Good news?

[doubledose]

https://khn.org/news/article/montana-considers-allowing-physician-assistants-to-practice-independently/amp/
 

what do you guys think? 

[EMEDPA]

This is the wave of the future. NPs can already do this in many states and our education is at least equivalent to theirs and oftentimes better.

[Hope2PA]

7 hours ago, EMEDPA said:

This is the wave of the future. NPs can already do this in many states and our education is at least equivalent to theirs and oftentimes better.

Curious as to why you say education equivalent. I have looked at many NP and PA programs, comparing within schools that provide both. I've not found one NP program equivalent to PA. There are NPs who may have worked in area, say ICU for years then get NP with ICU rotations. But apples to apples, a PA that was RT working in Critical care primarily, wouldn't that PA be better educated. I just think apples to apples, the two are not equivalent. Individuals experience makes a difference, with that, there are few PAs and NPs better qualified for particular positions than physician. Such as EMPA with residency EM experience, may not have equivalent education as physician, but better qualified than family med physician.

As far as going for independence, PAs better go for it, yesterday. In an independent NP state. Most positions, including VAMC, will not even consider PAs. 

[kettle]

ND already has this, SD is very close as well. I think after 5000 hours you can open a clinic, have to go before the medical board, only limitation is it is not meant to be a medispa or do solely derm. Everything else is fair game in ND

[Reality Check 2]

This needs to happen. The PA profession is dying at the hands of lesser trained NPs who have the backing of humongous RN unions and PACs.

PAs are better and more consistently trained with set number of hours, etc.

We are trained on the medical model, not advanced nursing - whatever that is.

We need this. American healthcare needs this.

The number of MDs isn't going to improve quickly and they don't pick Primary Care or Psychiatry with any needed numbers.

Few want to live in rural places.

This is a PA niche. We need to jump all over this.

[TeddyRucpin]

15 hours ago, doubledose said:

https://khn.org/news/article/montana-considers-allowing-physician-assistants-to-practice-independently/amp/
 

what do you guys think? 

I think it's awesome. It is also going to be harder to argue against with neighboring states having passed pro-PA legislation and things are going OK. No one wants to lose medical providers as well. 

Edited February 11, 2023 by TeddyRucpin

[kettle]

1 hour ago, Reality Check 2 said:

This needs to happen. The PA profession is dying at the hands of lesser trained NPs who have the backing of humongous RN unions and PACs.

^^^This!!! It is power in numbers, and lobbying money. Even if all the PA'S unionized we are still a fraction of the RN union. Regarding solo practice the way ND got it through was showing the need in undeserved and rural areas. Subsequently the metro area PA'S benefited as well. It's all about the approach and showing need over the feeling of wanting something just because someone else has it

[TeddyRucpin]

8 minutes ago, kettle said:

^^^This!!! It is power in numbers, and lobbying money. Even if all the PA'S unionized we are still a fraction of the RN union. Regarding solo practice the way ND got it through was showing the need in undeserved and rural areas. Subsequently the metro area PA'S benefited as well. It's all about the approach and showing need over the feeling of wanting something just because someone else has it

This is the kind of state where this type of legislation is needed and should pass. NPs already have independence; neighboring states already have very recently passed pro-PA bills.

[ventana]

It takes money. 
 

We could change everything in a few years if people took up a voice and donated. 
150,000 pa. 
$100 each 

15m for advocacy 

better yet send $50/m to AAPA or your state PA group. If we all did it that is well north of 60m

 

we just gotta be vocal and buy into special interest politics. 

[rev ronin]

1 hour ago, ventana said:

better yet send $50/m to AAPA or your state PA group. If we all did it that is well north of 60m

State orgs often reflect the priorities of their leadership, which aren't necessarily aligned with PA's. Before you give a ton of money to any PA org, make sure they are going to use it to advance PAs, not their own particular political interests, like expanding access to abortion or physician assisted suicide. Those are certainly debatable topics, but when a PA leader drives a divisive agenda, they compromise the ability of PAs to succeed by dividing the PA population along political lines, rather than preserving a big tent.

[EMEDPA]

14 hours ago, Hope2PA said:

Curious as to why you say education equivalent. I have looked at many NP and PA programs, comparing within schools that provide both. I've not found one NP program equivalent to PA. There are NPs who may have worked in area, say ICU for years then get NP with ICU rotations. But apples to apples, a PA that was RT working in Critical care primarily, wouldn't that PA be better educated. I just think apples to apples, the two are not equivalent. Individuals experience makes a difference, with that, there are few PAs and NPs better qualified for particular positions than physician. Such as EMPA with residency EM experience, may not have equivalent education as physician, but better qualified than family med physician.

As far as going for independence, PAs better go for it, yesterday. In an independent NP state. Most positions, including VAMC, will not even consider PAs. 

read what I wrote. "At least" equivalent. I was being politically correct. 

[ventana]

10 hours ago, rev ronin said:

State orgs often reflect the priorities of their leadership, which aren't necessarily aligned with PA's. Before you give a ton of money to any PA org, make sure they are going to use it to advance PAs, not their own particular political interests, like expanding access to abortion or physician assisted suicide. Those are certainly debatable topics, but when a PA leader drives a divisive agenda, they compromise the ability of PAs to succeed by dividing the PA population along political lines, rather than preserving a big tent.

in some ways this is a single issue topic

 

we will become outdated and no jobs unless we get independence

 

time to pay up and get us independent...

 

and what we really need is to stuff the boards (state and AAPA) with people that support the big I (independence) 

 

[CAAdmission]

On 2/12/2023 at 9:28 AM, ventana said:

and what we really need is to stuff the boards (state and AAPA) with people that support the big I (independence) 

I think we are heading that way. Most of the "first generation" PAs are aged out of the game. They did great work getting us where we are, licensed all across the US. The young folks now need to bring the energy and momentum for the next big push. 

It's been my experience that progress isn't a smooth, upward curve. It's usually a pretty choppy ride. 

 

Edited February 21, 2023 by CAAdmission

[newton9686]

I would be curious how much of the gains NPs have made is secondary to independent practice versus perceived public perception of hiring a "a physician's assistant" versus "doctorate nurse practitioner". As far as I am aware due to insurance most hospitals want all notes co-signed so they can bill at a higher rate. And the ERs where I have worked want notes co-signed as well. 

 

I am in NC so I don't believe NPs have independent practice here. And there is no co-sign requirement in NC, just benefit in the hospital for additional billing. And I am more inpatient versus outpatient, so my views may be skewed from that prospective as well. 

 

I would just be curious to see any studies that actually compared hiring practices and perceptions of NPs versus PAs and to see if PAs need to focus more on independent practice or public perception. 

 

My view is all new PAs/NPs must complete a 70+ hour 1 year residency (just like MD/DOs) to be able to apply for a license to practice medicine. Only after then do you talk about independent practice and just like MD/DOs you don't get to practice independently with a one year license unless you are doing urgent care, something super rural (hospitalist/ER) or not very medical (med spa, iv hydration, marrijuana dispensary etc). Family medicine and psych maybe independence after residency and 5k-10k additional hours after residency. But again I get the argument that because NPs are getting independence, so should PAs. But also have to realize your average new PA don't know anything either (I know I didn't), so we have to be careful with granting independence for everyone when a large portion of the profession is not prepared for it (everyone with less than 4-5 years in their speciality lets say). 

 

[rev ronin]

11 hours ago, newton9686 said:

My view is all new PAs/NPs must complete a 70+ hour 1 year residency (just like MD/DOs) to be able to apply for a license to practice medicine.

Um, no. If you want hours, specify hours, but 70+ hours (assuming per week) is not honoring professional distinctives. Do not give up the work-life balance that some PAs are able to maintain throughout their career.  Else, why not just do a 3 year MD and an internship to be a GP? It'll cost more, but same time investment, better pay, and once you're an MD you can do whatever you want.

I much prefer Malcolm Gladwell's 10,000 hour "rule."  I really think that about five or six years into PA practice I knew what I was doing. Nine years in, I opened my own practice in a specialty I'd been working in for six years by that point.  I don't care if you crammed 3500 hours into a 1-year hell year after PA school graduation, I still would not be anywhere near as good at my job as I am now.

[sas5814]

23 hours ago, newton9686 said:

you don't get to practice independently with a one year license unless you are doing urgent care, something super rural (hospitalist/ER) or not very medical (med spa, iv hydration, marrijuana dispensary etc). Family medicine and psych maybe independence after residency and 5k-10k additional hours after residency.

It has always interested me that people think UC is some easy-peasy thing any half wit PA can do. UC is probably one of the most challenging fields because the potential to miss something important is so high. It is hours of mindless drivel and, in the middle of a crushing day, chest pain or a pneumothorax. I have had people come in with stab wounds to the abdomen, gun shot wounds, horrible dog maulings. It isn't someplace for new grads and old farts who just want something easy to do.

Lets review independence for really rural areas. Why would it not be appropriate in a medical center where you can't sling a dead cat without hitting a specialist but appropriate in a place where medical support may be hours away? I worked the north slope of Alaska where, if the weather was just right, I could get an evac plane on site in about 2 hours and its not impossible to be weathered in for days. I had colleagues have to sit on surgical bellies for 4 or 5 days waiting for the weather. Doesn't sound like a place for independent new grads. Maybe people who don't have access to health care are only entitled to mediocre care and they should be glad for it.

A thing is either safe and reasonable or it isn't. There aren't 2 standards for rural vs urban.

The very survival of this profession rests on remaining competitive in the market. That means autonomy. Each and every one of us should be credentialed according to our experience and skills JUST LIKE EVERY OTHER MEDICAL PROFESSION.

We need to start thinking and acting like a fully developed grown up profession. The alternative is oblivion.

Edited February 23, 2023 by sas5814

[newton9686]

On 2/23/2023 at 12:44 AM, rev ronin said:

Um, no. If you want hours, specify hours, but 70+ hours (assuming per week) is not honoring professional distinctives.

Isn’t that what we are asking for with independence? If NPs want we MD/DOs have and PAs want to be treated to equally to NPs, is that not asking to have professional distinctions removed?

 

20 hours ago, sas5814 said:

 

A thing is either safe and reasonable or it isn't. There aren't 2 standards for rural vs urban.

 

there’s supply and demand as well. Plus what’s the alternative. We don’t need family docs doing colonoscopies and c sections at Duke or Harvard. They aren’t going to be as capable as GI docs and OBGYNs. But in rural Kansas that cant support a GI doc doing scopes on patients that otherwise wouldn’t have a colonoscopy, it makes a lot of since.

it’s fine that y’all have your own opinions after 20+ years practicing medicine. I’m sure you’re better clinicians than I can ever dream of being. But there’s something of a respect that comes from surviving the hazing of residency and medical school. It’s not just are you proficient at your job. Not saying it’s right or wrong, it’s just part of the process. Also when you are independent you don’t know what you don’t know. Even if you don’t get burnt, doesn’t mean you weren’t oblivious to something. We all don’t know what we don’t know, even those 20+ years our. And as someone who is giving up 7+ years of my life to become a physician, I think I’m being pretty reasonable in how I want to support PAs so they don’t have to go through what I’m going through. So PAs can either say F-U to physicians and try to do it on their own like NPs, or they can raise their floor by mandating residencies for new PAs and continuing to gain the respect of the medical community. I mean the fact that new grad PAs struggle to get jobs alone should tell you medicine has changed and it’s time to make residencies for everyone who graduate PA school. 
 

 

[CAAdmission]

2 hours ago, newton9686 said:

I mean the fact that new grad PAs struggle to get jobs alone should tell you medicine has changed and it’s time to make residencies for everyone who graduate PA school. 

I'm not sure this is a given everywhere. There are certainly areas where the market is saturated, and there are also new grads that have completely unrealistic expectations of what value they bring. If you think you are going to land a job for $220k in Manhattan out of school, you are dreaming. But if you are willing to look around a bit and move, there's no problem finding a job. 

[sas5814]

2 hours ago, newton9686 said:

you don’t know what you don’t know.

The first thing I have told every medical student, PA student, and NP  student on day one of working for me is you better know what you don't know. It is more important than what you know. You don't know what you don't know is a bumper sticker they sell at the AMA convention.

[ventana]

7 hours ago, newton9686 said:

Isn’t that what we are asking for with independence? If NPs want we MD/DOs have and PAs want to be treated to equally to NPs, is that not asking to have professional distinctions removed?

 

there’s supply and demand as well. Plus what’s the alternative. We don’t need family docs doing colonoscopies and c sections at Duke or Harvard. They aren’t going to be as capable as GI docs and OBGYNs. But in rural Kansas that cant support a GI doc doing scopes on patients that otherwise wouldn’t have a colonoscopy, it makes a lot of since.

it’s fine that y’all have your own opinions after 20+ years practicing medicine. I’m sure you’re better clinicians than I can ever dream of being. But there’s something of a respect that comes from surviving the hazing of residency and medical school. It’s not just are you proficient at your job. Not saying it’s right or wrong, it’s just part of the process. Also when you are independent you don’t know what you don’t know. Even if you don’t get burnt, doesn’t mean you weren’t oblivious to something. We all don’t know what we don’t know, even those 20+ years our. And as someone who is giving up 7+ years of my life to become a physician, I think I’m being pretty reasonable in how I want to support PAs so they don’t have to go through what I’m going through. So PAs can either say F-U to physicians and try to do it on their own like NPs, or they can raise their floor by mandating residencies for new PAs and continuing to gain the respect of the medical community. I mean the fact that new grad PAs struggle to get jobs alone should tell you medicine has changed and it’s time to make residencies for everyone who graduate PA school. 
 

 

I find it odd that you already are putting senior PA down.  As a 20+ yr primary care PA I function exactly like a doc.  Very similar knowledge base at this time.  I’m t is not just 3 yrs of residency that can gain knowledge.   But also 20+ years of hitting the books for PCP issues.  
I love being part of a team and no one practices alone.  

as for only residency trained docs knowing what you don’t know.  There is no major that happens in residency and the would put many of the senior PA on this board against a new doc every day of the week.  

[deltawave]

20 hours ago, ventana said:

I find it odd that you already are putting senior PA down.  As a 20+ yr primary care PA I function exactly like a doc.  Very similar knowledge base at this time.  I’m t is not just 3 yrs of residency that can gain knowledge.   But also 20+ years of hitting the books for PCP issues.  
I love being part of a team and no one practices alone.  

as for only residency trained docs knowing what you don’t know.  There is no major that happens in residency and the would put many of the senior PA on this board against a new doc every day of the week.  

Docs ask for my advice all the time. And I theirs. It’s a team game. No matter how you slice it. 
However, legislation is where we need to fight and advance. 

[ventana]

4 hours ago, deltawave said:

Docs ask for my advice all the time. And I theirs. It’s a team game. No matter how you slice it. 
However, legislation is where we need to fight and advance. 

Exactly!!!

 

I am cross tapering a patient from methadone to suboxone.  4 docs in my practice.   One has minimal knowledge for this.  Other nada.  I am the knowledge expert.  
 

but political advancement takes money and not infighting.  PAs need to stand together (surgery needs to support primary care and vise versa ) and donate to get change. 
 

we are the ONLY profession that is controlled by another independent profession.  Time for a change.  

[rev ronin]

16 hours ago, ventana said:

we are the ONLY profession that is controlled by another independent profession.  Time for a change.  

Dental hygienists?

[Farafish260]

On 2/23/2023 at 12:44 AM, rev ronin said:

Um, no. If you want hours, specify hours, but 70+ hours (assuming per week) is not honoring professional distinctives. Do not give up the work-life balance that some PAs are able to maintain throughout their career.  Else, why not just do a 3 year MD and an internship to be a GP? It'll cost more, but same time investment, better pay, and once you're an MD you can do whatever you want.

I much prefer Malcolm Gladwell's 10,000 hour "rule."  I really think that about five or six years into PA practice I knew what I was doing. Nine years in, I opened my own practice in a specialty I'd been working in for six years by that point.  I don't care if you crammed 3500 hours into a 1-year hell year after PA school graduation, I still would not be anywhere near as good at my job as I am now.

Yup! I agree with this! 10K hours is sufficient..

[MoMofCHL3]

On 2/24/2023 at 4:08 AM, newton9686 said:

Isn’t that what we are asking for with independence? If NPs want we MD/DOs have and PAs want to be treated to equally to NPs, is that not asking to have professional distinctions removed?

 

there’s supply and demand as well. Plus what’s the alternative. We don’t need family docs doing colonoscopies and c sections at Duke or Harvard. They aren’t going to be as capable as GI docs and OBGYNs. But in rural Kansas that cant support a GI doc doing scopes on patients that otherwise wouldn’t have a colonoscopy, it makes a lot of since.

it’s fine that y’all have your own opinions after 20+ years practicing medicine. I’m sure you’re better clinicians than I can ever dream of being. But there’s something of a respect that comes from surviving the hazing of residency and medical school. It’s not just are you proficient at your job. Not saying it’s right or wrong, it’s just part of the process. Also when you are independent you don’t know what you don’t know. Even if you don’t get burnt, doesn’t mean you weren’t oblivious to something. We all don’t know what we don’t know, even those 20+ years our. And as someone who is giving up 7+ years of my life to become a physician, I think I’m being pretty reasonable in how I want to support PAs so they don’t have to go through what I’m going through. So PAs can either say F-U to physicians and try to do it on their own like NPs, or they can raise their floor by mandating residencies for new PAs and continuing to gain the respect of the medical community. I mean the fact that new grad PAs struggle to get jobs alone should tell you medicine has changed and it’s time to make residencies for everyone who graduate PA school. 
 

 

 Physicians must stop acting like medicine is some secretive elusive exclusive thing and that residency somehow unlocks that magic and is given to physicians only in residency. Medicine in the US is standardized, to name a few: Goal-directed-medical-therapy, IDSA guidelines, management of decompensated cirrhosis, JNC/AHA guidelines are all PUBLIC and Standard practices of medicine universally practiced in the US. Residency allows for significant oversight, targeted learning, and to learn in an organized yet chaotic environment. “Right of passage” during residency does not in any way correlate with being a competent provider. The level of forced exposure and servitude in residency insure a certain minimum level of knowledge to be obtained but what is built after that is strictly by the individuals effort. What I am saying is a PA has access to all of that information through CME, physician supervision/collaboration, or just plain reading medical journals and keeping abreast of the new medical guidelines. I am tired of the argument of “you didn’t do a residency” so you don’t understand the pathophysiology of hepatic encephalopathy. The argument is illogical and minimizes the intelligence of an individual. PAs who are serious about their career and love learning can be as capable as any physician in their specialty (not surgery) if they tried. Likewise, there are lazy ass/uninterested crappy physicians who have passed their boards and get the respect simply because they have an MD after their name so can hide under that guise and be shitty mediocre providers without ever being questioned. We’ve all worked with those people. For people who want to learn and take their job seriously BOTH physicians and PAs can advance their understanding. The ability to continue learning as a provider is not exclusive to physicians.