Let me provide a short background story for anyone who isn’t familiar with the recent happenings in Florida: There was legislation was pending, allowing independent practice in primary care for PAs and NPs in Florida under specific rules. To pass legislation, differences in the House and Senate bills have to be reconciled. The simplest thing to do would be to include PAs in the house bill and boom; there would be independent practice for both groups. The Senate bill made the provisions for PAs and NPs, yet when the companion bill was released in the house, it only mentioned NPs. Instead, the bills were reconciled by dropping PAs from the legislation. This happened despite a fantastic effort by FAPA (Florida Academy of PAs), its leadership, and PAs from all over the country.Why did this happen, and what should we do now? I believe we just saw, in its purest form, the political will of NPs. When there were discrepancies that needed to be reconciled in the two bills, they simply did what was best for them, and worked to have everyone but themselves removed from the legislation. Why would they put their agenda at risk to try to include another group? How would that benefit them? Simply put, it wouldn’t. So they did what was best for them. Many people will want to be angry about this and, while I am frustrated we weren’t able to make things go in our favor, we need not be angry with the NPs but, learn from them. They have, for over 20 years, demonstrated a dogged determination, general disregard for the opinions of other stakeholders, and a will to make their profession successful and that deserves respect. So let us stop carrying on about what they are doing and learn from it. What Do We Do Now? I believe there are a few big things we need to do to get our heads screwed on straight, face-forward, and get back to work. 1. We MUST purge our professional DNA of the urge to please and the fear of making any other group unhappy. It seems to be collectively hard-baked into us to worry about what the physicians think. Let me tell you what they think (at the organizational and political level). They believe we are inferior and undeserving of respect. They think we need to be controlled and closely monitored by physicians. They think if we slip our chains, it will cost them money, power, and control. They think they must keep us in our place. 2. Understand what the NPs are doing and how they are doing it. I don’t think they are our political enemies. I also don’t think they are our friends. They have been killing it legislatively for years. There is zero profit for them in adopting us to help with their causes. We are so far behind them; we would only be a liability if they decided to make us part of their efforts. They have left us in the dust, and they know it. Will there be chances to work together for our mutual benefit? Without a doubt. However, recent happenings in Florida should give all of us a clear view of what happens if we are perceived as dead weight. It is every man and woman for themselves. 3. We need to promote ourselves aggressively and unashamedly without the first care what any other group thinks about our self-promotion. My father used to say, “If you don’t blow your own horn, it doesn’t get blowed (sic),” and he was right. 4. We need to look people in the eye and tell them how amazing we are. We need to say, “we want to help…to do more…and you are stopping us. Why?” Then we don’t settle for pat answers. 5. We should demand to know why they want to keep us from being and doing our best. We need to demand data and proof when people say foolish things like “ people are going to die .” or “ you order too many tests because you don’t know what you are doing .” Physician groups, in particular, love bumper sticker answers that are not answers at all. The current favorite is “they don’t know what we know,” which makes me grind my teeth every single time I hear it. When this happens the speaker needs to be called out and this little bit of pithy sophistry needs to be exposed for what it is…nonsense. In short, we need to learn to look after OUR profession first and without excuse or apology. We have too much to offer and have too many amazing people in this profession to ever put our heads down or be so reluctant to trumpet our capabilities and accomplishments. We are amazing.
2018, The Unwritten Chapter
Robert M. Blumm, MA, PA, PA-C Emeritus, DFAAPA
The year 2017 was an amazing chapter in our lives with many changes in leadership, politics, healthcare, the advancement of both the NP and PA professions, tremendously increased knowledge in medical education, the loss of at least twenty-five international personalities and, for a number of us, a year of unprecedented medical litigations due to medical errors, the traps of an EMR, informed consents and failure to diagnose. We have gained much in the ability to enter new fields of interest and to become pioneers in specialties, but all of this has a cost. We always will pay a price to gain a prize.
We are now writing the first few pages of a new chapter with the hopes of improving our personal skills, our professional achievements, our outcomes with our patients and our overall success in life and in the marketplace. “The new year stands before us, like a chapter in a book, waiting to be written. We can help write that story by setting goals.” Melody Beattie
In order to set goals, it is essential to know the facts and change the outcomes or the injury created by a faulty outcome. CM&F insures 12,000 NPs and PAs and serves them with diligence, respect, and instant access. With OPA becoming the buzz word for PAs in this new year, it is my hope that PAs with an eye toward future independent practice will become aware of the absolute need to have a personal liability insurance policy as offered by CM&F as the endorsed group for the AAPA. This could have an extremely favorable impact on premiums for PAs.
There are so many positive aspects of independent practice for NPs, but payouts for malpractice claims filed against NPs are on the rise, according to a new report. The average payout was $240,471 according to studies from CNA Insurance which covers NP malpractice insurance. The highest area of claims is neonatal, which at only 1% of the claims was $630,411. Obstetrics, another high-risk area, had indemnities that averaged $417,500. The lowest of the three was emergency medicine with indemnities averaging $277,812. Though those three specialties accounted for the costliest claims, the vast majority of closed claims were related to four other specialties: adult primary care, family practice, behavioral health, and gerontology. It is surprising, as well as a hidden trap, that most of these were related to a failure to order a medical test or obtain an address that test result.* As I mentioned earlier, knowledge of the facts can dramatically change the outcome; the meticulous attention of the provider is essential.
So my fellow colleagues, how will we write the 2018 chapter of our history? We can all hope for a greater future with less misadventure, fewer litigations, and healthier patients. But we must engage with the conscious reminder that we are caregivers and we are, therefore, vulnerable. Why carry that vulnerability on our own shoulders when the fear, anxiety, and burden can be shouldered by personal liability insurance? How empowering is the knowledge that we are protected from potential errors by specialists who are experienced fighters in this field of litigation? What do you believe? What price are you willing to pay to obtain security and peace? “Beliefs have the power to create and the power to destroy. Human beings have the awesome ability to take any experience of their lives and create a meaning that dis-empowers them or one that can literally save their lives.” Tony Robbins. Let us join hands together and make the latter choice.
* Source- CNA and Nurses Services Organization (2017, October). CNA and NSO Nurse Practitioner Claim Report (4th Edition): A Guide to Identifying and Addressing Professional Liability Exposures, page 12. Retrieved from https://www.nso.com/Learning/Artifacts/Claim-Reports/Nurse-Practitioner-Claim-Report-4th-Edition-A-Guide-to-Identifying-and-Addressing-Professional-Liability-Exposures. --
Robert M. Blumm, MA, PA, PA-C Emeritus, DFAAPA Surgical PA, National Conference Speaker, Author, Suture Workshop Director, Former AAPA Liaison to American College of Surgeons, Past President four National Associations, Editorial Board Clinician1.com, Advisory Board POCN., AFPPANP Treasurer
I don't know if anyone else saw the NP ad on TV. I saw it last night on CNN. I was going to link it here, but I cannot find it. It was very professional and gave the message that NPs are being limited their practice across the country. They can provider excellent care. If you want better access to excellent care, support the NPs. My paraphrase. This is the kind of ad, that may have been helpful to the PAs a while ago.
I will be a new grad soon and looking for employment. My number 1 city I plan to look in for employment has significantly more NP job postings than PA. Has anyone had luck getting an interview from an NP posting? Or better yet, an offer? Were you basically convincing them why PA is better?
Any advice is appreciated!