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PA's: the redheaded stepchild of healthcare reform


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http://www.nytimes.com/2012/12/16/opinion/sunday/when-the-doctor-is-not-needed.html?hp&_r=0&pagewanted=all

 

When it comes to health care reform, it seems that NP's are here to save the day! But when doctors protest midlevels encroaching on their turf by practicing medicine independently, suddenly we are NP/PA's. We absorb the bad press of NP's, but get none of the credit for the good stuff we do.

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This article is an example of the magnitude of the IOM study that will propel NPs into the forefront of the next PCPs of American. They have taken that study and run with it. It is now common knowledge in medical, hospital, government circles of the importance of NPs to primary care. I believe they will eventually replace primary care physicians in many places, such as rural and inner city clinics. NP organizations are savvy, legislatively astute, and they stand up and fight for their profession. I do not fault them for that. PAs do not stand up for our profession. We are dependent providers and do not have the inner will to assert autonomy or to step up to the plate and hit home runs for ourselves. AAPA will never sever the ties to the physician groups as it would be an uphill battle. PAs do not have clout like the NPs. PAs do not have Robert Wood Johnson foundation behind us. We do not have IOM behind us. CMS is not behind us. Kathryn Sebelius in not behind us. We are invisible......except for our red hair.

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We are dependent providers and do not have the inner will to assert autonomy or to step up to the plate and hit home runs for ourselves. AAPA will never sever the ties to the physician groups as it would be an uphill battle. PAs do not have clout like the NPs. PAs do not have Robert Wood Johnson foundation behind us. We do not have IOM behind us. CMS is not behind us. Kathryn Sebelius in not behind us. We are invisible......except for our red hair.

 

Agreed. If we ever tried to assert complete autonomy (as the NP's do) we would be screwed. The NP's can get away with it because of their clout and visibility. If we tried to do it, the physician groups would drop us like a bad habit, and without their support we have nothing.

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Agreed. If we ever tried to assert complete autonomy (as the NP's do) we would be screwed. The NP's can get away with it because of their clout and visibility. If we tried to do it, the physician groups would drop us like a bad habit, and without their support we have nothing.

 

Unless, they drop us and we can then get the support from the gov't to legislate that we are able to be autonomous providers. Physician groups give us quasi-support now. You are right tho, they would drop us like a bad habit. I still cannot get it why PAs cannot be independent like OD, DPM, Chiro. Add one full year of a residency after PA school and our training time should closely equal those of ODs. However, physician groups would probably refuse to grant us any residency slots and would refuse to be our mentors and educators in that setting. I'm still hopeful and working with PAsfor tomorrow to move the profession forward. It is a long uphill climb.

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Unless, they drop us and we can then get the support from the gov't to legislate that we are able to be autonomous providers. Physician groups give us quasi-support now. You are right tho, they would drop us like a bad habit. I still cannot get it why PAs cannot be independent like OD, DPM, Chiro. Add one full year of a residency after PA school and our training time should closely equal those of ODs. However, physician groups would probably refuse to grant us any residency slots and would refuse to be our mentors and educators in that setting. I'm still hopeful and working with PAsfor tomorrow to move the profession forward. It is a long uphill climb.

 

Why do we need to be dependent practitioners other than to compete with NP's? Frankly, that's what leaves a bad taste in my mouth about these NP's. They are not physicians, yet are wanting to claim to be equal or better than them. We as PA's are to work as extension of physicians right? If you wanted to be an independent practitioner why not go to MD or DO school?

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I'm way too old for MD school and in retrospect, it might have been a better choice in the long run. I think you meant to ask...why do we need to be independent practitioners other than to compete with NP's? That is exactly why we need to be independent. We cannot compete with NPs who are independent. We can compete with those who are not independent. THe AANP goal is to have full plenary authority in all states by 2020, and I believe they will get there. They now have full plenary authority in approximately 34% of the states. We will become third tier in medicine (in primary care) and will not get jobs in rural or inner city clinics when NPs are fully independent. For those of us who live and breathe rural medicine, commute 100 miles a day, live in the sticks, and do not want to move to the city, we will lose our jobs to NPs. The physicians are not flocking to the rural areas, at least not in my rural area, so where there is no MD/DO there is no PA.

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This article is an example of the magnitude of the IOM study that will propel NPs into the forefront of the next PCPs of American. They have taken that study and run with it. It is now common knowledge in medical, hospital, government circles of the importance of NPs to primary care. I believe they will eventually replace primary care physicians in many places, such as rural and inner city clinics. NP organizations are savvy, legislatively astute, and they stand up and fight for their profession. I do not fault them for that. PAs do not stand up for our profession. We are dependent providers and do not have the inner will to assert autonomy or to step up to the plate and hit home runs for ourselves. AAPA will never sever the ties to the physician groups as it would be an uphill battle. PAs do not have clout like the NPs. PAs do not have Robert Wood Johnson foundation behind us. We do not have IOM behind us. CMS is not behind us. Kathryn Sebelius in not behind us. We are invisible......except for our red hair.

 

 

It's more than the IOM article. The Macy Foundation had a study about two years ago that said the same thing about NPs. The simple fact is, they can get away with going for independence as they are under the Board of Nursing...NOT the medical board like PAs. They have an incredibly strong lobby with NPs and nurses donating lots of money. There are 4.5 million nurses across this nation......they dwarf us.

 

Mary Mundinger is smart and brilliant. I've had some interactions with her, and never found her to be anything less than cordial, professional, pleasant, and passionate.

 

We will never be completely independent....which is why another of my friends is now going back to medical school, and 2 others have left being a PA recently as well. One to start his own medical supply company, and another into administration.

 

As for me, let's just say, I recently got back from an international research collaborative and while it was somewhat weird to be called an "organizational scientist" and not a PA.......and to have some of the top HSR researchers in the world ask me my opinion, not as a formality or afterthought, but as being recognized as a peer and an equal...well, I'll be honest, it felt good, and I felt at home.

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