offensive apostrophe. At the end of the day, the AAPA advocated for our profession on a national forum. I get that there are four pages of people who disagree with me but I saw this as a positive interview.

[Contrarian]

Just a couple of humorus observations...

 

I need to see some data on where newly graduated PAs end up practicing, but my anecdotal data with involvement at 2 PA programs suggests that a sizable percentage of them are NOT going into primary care. After all, who could blame them? If you are given the option of starting out at 120-140k in a subspecialty vs 80k in primary care, its not hard to see why most of the PA students I know are talking about going into surgical fields or other lucrative subspecialties

 

So YOU need to see some "data" on where new PAs practice... but then immeadiately toss out a inflated new grad salary without providing DATA...

 

 

 

Joanna - It this is all you got out of what I wrote, then I utterly failed to express my thoughts effectively. Of course Paula practices medicine. I practice medicine. You practice medicine. That is what is meant by practicing independently. It would be nice if your description of what an FP physician does (which would be my description too so don't also accuse me of sarcasm.... :-) ) was universal to physicians and the health care system. Let me know if you feel the same way after you work with ER physicians or surgeons.

 

I have reread the thread many times, and if you think that this is only about whether or not Ann stated that "PAs practice medicine," then you are misinterpreting what is truly being discussed here. However, you and everyone else here taking the time out of their busy day practicing medicine is entitled to their opinion, and I will hang onto mine.

 

Yes... again you 'utterly failed to express your thoughts effectively.'

 

Who is talking about "practicing independently"... and why is that relavent to what she is talking about here... ??

Which seemed to be that the official AAPA voice, FAILED to drive home the message that like their physician supervisors/sponsors/counterparts... PAs PRACTICE MEDICINE in every specialty regardless of the daily administrative minutia.

 

What does her description of "what an FP physician does" have to do with 'her working with ER physicians or surgeons'...???? Sounds like a dismissive "bait and switch" or strawman. Hell... most specialist don't think non-invasive radiologist actually "practice medicine" by sitting at home and reading images on the home computer... but that doesn't make it so.

 

Every post YOU write digs a deeper hole and reinforces the idea that its long time for the AAPA old guard to pack it on up and move into the retirement villa...

 

Contrarian

 

P.s... your contempt for non-AAPA groupies is barely hidden in the under tones of your replies.

Keep up the good work....!!!

[lkitsko1]

I just finished listening to the interview and I did not feel slighted by the PA spokesman. I thought the moderator was a tool and clueless about the PA profession, but I did not feel the PA sabotaged the profession. I wish she would have corrected him regarding "physician's assistant." I can understand PA's being upset that she didn't say we practice medicine, but I really think she was trying to use the Team concept between PAs and docs. Just my 2 cents.

[burnpac]

I did read what you wrote, and I believe I understood it. It would be something interesting to discuss in a different thread. But what you said is not at the heart of the concern on this thread. You say "of course" we practice medicine. That is not what Ann Davis, as a rep of the AAPA, conveyed in her interview. And therein lies the rub.

 

Joanna - I think that it is interesting to discuss in this thread, and is on topic in my opinion. Who decides what is "...at the heart of concern on this thread."? We are having an intelligent, respectful and spirited conversation about a seemingly simple issue, which I opine is not so simple and straightforward. Just like everything in the practice of medicine. That which seems simple and straightforward, never is. That is the perspective I'm trying to bring here. I have a different opinion as to what Ann was trying to convey in her interview, and a different interpretation as to what are the real issues, which is equally valid to your opinion and interpretation.

[LIPPER]

I think it all depends what your meaning of the word "is"....is

[Acromion]

I just finished listening to the interview and I did not feel slighted by the PA spokesman. I thought the moderator was a tool and clueless about the PA profession, but I did not feel the PA sabotaged the profession. I wish she would have corrected him regarding "physician's assistant." I can understand PA's being upset that she didn't say we practice medicine, but I really think she was trying to use the Team concept between PAs and docs. Just my 2 cents.

 

I agree. It was a roundtable discussion about ways of alleviating the primary care shortage intended for a general audience. She did a good job of explaining how PA's can make better use of physician resources. I'm guessing she kept using "collaboration" because everyone now is talking about how "fragmented" our system is. This is good PR. If you have 5 minutes if airtime to explain the PA role in improving primary care to a lay audience, focus on easy to swallow buzzwords. Do I know exactly where a paralegal's abilities end and a lawyers' begin? No, and why should I? I don't know enough about law to understand that distinction anyway. All I need to know is that I can trust this arrangement. (Also she probably didn't want to correct or overstep the host when he told his anecdote about the PA who sutured his hand. It can make you sound arrogant and you could alienate the audience.)

 

PA's need good advocacy and lobbying, but I really don't see what everyone is getting so worked up about. The healthcare landscape in the next few decades could not be more favorable for our profession. Few professions in this economy can say that.

 

Those of you still worried about independent practice arent paying attention to the big picture. Primary care is consolidating into large managed practices. More and more doctors will be employees rather than solo practitioners. I know many docs already closing up shop and joining large practices because they cant afford to practice solo anymore.

 

Everyone is trying to cut costs, everywhere. Insurance companies, Medicare, and Medicaid will try to squeeze every last dime out practitioners. Doctors will be subject to increasingly stringent cost containment guidelines and PA's will be used to their maximum potential.

 

The whole paradigm is shifting and some of you are still stuck fighting yesterday's turf wars. Look how foolish the NP's have been. In their perpetual insecurity over not being a doctor, they went ahead and made up their own clinical doctorate, and then made it mandatory to practice as an NP. So when everyone else is trying to move toward cheaper more efficient education, standardized practice, and measurable outcomes, they went in the opposite direction! They took their one bargaining chip, which was the ability to provide cheaper primary care, and threw that away so they could call themselves doctor. (question: Will they still be licensed under the nursing boards?) And why would we want to risk alienating the docs? We know who butters our bread, and frankly, it's not such a bad arrangement.

 

I'm still a PA student, so perhaps you will think I'm naive, but I'm not at all worried about our role in healt care. Health care is big business, and the people who make the important decisions know what PA's do and if they don't yet they will soon. Whether we are called "assistant" or "associate" is so irrelevant at this point. No one cares about that outside our professional enclave. We should be focusing on big ticket items like tort reform or passing legislation favorable to PA's like the bill allowing us to provide end of life care.

 

Ok theres my 2 cents Ill get off the soapbox now.

[joanna.nola]

Ok, talk about whatever you want to, Stephen. Threads rarely stay on one point.

 

Personally, I want to focus on Ann Davis (as an AAPA rep) failing to mention that we practice medicine in a 30 minute interview where she was given every chance and opportunity to do so. And perhaps talk about a way to move forward. Or, if it's easier to hear coming from a more experienced PA, my point is that "the official AAPA voice, FAILED to drive home the message that like their physician supervisors/sponsors/counterparts... PAs PRACTICE MEDICINE in every specialty regardless of the daily administrative minutia."

Thanks, Contrarian.

 

And one more thing while we are talking about opinions. That she failed to mention we practice medicine is actually a FACT. My analysis that this is a VERY BAD thing for our profession is my OPINION. Fortunately, I'm not alone in this opinion.

[Guest hubbardtim48]

"they went ahead and made up their own clinical doctorate, and then made it mandatory to practice as an NP." Not a true statement...it is NOT mandatory.

[Guest hubbardtim48]

Requiring BSN for all RNs to work...not in my area. DNP is not a clincial doctorate and yes the BON wanted to be "nursing doctors" because they have more education that physicians...what a big bunch of crap...that DNP is only for the public to make everyone think they are "doctors" and they really did something to gain a DNP. How is the DNP NOT going to cost everyone more? It is one big pi$$sing contest between docs and RNs and it is getting old. If one wants to be a physician then go to medical school, if not then suck it up and do your job. Also, medical schools are becoming cheaper by adding the 3 year primary care route. Don't see them adding another docotorate to make the public think they are God.

[burnpac]

...if it's easier to hear coming from a more experienced PA....

 

It seems that I'm not alone in my opinion either....

 

Joanna, I respect your opinion and viewpoints. As far as I'm concerned, you are a licensed PA, and my peer and colleague. You and others on this forum care about the profession and want to make a positive difference. That is all I need to know about you.

 

As we learn on this forum and in life every day, experience doesn't necessarily equal intelligence, or accurate information.... :-)

[joanna.nola]

Joanna, I respect you opinion and viewpoints. As far as I'm concerned, you are a licensed PA, and my peer and colleague. You and others on this forum care about the profession and want to make a positive difference. That is all I need to know about you.

 

As we learn on this forum and in life every day, experience doesn't necessarily equal intelligence, or accurate information.... :-)

 

Thanks. I learn a lot from all the more experienced PAs on this forum, you included, of course; I'm grateful this forum exists. Although, as you point out, we all have to form our own opinions (and maybe take some information on here with a grain of salt). Fortunately, I don't think the PA profession is lacking in critical thinkers and opinionated folks! I think we can all agree that we want the PA profession to grow and be better understood and respected by the public. We are on that path, but certainly have our work cut out for us!

[burnpac]

Thanks. I learn a lot from all the more experienced PAs on this forum, you included, of course; I'm grateful this forum exists. Although, as you point out, we all have to form our own opinions (and maybe take some information on here with a grain of salt). Fortunately, I don't think the PA profession is lacking in critical thinkers and opinionated folks! I think we can all agree that we want the PA profession to grow and be better understood and respected by the public. We are on that path, but certainly have our work cut out for us!

 

Well said, and I agree. What is missing from this discourse is the "human moment". If we were all working together in person everyday, our discourse would be much different because of the professionals that we are, and how we have been brought up to act in the social environment. We lose all of the visual cues and nonverbal communication critical to full understand on a text based forum such as this.

 

All the best to you.

[andersenpa]

I agree. It was a roundtable discussion about ways of alleviating the primary care shortage intended for a general audience. She did a good job of explaining how PA's can make better use of physician resources. I'm guessing she kept using "collaboration" because everyone now is talking about how "fragmented" our system is. This is good PR. If you have 5 minutes if airtime to explain the PA role in improving primary care to a lay audience, focus on easy to swallow buzzwords. Do I know exactly where a paralegal's abilities end and a lawyers' begin? No, and why should I? I don't know enough about law to understand that distinction anyway. All I need to know is that I can trust this arrangement. (Also she probably didn't want to correct or overstep the host when he told his anecdote about the PA who sutured his hand. It can make you sound arrogant and you could alienate the audience.)

 

Paralegals don't practice law; PAs practice medicine. The training for each profession relative to MD or JD is different. So it's not a good analogy.

My criticism is that PAs rarely have a national voice to reach a large audience, and when they do, they need to take advantage of that opportunity. There is a necessity to use the talk about PA practice to springboard into further education of the general public about what we do. We have never had that microphone, so we need to use any in we can get.

Furthermore patients cannot "trust that arrangement" when an AAPA repair says that it takes a physician's full training to practice primary care. Not exactly creating trust.

 

PA's need good advocacy and lobbying, but I really don't see what everyone is getting so worked up about. The healthcare landscape in the next few decades could not be more favorable for our profession. Few professions in this economy can say that.

 

Those of you still worried about independent practice arent paying attention to the big picture. Primary care is consolidating into large managed practices. More and more doctors will be employees rather than solo practitioners. I know many docs already closing up shop and joining large practices because they cant afford to practice solo anymore.

 

This thread is not about independent practice (?) This is about creating a national brand for PAs which is defined as a professional who practices medicine, not a coordinator or procedure monkey.

 

Everyone is trying to cut costs, everywhere. Insurance companies, Medicare, and Medicaid will try to squeeze every last dime out practitioners. Doctors will be subject to increasingly stringent cost containment guidelines and PA's will be used to their maximum potential.

 

The whole paradigm is shifting and some of you are still stuck fighting yesterday's turf wars. Look how foolish the NP's have been. In their perpetual insecurity over not being a doctor, they went ahead and made up their own clinical doctorate, and then made it mandatory to practice as an NP.

 

They have expanded their ability to practice independently every year, and have been more successful at creating their own brand- as a legit independent PCP alternative to physicians. Hardly foolish.

 

In their perpetual insecurity over not being a doctor, they went ahead and made up their own clinical doctorate, and then made it mandatory to practice as an NP. So when everyone else is trying to move toward cheaper more efficient education, standardized practice, and measurable outcomes, they went in the opposite direction!

 

Agree that they may hurt themselves trying to get 100% reimbursement parity, but if they have market share then they win either way. They are looking to further their profession and not always defaulting to the need to service the health care system before establishing their niche.

 

They took their one bargaining chip, which was the ability to provide cheaper primary care, and threw that away so they could call themselves doctor. (question: Will they still be licensed under the nursing boards?) And why would we want to risk alienating the docs? We know who butters our bread, and frankly, it's not such a bad arrangement.

 

They did not pursue the DNP for the title alone, a common misunderstanding. The importance is in how the degree and the title create opportunities in leadership, administration, management, and education. These opportunities then create a fertile base of NPs in the areas where system-wide workforce decisions are made- and you can be damn sure they're going to implement NPs, not PAs.

 

I'm still a PA student, so perhaps you will think I'm naive, but I'm not at all worried about our role in healt care. Health care is big business, and the people who make the important decisions know what PA's do and if they don't yet they will soon.

 

They don't. It's evident in mutliple pieces of legislation that have come out in the past few years, in the health care news where journalists cite docs and NPs/nursing but not PAs, in the interactions that trailblazing PAs have with the barriers to practice thrown down by the states and insurers.

 

Whether we are called "assistant" or "associate" is so irrelevant at this point.

 

See the above about how titles and degrees create opportunities. It's not as irrelevant as you think.

 

No one cares about that outside our professional enclave.

 

Why would they? As you alluded to they probably don't know what we do. Wy would they care about a title when they get what they want from us- graduate level trained providers who practice gold standard medicine and get underpaid relative to their physician counterparts? Most egregious in the primary setting where PA vs MD practice is often indecipherable to the lay person. If they do the same job, they should have the same opportunities.

 

We should be focusing on big ticket items like tort reform or passing legislation favorable to PA's like the bill allowing us to provide end of life care.

 

Ok theres my 2 cents Ill get off the soapbox now.

 

The pursuit of those items is important. But like a true AAPA talking point, you indicate that we need to do those things before anyone else. They need to be pursued simultaneously as part of a multipronged campaign.

[Guest hubbardtim48]

I would rather be true to someone in telling them my actual skills/knowledge base then by adding a DNP to my name and calling my self doctor hubbardtim48 so I "look/feel" better about my self. That is a crappy way to make your BON look better by making people think you are something YOU ARE NOT. In the long run their image will NOT be improved when everyone understands the DNP curriculum and it is nothing close to a clinical doctorate. I don't really care nor do I know about the cost of the DNP to the BON, but it only makes sense that it will cost more to everyone because of the push for all nursing schools to have it and for the public to know about it. The 3 year medical school DOES cost around $50,000 dollars less, read all the articles about it and how would it NOT cost less if you cut year off and are not paying tuition? hhhmmm...simple math to me...but I am only a RT and PA-S...The last point was just a stupid comment because it is just as stupid as the DNP and how BON wants respect...Yes I do get it and have facts to back it up, unlike your ignorant comments.

[andersenpa]

I am just coming across this discussion and am genuinely surprised at the tone. I listened to the radio program last week and came across with a completly different impression. I came away with the idea that the US is facing a massive shortage of providers in primary care and that PAs are part of the answer in how to bridge the gap. I would be surprised if the casual listener came across with a different message. We, of course, are a different audience who tend to be on the hunt for the occasionally offensive apostrophe. At the end of the day, the AAPA advocated for our profession on a national forum. I get that there are four pages of people who disagree with me but I saw this as a positive interview.

 

At the risk of repeating myself, we need to look at 1) what serves the system as a whole and 2) what serves the profession. Of course we want 1 and 2 at the same time. The AAPA dogma has been always 1 first, and 2 when we have the resources (which is rarely if ever). I'm not claiming to be a PA visionary or anything but I think placing some priority on #2 would serve the profession in many ways. Create a brand and market where patients seek PAs out. Or at least lessen the incidence of patients feeling shortchanged when they are seen by a PA (a common story we see here on the forum).

 

I bet the casual listener would not notice anything. That's the problem. PAs are described in this interview in a way that doesn't resemble the way they really practice. The casual listener would hear that the assistant coordinates the dialysis session and know how to suture. No mention of solo PAs, remote supervision, specialty PAs with their own clinics, even the advanced critical care work that you and I do as cardiac PAs. The things that embody our excellence. The casual listener knows nothing about that. Dave, if you filmed one of us running a code on a CTS patient, lining them up, managing complex hemodynamics, opening the chest, intubating, etc....and showed it to 100....even 1000 people off the street, none of them would think it was a PA. MAYBE a few at best. Even if you prefaced it with a list of professions and ask "who do you think this is?", it would still be a minimal response.

 

I can't be content that 1) PAs are allowed a place at the table 2) that our SPs continue to pay us so we should follow any directive they create for OUR profession or 3) PAs should look only too be the gap fillers in health care and serve the greatest need before taking the reins of their profession and steer it in a direction that brands and defines us for what we ARE.

 

Pride and dignity are a big part of this. The dignity and pride of PCP PAs was severely undercut by Ms Davis' comment.

In medicine, we have standard practices and policies in place that preserve patient dignity. We recognize it as a fundamental aspect of life. PAs should also be allowed that dignity in their work, and it is taken away when we are dismissed (or ignored) as practicing medicine and instead described as coordinators of care. In all the comments in this thread (and others, particularly about the name change), our dignity in what we do is routinely disreagrded as if what matter is that we are allowed to come in the big house and should be satisified. It's time for this profession to seize the opportunity that the ACA act offers and stake our claim for both practice rights, scope, AND pride and dignity.

[Guest hubbardtim48]

"when you liken this to the PA situation, you are like the folks who say "i dont care what they call me as long as they pay me what they do.

I never said that nor would I ever. So, why is the BON so big about how NPs are the same level as MD/DOs and that NPs have the nursing background that can make them just or better providers than MD/DOs...? Lots of RNs think this and it really is more confusion for patients when someone says, HI, I am Dr. X your NP...there are just as many PAs that have PhDs, DHSc as NPs, but you don't see a big push for them to be like a MD/DO, they just go back to medical school. They big DNP "Doctor of Nursing Practice" is crazy, it is a doctorate and does not make you a physician. Go practice being a RN and less trying to practice medicine and wanting to be a physician (via a easier route). The DNP manager won't make me change my ways of practice and still makes me in control of MY patients, let the DNP pay the bills and schedule appointments and coordinate care, less work I have to do. You have no other comments about my statements I made about all the other things you said incorrectly or did you look it up and say ahhhh man I should have looked that up before I said something....?

[EMEDPA]

no way. folks need to know that a PA is capable of being a starter in most cases, and will in fact be calling the plays.

 

EXACTLY. we are not lackeys, we are "executive officers" to use the navy terminology. sure, the captain is the captain, but when they are away the XO runs the ship.....when the captain is present the XO defers to the captain but there is mutual respect and consultation regarding issues crucial to the well being of the ship(or the practice).

that's how it should be at least

[cinntsp]

Can y'all take the DNP back and forth to another thread? It is just off-topic visual noise.

 

Sent from my Galaxy Nexus using Tapatalk 2

[Guest hubbardtim48]

Take yourself off the forum or block us OR better yet, make a forum thread for PAMAC and I! :)

[Guest hubbardtim48]

That is just one article, but several more that state $50,000 decrease. I never stated that they DNP would run MY life, just the office life (i.e. paying the bills, coordinate care, schedule MY appointments for MY patients, etc...). The DNP would attend some meetings when talking about the clinic, but not about medicine, I would also be interviewing providers and have a HUGE say in this because I would be the ONE working with the PROVIDER not the DNP, I would decide what CMEs I would need because of the law change and plus what stuff I need to be better educated on and I decide (even now as a RT) when my vacation is. Could try on this, but the DNP would not be my MOM, but a co-worker to help run the clinic better and coordinate care (just as your above statements).

[Guest hubbardtim48]

Never said the AAPA couldn't learn from the BON. They could learn A LOT and wish they would, but my argument was over the DNP. Someone in the AAPA will finally look at the BON and say we need to do somethings like them because it has worked for them so it should work for us.