The future of the profession - concerns of a recently accepted student

[primadonna22274]

"To what degree does having my own medical license matter to me?"

 

PA's have their own medical license....

 

I don't--not in SC. Remember last year when my flaky SP sent a letter to the BME revoking his supervision and I didn't know about it until I got a letter that my license was INACTIVE?

 

Took 8 mos to reactivate the damn thing after 11 yr of practice, unrestricted licenses in 4 states, never a complaint or malpractice claim, never an ethical breach. Just slow southern bureaucracy. If I had not been in medical school at that time and instead was dependent on my SC license it would have been a financial DISASTER.

[nicovazquez]

I agree that both would be competitive. The kicker would be for the NP to get ICU experience. Its very hard to get into an ICU as a new grad (or even a job). Two years ago the only Emory BSN students that had jobs after six months were the scholarship students. If you want to do a post grad course I would also agree with EMEDPA that PA is the way to go. There are five or six NP post grad programs out there. There are more critical care post grad programs than that for PAs.

columbia university also has one of these joint NP/PA post grad programs. I'm hoping to get into one of these after I finish the MSN. Here is the link: http://www.cumc.columbia.edu/pulmonary/clinical-centers/critical-care-np-pa-program

[physasst]

physasst - I see your title is "Health Services Researcher/Collaborative Scientist focused on PRO (patient reported outcomes), analyses of response shift/recollection bias in PRO models, clinical decision rule implementation/evaluation, shared decision making models, and audit and feedback research in providers. Methodologist. PA practicing in non operative spine management."

 

Could you tell me a little bit about what that means and what you are doing? It is interesting to see you are a PA with non-clinical responsibilities as well.

 

Have my doctorate in Organizational Behavior, more researcher than PA now. Involved in healthcare delivery scholars research program. Basically, doing a lot of writing....either grants or papers. Was also involved in the health reform debate as part of our Health Policy Center (basically, lots of symposia and meetings, and lots of time in DC), but that has sort of fizzled out now that reform is in implementation stage. Still practicing clinically....for now at least. Research interests are primarily in behavioral workforce studies. High level questions- How do we create a better medical team? How do we get providers to follow guidelines? How do we develop tools to help providers follow guidelines? How can we get patients and providers to work together to make decisions? etc.etc. I also help teach theory and Organizational principles to scholars (Junior Attending Physicians) in this program...that sort of stuff.

[rcdavis]

I don't--not in SC. Remember last year when my flaky SP sent a letter to the BME revoking his supervision and I didn't know about it until I got a letter that my license was INACTIVE?

 

Took 8 mos to reactivate the damn thing after 11 yr of practice, unrestricted licenses in 4 states, never a complaint or malpractice claim, never an ethical breach. Just slow southern bureaucracy. If I had not been in medical school at that time and instead was dependent on my SC license it would have been a financial DISASTER.

 

Lisa, SCAPA last month has sponsors in the state legislature proposing several practice legislation: not marrying license to sp, schedule II authority, greater number PAs to SP, broader mileage and less SP on site requirement... Apparently all informally agreed upon by BME. BME apparently rejected( or wants to have rejected) proposal requiring its involvement in clinical practice authority( eg they want to approve per PA individual procedures, rather than letting SP and hospital locally authorize)

[primadonna22274]

Lisa, SCAPA last month has sponsors in the state legislature proposing several practice legislation: not marrying license to sp, schedule II authority, greater number PAs to SP, broader mileage and less SP on site requirement... Apparently all informally agreed upon by BME. BME apparently rejected( or wants to have rejected) proposal requiring its involvement in clinical practice authority( eg they want to approve per PA individual procedures, rather than letting SP and hospital locally authorize)

 

That will all be good...just in time for me to be a supervising physician LOL

thanks Davis ;)

[NAP1986]

I have what is perhaps a philosophical question. I have a general understanding of physician "supervision" meaning the development of a "supervising" or "collaborative" practice agreement between the PA and physician describing scope of practice, a certain percentage of chart co-signatures or review, and perhaps a limit on the number of PAs a physician can supervise or a mileage restriction. I know the AAPA is lobbying to remove chart co-signatures, remove limits on prescriptive authority, remove limits of PAs a SP can supervise, remove mileage or on-site requirements, and allow the practice agreement to be determined by the individual PAs and physicians in their specific practice based on the setting and PA's experience rather than have laws specifying what a PA can or cannot do ("scope of practice laws").

 

If those above restrictions are removed and provisions adopted, what is the difference between an "independent" NP (in one of the states that have "independent" NPs) and a PA? Assuming an equal scope of practice (which is an ASSUMPTION and may be different in reality) is it simply that an "independent" NP does not need a "practice agreement" (or "collaborative practice agreement") with a physician and can be billed as an independent provider for the services he or she provides? To what degree do you feel yourself butting heads with your SP and doing things you don't agree with?

I am really trying to make as much sense of this as possible and figure out, on a very concrete level, what it means to be "independent". What are your thoughts?

 

To put things in perspective: I see myself either working in an ICU or working in an outpatient clinic setting in one of the following: cardiology, neurology, nephrology, or women's health. I know a PA can work in all those settings and transition fluidly, but if I become an acute care nurse practitioner, I would have to go back to school and get a family nurse practitioner certification.

[NAP1986]

full scope practice means no arbitrary restrictions that only apply to PAs. " PAs can't do u/s, PA's can't manage level 1 pts", etc

at my regular job I am restricted from many procedures and pt populations(busy trauma ctr). we also run a satelite facility where I work solo most of the time now. at that facility I am limited only by minimal ancillary staff and lack of certain labs and diagnostic capacity so end up transferring a lot of folks.

at my rural job I can do pretty much anything I want. I would love to work there full time and over the past yr have increased my hrs there from 16 to 36/mo....maybe when the kids go to college(schools suck there).

I think in time with the provider shortage and increased requirements for PAs to practice that supervision will be lessened but never go away completely(except maybe in outpt primary care). the aapa goals are good and noble but don't cover a lot of important ground. oregon, for example per the aapa looks great, but in reality is not very pa friendly. stuff regarding your practice is sent to your sp with a cc to you as an afterthought. we are managed in a sub-board of the bom that also covers acupuncture. they take forever to make simple changes to practice descriptions. adding a new skill is like pulling teeth.

I am in favor of pa to doc bridges but think they should work towards 2 years( 1 classroom, 1 clinical) and not require the mcat as a prereq.

in my perfect world of pa to doc bridges they would require at least a bs to apply, 6 yrs as a pa and passage at least once of the panre. I would have no problem if they did what lecom does now: 50% of seats for primary care, 50% for specialties.

 

I have what is perhaps a philosophical question. I have a general understanding of physician "supervision" meaning the development of a "supervising" or "collaborative" practice agreement between the PA and physician describing scope of practice, a certain percentage of chart co-signatures or review, and perhaps a limit on the number of PAs a physician can supervise or a mileage restriction. I know the AAPA is lobbying to remove chart co-signatures, remove limits on prescriptive authority, remove limits of PAs a SP can supervise, remove mileage or on-site requirements, and allow the practice agreement to be determined by the individual PAs and physicians in their specific practice based on the setting and PA's experience rather than have laws specifying what a PA can or cannot do ("scope of practice laws").

 

If those above restrictions are removed and provisions adopted, what is the difference between an "independent" NP (in one of the states that have "independent" NPs) and a PA? Assuming an equal scope of practice (which is an ASSUMPTION and may be different in reality) is it simply that an "independent" NP does not need a "practice agreement" (or "collaborative practice agreement") with a physician and can be billed as an independent provider for the services he or she provides? To what degree do you feel yourself butting heads with your SP and doing things you don't agree with?

I am really trying to make as much sense of this as possible and figure out, on a very concrete level, what it means to be "independent". What are your thoughts?

 

To put things in perspective: I see myself either working in an ICU or working in an outpatient clinic setting in one of the following: cardiology, neurology, nephrology, or women's health. I know a PA can work in all those settings and transition fluidly, but if I become an acute care nurse practitioner, I would have to go back to school and get a family nurse practitioner certification.

[EMEDPA]

even in states without chart review requirements (like WA and NC) an SP is still required to work as a pa. their involvement (at least in outpt practice) can be pretty minimal. in NC the requirement is that the doc and pa meet for 30 min twice/yr to "discuss the practice". this is called going to lunch or a round of golf...

[EMPAhopeful]

To put things in perspective: I see myself either working in an ICU or working in an outpatient clinic setting in one of the following: cardiology, neurology, nephrology, or women's health. I know a PA can work in all those settings and transition fluidly, but if I become an acute care nurse practitioner, I would have to go back to school and get a family nurse practitioner certification.

 

ACNP would allow you to work in an ICU or specialty clinic (cardiology, neurology, nephrology), as the Vanderbilt ACNP website mentions this. For women's health however, you would indeed have to go back and get a post-masters certificate in women's health NP (not sure if family NP would be applicable).

[WanderlustPA]

Mom sent this article my way from her AARP magazine. It applies to this thread, and gives somewhat of a picture of what the future of our profession may look like. I believe the future is really bright! :)

 

http://www.aarp.org/health/medicare-insurance/info-03-2013/how-to-beat-doctor-shortage.html