Why not "Associate Physician" instead of "Physician associate"?

[andersenpa]

This is inaccurate. An NP cannot provide the same services that a physician does...neither can a PA. We can provide the same services in certain patients, but you are showing your inexperience if you think that you can see all of the same patients as a physician can. This is dangerous ground. NP's have independence sure, but less than 2% of them practice independently based on the last numbers I saw. Why? Cause it's not the same. No matter what the NP leadership has said in the past, a DNP does not grant equivalence to an MD/DO in primary care....neither does a PA degree.

 

I am currently working in a PM&R spine practice and am completing the same training program the fellows go through. I had to take a pre-test, which I scored decently on, but was extremely difficult (and I have 7 years of Orthopedic experience, and 2 years of Neurosurgical Spine training already) This group wants me to have my own "independent" practice, but I already know, after being a PA for a long time, that there will ALWAYS be patients that I need some physician help with. Even if it's just a "Hey, can I run something by you.....should I be thinking of anything else?"

 

Don't fall into the trap of thinking that PA or NP training provides equivalence. I have 4 friends that were PA's that went back to med school....everyone of them said it was much more difficult than PA school and they learned things that they never learned in PA school. The biggest thing about being a PA (or an NP I would argue)....know your limitations....

 

 

We're not talking about Spine or specialty care. The focus on MD-PA-NP equivalence is all about primary care, where the relevant allocation gap is.

 

A trained/experienced PC PA can provide physician level services in that discipline. We currently have no good metric for that level of training and experience unfortunately.

[Contrarian]

Collaborate or SP, it does not make any diff! Some physician is still getting paid for back up. PAMAC sounds like you need to go to med school!

 

Dude...!!!

Your condesension is showing.... tuck in that skirt...!!!

 

The last remark was pure dumb-a$$-ed-ness...

 

There IS a HUGE difference between "supervise" and "collaborate" ... but yeah... kinda didn't expect YOU to understand that since you have demonstrated that you are having great and insurmountable difficulty grasping the difference between "Associate" and "Assistant."

 

We are all left to assume that your grasp of the english language is "slippery."

 

:heheh:

[Contrarian]

... [brevity edit] ... I already know, after being a PA for a long time, that there will ALWAYS be patients that I need some physician help with. Even if it's just a "Hey, can I run something by you.....should I be thinking of anything else?"

Don't fall into the trap of thinking that PA or NP training provides equivalence. I have 4 friends that were PA's that went back to med school....everyone of them said it was much more difficult than PA school and they learned things that they never learned in PA school. The biggest thing about being a PA (or an NP I would argue)....know your limitations....

 

Are you actually thinking about what you are trying to say BEFORE you type it...??? Or are you simply trying to put the "non-PA" in his place, and/or support the buearaucrats YOU invited here...???

 

I ask because my yrs of experience observing physicians while taking care of patients in various roles in healthcare has CLEARLY demonstrated TO ME that Physicians (as in MDs and DOs) also ALWAYS have 'patients that they need some help with. Even if it's just a 'Hey, can I run something by you.....should I be thinking of anything else?'

 

ALL (good, current, competent) Physicians consult and collaborate with other providers. I've stood next to them when they asked the Sonogrpher questions, or asked the Nutritionist questions, or asked the Pharmacist questions. I've even had quite a few psychiatrists ask ME medical questions and seek recommendations concerning patient management.

 

The reality I know is that... NO physicians practices medicine in a "bubble" on a "Island."

Nor does any one physician KNOW everything. They ALL collaborate and Consult.

So the point it "seems" that YOU were trying to make is MOOT.

 

Unless of course... I'm misunderstanding your intentional point... which is possible, and has happened before...

[EMEDPA]

there is a difference.

collaborate means" I call you when I need you".

supervise means "you review and critique all my charts and if you quit I close up shop".

[LIPPER]

due to the confusion the word "ASSISTANT" causes MOST of the lay public (consumers).

 

People just can't wrap their minds around the notion that ... as "assistants"... there MUST be someone present for us to "Assist."

 

 

For example..

As was in my original business plan, we are adding pain management to our "lines of service." In my opinion, to do this correctly, this means that we must add small and large joint injections.

 

So to accomplish this... over the last 2 months, I've been shopping for some Ultrasound equipment.

I called several US manufacturers and explained what my goal is then left contact info for reps to do demos.

Each and every one of them has either asked to speak with "the doctor I work for," or has given me info and basically instructed me to tell the physician I ASSIST what the benefits of their products were.

 

One even told me that they would pay for/subsidize a mini ultrasound internship for the physicians in the practice. When I told her that it would be a non-physician using the equipment and doing the injections, she said that the internship was only for physicians... and that the company would only pay for physicians. I then explained that I am the business/clinic owner and therefore decide WHAT machine from which company we would use and the sole clinician onsite and would be doing the US guided injections. She didn't know how to respond to that so had her supervisor call me.

 

 

Supervisor called and asked to speak with the DOCTOR that I worked for...:heheh:

So you are saying many of your problems will just go away by changing to Associate? Won't you still be facing the exact same challenges?

Being the "non-physician"..."the doctor you work for", "the sales-person that didn't know how to answer the question"......I hear you (and anticipate your answer), I appreciate that somePA's here are trying to go at it alone., I just can't see the difference. An uneduacted public will remain uneducated with either title.

 

Sometimes I feel like I must live in a time warp when I read threads like this. What it would have been like for me had I started many more years ago...Yet you are living it in the present.....I can completely understand the problems and frustrations that are felt..... I just never encounter them....So I can't truely feel your pain .

[physasst]

We're not talking about Spine or specialty care. The focus on MD-PA-NP equivalence is all about primary care, where the relevant allocation gap is.

 

A trained/experienced PC PA can provide physician level services in that discipline. We currently have no good metric for that level of training and experience unfortunately.

 

I see your point Andersen, but I do not believe that a PA or NP can provide physician level services FOR ALL PC patients.

 

Hell, I'm going to be fairly independent in Spine, and have my own panel of patients. But not ALL spine patients will be appropriate to be in my panel.

 

And my point to PAMAC was that he stated Need 40000 new physicians? Give PAs more independence and we'll make up more than a quarter of that number for you at half the cost of what a quarter of those physicians would be. But the condition is that they need parity with NPs. It had nothing to do with putting anyone in their "place". It has to do with the recognition that we cannot substitute at a 1:1 rate, even in primary care.

[physasst]

 

I ask because my yrs of experience observing physicians while taking care of patients in various roles in healthcare has CLEARLY demonstrated TO ME that Physicians (as in MDs and DOs) also ALWAYS have 'patients that they need some help with. Even if it's just a 'Hey, can I run something by you.....should I be thinking of anything else?'

 

ALL (good, current, competent) Physicians consult and collaborate with other providers. I've stood next to them when they asked the Sonogrpher questions, or asked the Nutritionist questions, or asked the Pharmacist questions. I've even had quite a few psychiatrists ask ME medical questions and seek recommendations concerning patient management.

 

The reality I know is that... NO physicians practices medicine in a "bubble" on a "Island."

Nor does any one physician KNOW everything. They ALL collaborate and Consult.

So the point it "seems" that YOU were trying to make is MOOT.

 

Unless of course... I'm misunderstanding your intentional point... which is possible, and has happened before...

 

Of course they do, but following that same logic, why then to you oppose the collaboration of supervision of PA's? BTW, I'm not supporting any bureaucrats.....and I support the name change...as I have all along. But YMMV....

[EMEDPA]

IF I read him right I think he is ok with collaboration but not "supervision".

I think new grads need "supervision" but someone a few yrs out only needs the ability to "collaborate".

[coloradopa]

Th above was just a long way of saying that it isn't 1:1.....

 

So, when we do workforce research, and run analysis and projections. We currently are looking at a projected shortage of about 140,000 physicians by 2025. 65,000 of which are in primary care. But we can't simply say...."Hey, if we train 65,000 PA's and NP's we can eliminate the shortage".....It doesn't work like that. It's not a 1:1 replacement. We don't know what it is, but let's assume 90%. We can fill 90% of the shortage, that would mean a need of 58,500 PA's and NP's.......and still have a physician shortage, also, we don't make enough PA's and NP's to fill that many spots. Especially considering the shortage in other specialties......Cardiac Surgery for example is going to have a REAL problem in about 10 years.

This assumes that there is no change in physician deployment. Take a 60,000 physician shortage. Add 60,000 PAs. Move the physicians to other duties such as collaborating on complex cases or taking the 10% that we supposedly need a physician for. Problem solved. Even if you assume a 10% reduction in efficiency, you can solve that with another 6,000 PAs. To add 65,000 physicians over 10 years would require 5000 additional medical school seats and cost more than (conservatively) $700,000 per physician. To add the equivalent number of PAs is in the neighborhood of $120,000 per PA. Also they would be available 5 years earlier.

 

The further advantage of PAs is that unlike physicians they can be redeployed. Need 20,000 more gerentologists and 10,000 less pediatrics. Easy enough. Try doing this with any other profession.

 

The real problem is that until we start reimbursing for cognitive skills and stop reimbursing for procedural skills both the PA and physician profession will move to specialties.

[ventana]

physasst-----

 

you might feel that PA could neer provide physician level care - and maybe in your microworld of medicine this is true

 

BUT you have to listen to others on this forum

 

In primary care the game if very different - I have Dx many pathology issues that the doc's missed, I have educated doc's about areas they have not idea (I have a varied speciality background) I manage issues the doc's are not familiar with, and have a very different outlook then I had in speciality medicine. Your insistence on needing doc level care is based on your own liimited experience and not on what I am living every day

 

 

 

As for the "Medical Assistant" remark earlier in this thread - That was my issue with the state of MA with trying to incorportate my new practice - seems the person charged with reviewing the paperwork wanted a statement from the "Medical Assistant Board" that I was in good standing - This is the simple fact of a bad name - people get confused and assume things that are incorrect. If we were phhysician associates would they have ever thought we needed the "Board of Medical Assistants" sign off? Heck no

 

 

 

I see an ongoing message between the lines in this thread that deals more with PA's in speciality medicine saying things don't need to change and the PA's in the trenches of primary care saying they do - instead of realizing that we are doing two entirely different jobs and that the PCP PA's are really being hampered by this and supporting the change the specialty PA's are jsut saying it is not needed.

 

 

PLEASE take a moment to stop and think about your own experiences, but then think of the generalist PA or the PA that is starting a clinic and learn about what their issues have been and maybe you will take a new perspective on this issue. Heck when I was in speciality medicine (physiciatry, chronic pain, ortho(per diem),and even ER) there was times that I felt the patients deserved a HIGHLY experienced provider - and since the doc filled that roll they need doc level care - BUT honestly I would refer to Jim for Headache management patients long before ANY of my local neuro's - Jim is HIGHLY experienced and deserves this respect. We all need to step back, listen to what a peers are saying about their experiences and try to understand how a name change that seems silly in our own little world might make a HUGE difference for other PA's - someday speciality PA's will need support for something - ie being in the OR with only Direct supervision(Surgeon not in the room but available) and still being able to bill and having the primary care PA's back up your quest to protect/advance your owns jobs would be helpful.......

[Contrarian]

IF I read him right I think he is ok with collaboration but not "supervision".

I think new grads need "supervision" but someone a few yrs out only needs the ability to "collaborate".

 

Correct...!!!!!

 

Everyone in healthcare "collaborates" and "consults"... or atleast SHOULD. That IS the practice of medicine, as I know it to be. There doesn't need to be a new law or code to encourage/codify seeking collaboration/consultation. I was taught by my mom and later PHYSICAN mentors that, 'if you don't know something... ask someone who does know and/or LOOK it up.'

 

So I'm still not understanding why/when 'non-physicians' [consult] its somehow considered a glaring demonstration of a knowledge deficit and a negative. But when physicians "consult," its just routine every day no biggie stuff.

 

Also... I'm still missing the point about this:

 

Hell, I'm going to be fairly independent in Spine, and have my own panel of patients. But not ALL spine patients will be appropriate to be in my panel.

 

Do you think that ALL (as in each and every) spine patients will be apropriate to be in ANY (as in each and every) spine physician's panel...??? Or do you think that individual spine physicians will occassionally need to "collaborate" and "consult" with other physicians and professionals (oncologist, Nuc Techs, radiologists, MRI techs, etc.) to appropriately care for challenging patients...??

[LIPPER]

physasst-----

 

you might feel that PA could neer provide physician level care - and maybe in your microworld of medicine this is true

 

BUT you have to listen to others on this forum

 

..... Your insistence on needing doc level care is based on your own liimited experience and not on what I am living every day

 

helpful.......

Maybe it's just me, but this is a problem. Since when/how is the self-critique of the PA field/member felt to be the qualification necessary to assume the 1:1 role? I mean what community-wide standard are you applying to say you're equal?... So I guess the drNP is now qualified as well bc they all feel so? I knownplenty of LPNs that are highly skilled, who feel the can/should substitute for RN's....what's the point of a degree and license if we can just skip around just because we feel like we can?

 

There is a shift occurring naturally. That will occur independent of title change. but to say PA's say the PA can do anything the MD can do, well that's just pretty arrogant.

[rev ronin]

IF I read him right I think he is ok with collaboration but not "supervision".

I think new grads need "supervision" but someone a few yrs out only needs the ability to "collaborate".

 

As a new grad, I placed good supervision with on-site doc(s) higher than salary in my job search. I will be working on a 3 provider team with 2 physicians, which seems great to me; we'll see how it works out in a couple of weeks...

[physasst]

This assumes that there is no change in physician deployment. Take a 60,000 physician shortage. Add 60,000 PAs. Move the physicians to other duties such as collaborating on complex cases or taking the 10% that we supposedly need a physician for. Problem solved. Even if you assume a 10% reduction in efficiency, you can solve that with another 6,000 PAs. To add 65,000 physicians over 10 years would require 5000 additional medical school seats and cost more than (conservatively) $700,000 per physician. To add the equivalent number of PAs is in the neighborhood of $120,000 per PA. Also they would be available 5 years earlier.

 

The further advantage of PAs is that unlike physicians they can be redeployed. Need 20,000 more gerentologists and 10,000 less pediatrics. Easy enough. Try doing this with any other profession.

 

The real problem is that until we start reimbursing for cognitive skills and stop reimbursing for procedural skills both the PA and physician profession will move to specialties.

 

Not what I meant. I meant that it isn't 1:1 not from an efficiency standpoint, but from a clinical severity standpoint. SO, if you have a 40,000 physician shortage, and you train PAs assuming that they can 95% of the cases from a severity standpoint, you would need 38,000 PAs, but you would STILL be 2,000 physicians short, as other providers CANNOT make up that shortfall.

 

Here we are experimenting in primary care with a diagnostic severity triangle created by one of our researchers Jim Naessens. The top two tiers are much lower in patient volume, but much higher in disease severity. We have case managers calling some of these patients daily, some weekly, and they are ALL followed by physicians +/- other providers. The lower tiers on the triangle are managed often by PAs or NPs alone.

 

I personally feel that there are some patients that need a physician level of care that a PA or NP should not be caring for alone. That's my feeling. I think we can handle most of what comes in the door...probably 95-98%......but not 100%.

 

Agree 1000% on the cognitive reimbursement stuff and it's something that I (as well as many others) am working on....

 

As far as redeployment, that might work with centralized workforce planning, ala NICE, but otherwise, the data suggests that even financial incentives won't likely move people into specialties that they don't like. In fact, that was probably the BIGGEST surprise coming out of my research. Much of rest seemed intuitive, but when I asked about mobilization factors, PAs overall said that more money wouldn't make them select PC.

 

I actually, as a chalkboard exercise for the brass here a few years ago, played around with the math and created a hypothetical clinic with 2 PAs, 2 NPs, and 1 physician. We used the AAFP data on panel sizes, and created a hypothetical schedule. Using certain assumptions and factoring in time away, PTO, etc. We figured that (assuming PAs and NPs made 50% of FP salary) that we could see the workload of 4 physicians (NOT five) at an FTE cost of 3 FTE physicians. This would also allow for more time with patients and greater flexibility for walk ins. I'd love to get a grant and a clinic and try it out.

 

Anyway, those are my thoughts....I know that not everyone will agree, which is okay. We all have different opinions.

[jsfelder0417]

My opinion: Now is the perfect opportunity for the PA profession as a whole to step up and show what we can bring to the table. To rest on our haunches I believe we would still grow as a profession, however, if we were to advocate and promote our qualifications and abilities, I believe we would be seen as part of the solution to the looming provider shortage. While the name change may seem frivolous to some, and will not automatically fix everyone's problems, it is still a step forward, in that we would stop being confused with MA's. Also, cost is often cited as an obstacle, so I will ask again: EMEDPA has suggested a cosmetic name change. Without the need to rewrite practice acts, and the need for only one piece of legislation, the cost would be pretty low. Why not use that route?

 

I also agree with Contrarion that collaboration is the name of the game and a better description than supervision. Supervision is what an apprentice gets, not a licensed provider. A provider collaborates with thier colleagues. I would be absolutely lost in Internal Medicine trying to deal with multiple comorbidities in a geriatric pt, so I would ask for help. However, that same doc that performs beautifully in IM would probably be lost in my area of expertise: Battlefield Medicine. If someone were to drop him in Baghdad in front of a soldier that had a traumatic amputation of an extremity with nothing but the clothes on his back and a flashlight in his pocket he would be fumbling, yet I would be able to stabilize that soldier just fine. Doesn't mean either one of us is special or any better than the other, just that we have different skill sets. Why can't that be recognized without being patronizing?

[coloradopa]

Not what I meant. I meant that it isn't 1:1 not from an efficiency standpoint, but from a clinical severity standpoint. SO, if you have a 40,000 physician shortage, and you train PAs assuming that they can 95% of the cases from a severity standpoint, you would need 38,000 PAs, but you would STILL be 2,000 physicians short, as other providers CANNOT make up that shortfall.

This assumes that the physicians already present don't do anything different. Let say that right now there are about 210,000 primary care physicians. Lets just assume that you need 40K more. You could add 40K physicians with the attendant cost or you could add 50K PAs with the attendant cost. Some of the primary care physicians would not want or would be unable to handle full panels of more complex patients (that number includes approximately 11k GPs) but most would. So they see more complex patients and collaborate as needed. The shortage is alleviated and you get better care. The rub would be to get primary care to band together into large enough groups to make this practical. Most primary care is either small group or solo (although this is changing).

 

Here we are experimenting in primary care with a diagnostic severity triangle created by one of our researchers Jim Naessens. The top two tiers are much lower in patient volume, but much higher in disease severity. We have case managers calling some of these patients daily, some weekly, and they are ALL followed by physicians +/- other providers. The lower tiers on the triangle are managed often by PAs or NPs alone.

 

I personally feel that there are some patients that need a physician level of care that a PA or NP should not be caring for alone. That's my feeling. I think we can handle most of what comes in the door...probably 95-98%......but not 100%.

 

Agree 1000% on the cognitive reimbursement stuff and it's something that I (as well as many others) am working on....

Even physicians don't handle 100% of what comes through the door. Old studies show a new grad could handle ~85% of what a family practice doc was expected to see. How that translates to todays medicine I have no idea. As far as tiered severity this is exactly what I am talking about. It actually applies to most specialties. If you deploy the physicians to maximize their knowledge/skills and use specialty PAs to handle follow up and less complex cases you get greater efficiency. I did a study for a Canadian province that showed that 100 PAs in GI would cut their wait time for colonoscopies from 2 years to 3 months and provide better follow up care.

 

As far as redeployment, that might work with centralized workforce planning, ala NICE, but otherwise, the data suggests that even financial incentives won't likely move people into specialties that they don't like. In fact, that was probably the BIGGEST surprise coming out of my research. Much of rest seemed intuitive, but when I asked about mobilization factors, PAs overall said that more money wouldn't make them select PC.

 

I actually, as a chalkboard exercise for the brass here a few years ago, played around with the math and created a hypothetical clinic with 2 PAs, 2 NPs, and 1 physician. We used the AAFP data on panel sizes, and created a hypothetical schedule. Using certain assumptions and factoring in time away, PTO, etc. We figured that (assuming PAs and NPs made 50% of FP salary) that we could see the workload of 4 physicians (NOT five) at an FTE cost of 3 FTE physicians. This would also allow for more time with patients and greater flexibility for walk ins. I'd love to get a grant and a clinic and try it out.

 

Anyway, those are my thoughts....I know that not everyone will agree, which is okay. We all have different opinions.

Its actually a chicken and egg issue. We don't understand exactly what characteristics make people want to do primary care. Certainly money and volume issues make it less pleasant. However, if we target the correct population of applicants programs have demonstrated that its possible. Thats one of the problems with ARC-PAs push for a bachelors. We should be opening more PA programs in rural areas not closing them down. PAs from rural areas trained in rural areas are more likely to stay in rural areas and more likely to do primary care.

 

As far as your clinic idea its the model that more than a few Kaiser offices use. However, it tends to wax and wane depending on the vagaries of the management.

[physasst]

This assumes that the physicians already present don't do anything different. Let say that right now there are about 210,000 primary care physicians. Lets just assume that you need 40K more. You could add 40K physicians with the attendant cost or you could add 50K PAs with the attendant cost. Some of the primary care physicians would not want or would be unable to handle full panels of more complex patients (that number includes approximately 11k GPs) but most would. So they see more complex patients and collaborate as needed. The shortage is alleviated and you get better care. The rub would be to get primary care to band together into large enough groups to make this practical. Most primary care is either small group or solo (although this is changing).

 

Of course, I was thinking in terms of simple static supply models.

 

Even physicians don't handle 100% of what comes through the door. Old studies show a new grad could handle ~85% of what a family practice doc was expected to see. How that translates to todays medicine I have no idea. As far as tiered severity this is exactly what I am talking about. It actually applies to most specialties. If you deploy the physicians to maximize their knowledge/skills and use specialty PAs to handle follow up and less complex cases you get greater efficiency. I did a study for a Canadian province that showed that 100 PAs in GI would cut their wait time for colonoscopies from 2 years to 3 months and provide better follow up care.

 

Agreed, although if I remember correctly, the 85% came not from severity, but from volume. It was in a paper that summarized that a PA could see 85% of physician volume in primary care. It was also what Medicare based their reimbursements on, though it was never validated, and the evidence was weak at best.

 

Its actually a chicken and egg issue. We don't understand exactly what characteristics make people want to do primary care. Certainly money and volume issues make it less pleasant. However, if we target the correct population of applicants programs have demonstrated that its possible. Thats one of the problems with ARC-PAs push for a bachelors. We should be opening more PA programs in rural areas not closing them down. PAs from rural areas trained in rural areas are more likely to stay in rural areas and more likely to do primary care.

 

As far as your clinic idea its the model that more than a few Kaiser offices use. However, it tends to wax and wane depending on the vagaries of the management.

 

Yeah, I know about Kaiser. One of the clinics up in the cities has also done something similar, but I would love to experiment with it in our model of care, which is already somewhat different than most models nationally. Agreed on the closure of rural programs. I was initially an Associates graduate as a PA, and in my office right now, next to the MS and DHSc degrees, sits my AAS degree as a PA.

[ToppDog]

Brilliant, amen..... I should have been this clear. What I had hoped to do was explain how the momentum in healthcare could be harnessed to advance PAs by touting them as a solution to the problems facing the US from the looming physician shortage.... Work towards solving the physician shortage by enabling an expansion of providers (cheaper non physician providers). So going back to my analogy, that 1/4 of the 40000 physicians that PAs would hypothetically make up for, could theoretically do 90 percent of what a physician could do, right? So all you did was shave off 10% of the productivity I was hoping to allow for by putting that proposal forward.

 

Go a step further to what coloradopa said, and you have an elegant, cost effective approach to winning the future.

 

You're right. It could be harnessed to advance PA's, & even the current administration is looking at increasing the numbers of PAs to help with this. But, in relation to primary care it really will not help much, as PAs still have to work under an SP, & MDs are avoiding primary care like the plague for the exact reasons ColoradoPA mentioned. Right now the only group poised to take advantage of this is NPs. While still advancing, PAs are losing ground to NPs who are advancing at a much faster rate. I took a 5 year break from pursuing PA partly because of the direction the profession is headed. It is daunting to consider that there will be fewer & fewer family practice jobs available to PAs because primary care could possibly be taken over by NPs by default.

 

PAs could be harnessed to solve all the problems of a physician shortage, but not very effectively using the current model. It will require more autonomy & possibly a bridge program down the road, but all of this is being blocked by the AAPA that wishes to maintain the status quo in order to not piss off the AMA. And, in my opinion, this is why there is such resistance against the name change. That one little word wields tremendous power in how PAs are perceived, & those in power who do not wish to see PAs advance know this, & are doing their utmost to see that it does not happen. As I see it, the name change is the last stick propping up a dam that is preventing the flow of change, & once it is broken, the course of what defines PAs will forever change in a new & improved direction.

[jdtpac]

Dude...!!!

Your condesension is showing.... tuck in that skirt...!!!

 

The last remark was pure dumb-a$$-ed-ness...

 

There IS a HUGE difference between "supervise" and "collaborate" ... but yeah... kinda didn't expect YOU to understand that since you have demonstrated that you are having great and insurmountable difficulty grasping the difference between "Associate" and "Assistant."

 

We are all left to assume that your grasp of the english language is "slippery."

 

:heheh:

 

Contrarian,

You amazed me. I guess I really get under your skin, but I think it is unnecessary for you to stoop so low and act childish with your inappropriate name-calling, on what is supposed to be intellectual forum. I have no problem with you not agreeing with my opinions but don't you think you should be a little more civil in your remarks. I can assure you I have no problem with understanding the English language. In my experience, I don't see there is such a " huge difference" between collaboration and supervision. Below is a comparison between Ohio nursing and PA law, maybe it is different where you practice.

 

Ohio Nursing Statutes

Chapter 4723-8 Advanced Practice Nurse Certification and Practice

4723-8-01 Definitions.

As used in this chapter:

(H) “Collaboration” or “collaborating” means:

(1) In the case of a certified nurse practitioner or a clinical nurse specialist, except as provided in paragraph (H)(2) of this rule, that a podiatrist or physician has entered into a standard care arrangement with the nurse and is continuously available to communicate with the clinical nurse specialist or certified nurse either in person, or by radio, telephone, or other form of telecommunication;

Ohio PA Statutes

 

4730.21 Duties of supervising physician.

 

(1) Except when the on-site supervision requirements specified in section 4730.45 of the Revised Code are applicable, the supervising physician shall be continuously available for direct communication with the physician assistant by either of the following means:

(a) Being physically present at the location where the physician assistant is practicing;

(b) Being readily available to the physician assistant through some means of telecommunication and being in a location that under normal conditions is not more than sixty minutes travel time away from the location where the physician assistant is practicing.

 

You tell me, is there that big of a difference in these 2 statutes? Currently, the only difference in the statutes between PAs and NPs is that they have scheduled II. I agree with phyasst, only about 2% of nurse practitioners truly practice independently. I have practiced in a healthcare system where PAs and NPs worked in the same department with the same job description, role and responsibilities.

[jdtpac]

I don't need to be equivalent to an MD... That was Jdtpac that told me I should look to med school if I wanted to have more control. All I wanted was to not be as beholden to MDs and the BOM, and the pitfalls experienced by PAs who seem to struggle due to red tape that wouldn't exist we're they NPs. His answer was "you should go to med school", and my answer was "why go to med school when ironically NPs already offer what I'd be looking for, and wish aapa would take strides towards".

 

PAMAC,

I made the comment to you about going to meds school because you make it sound like you want to practice independently from your supervising physician and without medical board control. I don't know any other way that you can get that independent role without being a physician. And currently, as I said to contrarian, in my experience the nurse practitioners do not have that much over PA's, and I don't think the DNP is going to make a difference. Obviously you feel different.

I'm not sure how you think the Academy will make anything different for you. There current policy is that PAs should be able to exercise a high level of autonomy in medical decision making. And even if they change that were autonomy to independent medical decision making you still have state laws that you have to deal with. I would like to hear your perfect scenario of what the Academy should be doing so you do not have to feel like you have to become a NP.

[jdtpac]

exactly... and you mention the bridge as well... which is continually shot down by some of the same folks on here who dont like the name change. thier claim is that is isnt a good idea to endorse an avenue that promotes exit from the profession. but lets use jdtpac's logic towards only 2% of NPs practice truly independent, so why worry about independence. well only a very small portion of PAs go on to med school, so why not endorse a bridge? "nope, cant do it", tey say.

 

but yes... in current form, NPs and not PAs could take advantage of filling the gap. name change goes hand in hand with getting parity with NPs. i dont care about parity with doctors, i just would like to enter a profession that has parity with NPs.... thats all anyone is asking for.

 

PAMAC,

You want to change the system, forget about bridge programs, go radical! If there is truly very little difference between PAs and NPs, why not just develop one provider. What PAs and NPs have demonstrated over the past 40 years is that it doesn't take 4 years of undergraduate, 4 years of medical school and 3 years of residency to provide high quality primary care services. The problem we are dealing with is in the basic training of all health care providers in our country. We are training 21st Century clinicians still using the old 20th Century model. And because of the stagnant health care education model we are still shackled by antiquated laws. Changing titles and asking the Academy to bolster its policies will not affect these facts. If we would change the system using the current model of PA training (Masters degree) that everyone would go through and become primary care providers we could address that need. Then if an individual wanted to go on for further training to become a specialist, that is where advanced training would start. Unfortunately, you would probably not get the support of the medical education establishment to even start a dialogue about such a radical change.

 

I never said I was against bridge programs, as a matter of fact I was board advisor to the Academy's Education Council in 2008 when we originally looked at this issue. I felt that bridge programs currently are not offering any great breaks by just taking off one year of medical school, I thought they should at least take off 2 years. I also was disappointed when the HOD did not pass a policy which addressed this issue.

 

Like I said, the current Academy policy is that PAs function at a high level of autonomy in medical decision-making, what more would you like them to say?

[Hemegroup]

*it must be the state he practices in. I know of a few PAs in Ohio that own their practice. Leased a bldg., hired a SP and started practicing. Realistically, there are a relatively small group of either PAs or NPs who own or operate a clinic.

 

The point is not the ownership. The point is that he was contacted as if he was a member of his state's Medical ASSISTANT association. The NAME was the problem!

[jdtpac]

PAMAC,

Your starting to break me down a little bit, but I don't think title change in itself will change much. And it is probably because, I'd never worked one day in primary care. I started my career 1980 in plastic surgery, became a surgical and medical house officer, in administration as a department head of over 35 PAs and then spent the last 13 years in emergency medicine. I just find it hard to believe that changing a title would have gotten me privileges to place central lines, chest tubes, lumbar punctures, provided inpatient coverage for a 370 bed acute care hospital without on-site supervision of the physician and also was respected enough by the medical staff to feel comfortable with me covering the emergency department by myself while my SP, who was Chief of Staff, attended a 2 hour medical executive committee meeting on a monthly basis. I have always been lucky enough to practice with very little oversight and a great deal of autonomy/independence.

 

I am neutral on the title change, wish the HOD would've passed resolution on developing a task force, so don't give up, get your supporters to take the issue back to the Academy. Title change aside, I think the Academy(fellow PAs) are doing as best as they can with promoting the growth and development of the profession within the resources they have available.

[ventana]

the point is not the ownership. The point is that he was contacted as if he was a member of his state's medical assistant association. The name was the problem!

 

 

 

exactly!!!!!!!!!!!!

[ventana]

thats cool that you supported the bridge, and i think that is to your credit. all i can say now is that i support a name change for the reasons ive cited. i think its a crucial first step to greater acheivements towards parity with nurses. the last comment i read on an NP thread over at allnurses was: "I know PAs who wish they'd become NPs, because of supervision/ind. practice issues (and the name as well, it's just god awful to be called an assistant when you're that highly skilled)."

 

another good quote from that thread:

"I want to clarify some of my statements. The PAs I know want independent practice. They don't want to be called Assistants anymore, they want independence, freedom and the ability to practice like NPs. PAs haven't been able to get their independence because they are associated with the AMA. When the only power you have comes from physicians it's hard to break away. How can you stay licensed if your authority comes from the AMA and you want independence? The AMA isn't going to give that control up, they don't like NPs on their turf, which is why they created PAs in the first place. So, while the nursing board lobbied for NPs, the AMA isn't going to lobby for PAs and neither are physicians. Why would you? You don't want more competition...

 

Second, I never said I was equal to an MD/DO, or had equal training to an MD/DO. I said in my family practice setting I do the same job as the MDs I work with. We all see the same patients, we all treat the same patients, refer and consult the same things. I by no means know everything and am the first to acknowledge my limitations. I run things by my colleagues if I have a question and never hesitate to do a quick consult in the hall. The docs do actually ask me or the other NP for advice at times. Sometimes, we NPs have the answer...after all we are the ones in the office the docs refer to the get their difficult patients BPs and Hgba1cs under control with diet, exercise and gasp, yes even medication adjustments.

 

I know my limitations,

 

I am an FNP and I feel that the training I received prepared me well to care for the patient population I see. Could it be that an MD/DO is over-trained for primary care? Possibly. Could it be that the future of primary care may better be served by FNP/PA, with MD/DO as specialists? Could be. There is a VERY, VERY large shortage of MD/DO in primary care as it is...maybe this turf war is a moot point to begin with???? "

 

good things to ponder on. some NPs seem to get it. name change is just one more step towards PAs defining themselves.

 

 

gotta point out a few things

 

as was pointed out before in a previous thread - I don't think your screen name is appropriate - initials aside PA as the first two letters is deceiving

 

second - you say you are well prepared to do Primary Care but at that same time their are some patients that a doc should be invovled in......

 

welcome to the fact that NP training is in no way equal to PA training - then in my case add in 10+ years of seeing patients and creating my own residency of sorts by working in about a 1/6 dozen specialities and I can honestly say that I suspect my comfort zone if FAR GREATER then just about any FNP that is with in 3-5 years of graduation

 

BUT somehow you come onto a PA site, as an FNP, and talk about how PA's should not treat ALL patients and that their needs to be Doc level invovlement...... guess what - that is just not true. Those harder cases are handled as a team with consultation with specialists - THE SAME WAY A DOC HANDLES THEM -

 

 

PLEASE realize that by having PA in your screen name you are in fact representing your self as something you are not - ow about setting up an automatic signature to CLEARLY state what your credentials are.

 

Then please stop talking about an area (highly experienced Primary Care PAs) which you really have very little to NO experience with.

 

 

 

 

MODS - this is thread is actually taking on a very interesting discussion - any way we can restart a new thread with abou tthe last 20 posts as the new subject as the Associate Physician VS Physician Associate....