What will pa practice look like in 2020. predictions...

[EMEDPA]

Ok, I will start.

At least one state(more likely several) will allow PAs to be either assistants or associates.

Many specialty jobs will require PAs to have a residency or CAQ.

The number of PA residencies will expand rapidly. many of these will be taught alongside physician residencies.

Several states will allow PAs practicing in primary care to do so "collaboratively" with physicians or independently (much like NPs).

The VA medical system and several other federal systems(prisons, IHS, etc) will allow PAs to practice independently.

PA's will have sch 2 DEA in all 50 states and all U.S. territories.

international opportunities for PAs will increase. reciprocity for PAs to practice overseas with nccpa passage will increase( and also international pa grads of accedited programs will be eligible for pance and will be able to practice here).

There will be several entry level doctoral PA programs.

Thoughts.....?

[Gordon, PA-C]

Ok, I will start.

At least one state(more likely several) will allow PAs to be either assistants or associates.

Many specialty jobs will require PAs to have a residency or CAQ.

The number of PA residencies will expand rapidly. many of these will be taught alongside physician residencies.

Several states will allow PAs practicing in primary care to do so "collaboratively" with physicians or independently (much like NPs).

The VA medical system and several other federal systems(prisons, IHS, etc) will allow PAs to practice independently.

PA's will have sch 2 DEA in all 50 states and all U.S. territories.

international opportunities for PAs will increase. reciprocity for PAs to practice overseas with nccpa passage will increase( and also international pa grads of accedited programs will be eligible for pance and will be able to practice here).

There will be several entry level doctoral PA programs.

Thoughts.....?

 

Until there is a separate PA board that is completely separate from the medical board then we will never be like the NPs. They might loosen up the rules a little bit, but there's no way we get complete independence like the NPs have.

 

The only way the nursing boards got there was because their state boards have complete independence from medical boards. That doesnt exist for PAs in any state.

[discogenic]

Until there is a separate PA board that is completely separate from the medical board then we will never be like the NPs. They might loosen up the rules a little bit, but there's no way we get complete independence like the NPs have.

 

The only way the nursing boards got there was because their state boards have complete independence from medical boards. That doesnt exist for PAs in any state.

 

Will that ever be possible?

[EMEDPA]

Will that ever be possible?

sure. if a state is hard up for medical providers it would be an easy thing to do.

several states allow for near independence at the present time. look at NC. you need to meet with a doc twice/yr for 30 min to discuss your practice. PAs own practices there that physicians never enter. and they are still under the state BOM.

[LT_Oneal_PAC]

Ok, I will start.

At least one state(more likely several) will allow PAs to be either assistants or associates.

Many specialty jobs will require PAs to have a residency or CAQ.

The number of PA residencies will expand rapidly. many of these will be taught alongside physician residencies.

Several states will allow PAs practicing in primary care to do so "collaboratively" with physicians or independently (much like NPs).

The VA medical system and several other federal systems(prisons, IHS, etc) will allow PAs to practice independently.

PA's will have sch 2 DEA in all 50 states and all U.S. territories.

international opportunities for PAs will increase. reciprocity for PAs to practice overseas with nccpa passage will increase( and also international pa grads of accedited programs will be eligible for pance and will be able to practice here).

There will be several entry level doctoral PA programs.

Thoughts.....?

 

I believe one state will allow collaborative practice and have the name associate.

 

Residency will expand and basically be a prereq for specialty practice.

 

All federal positions will be collaborative.

 

Most states will have DEA with exception of really restrictive ones like Alabama.

 

There will be some expansion of intensity expansion.

 

There will be a few Dsc programs for PAs

[EMEDPA]

Residency will expand and basically be a prereq for specialty practice.

I am guessing this will be more like 20+ yrs away, not by 2020(7 yrs from now).

by 2020 having a CAQ will likely be a prereq for the better (non-scut work) specialty jobs.

[discogenic]

I am guessing this will be more like 20+ yrs away, not by 2020(7 yrs from now).

by 2020 having a CAQ will likely be a prereq for the better (non-scut work) specialty jobs.

 

As far as the expansion of residencies, do you mean primary care-related residencies? Will funding be made available for anything other than primary care residencies?

[EMEDPA]

As far as the expansion of residencies, do you mean primary care-related residencies? Will funding be made available for anything other than primary care residencies?

I was thinking more specialty residencies. the current trend is for residencies in fields like em, surgery, trauma/critical care, derm, ent, neuro, urology, etc

in theory a pa can do family medicine right out of school as long as they have a good mentor(pa or md) to bounce things off of..

[Gordon, PA-C]

sure. if a state is hard up for medical providers it would be an easy thing to do.

several states allow for near independence at the present time. look at NC. you need to meet with a doc twice/yr for 30 min to discuss your practice. PAs own practices there that physicians never enter. and they are still under the state BOM.

 

As liberal as the rules are in NC, its still not close to the independence that NPs get. In NC you still have to have a physician who will sign up to be your "collaborator" or whatever you want to call it. Even if he never has to see any of your patients, thats a huge deal to have to beg an MD to sign up and be the SP of record. It gives them a huge amount of control.

[discogenic]

I was thinking more specialty residencies. the current trend is for residencies in fields like em, surgery, trauma/critical care, derm, ent, neuro, urology, etc

in theory a pa can do family medicine right out of school as long as they have a good mentor(pa or md) to bounce things off of..

 

But isn't 'the system' going to want to push/entice more PAs into primary care? Why would there be an expansion of specialty residencies?

[EMEDPA]

But isn't 'the system' going to want to push/entice more PAs into primary care? Why would there be an expansion of specialty residencies?

THE SYSTEM will make primary care more appealing by REQUIRING residencies for everything else....you can do primary care right out of school. you can't do first assist in neurosurgery with any level of competence without a residency or LOTS of ojt.

[mrpa]

Unrealistic.

Although... I can see that supervision from a physician will be relaxed in more states in the future.

 

Residencies?

Isn't being a PA basically like being a resident MD for life?

[EMEDPA]

residency is a structured learning experience with goals and expectations for certain exposures and procedures mastered.

a job isn't. you could be an em pa for 20 yrs and never put in a chest tube or a central line while every em pa resident will have done lots in just 1 yr.

[Contrarian]

As liberal as the rules are in NC, its still not close to the independence that NPs get. In NC you still have to have a physician who will sign up to be your "collaborator" or whatever you want to call it. Even if he never has to see any of your patients, thats a huge deal to have to beg an MD to sign up and be the SP of record. It gives them a huge amount of control.

 

++++1000...!!!!

 

Yep...

If you can't bribe someone to sign... you don't work.!!!

 

What I see happening in 10-15 yrs is that ALL Health professions with Terminal Doctorates will have independence in a eventual single payer system.

Leaving Physician "ASSISTANTS" to be "supervised" by MD/DO/DCs and DNPs...

[EMEDPA]

I don't think we will ever see PAs working for DCs or NPs....aside from the fact that no self respecting pa would do it the medical(MD) board will retain some degree of control

[discogenic]

I don't think we will ever see PAs working for DCs...

 

DCs can't employ/supervise PAs. DC scope too limited.

[Guest Paula]

++++1000...!!!!

 

Yep...

If you can't bribe someone to sign... you don't work.!!!

 

What I see happening in 10-15 yrs is that ALL Health professions with Terminal Doctorates will have independence in a eventual single payer system.

Leaving Physician "ASSISTANTS" to be "supervised" by MD/DO/DCs and DNPs...

 

I agree..we will be supervised by DNPs eventually. That will be their next campaign after the terminal degree for them is in place. Since a few states allow DPMs to supervise PAs, there is no reason why DCs will be restricted from supervising us. We will be a DC PA who works only in musculoskeletal area, and we will assist. Michigan allows DPMs to be PA supervising physician. Beats the heck out of me how that happened.

[Guest Paula]

Here is my prediction:

 

If PAs are unable to achieve full practice authority within 10 years or so, we are sunk as a profession that will be allowed to grow.

 

My dream: PAs achieve full practice authority within 10 years. We will be considered the same level as an OD/DPM who have independent rights, and who practice within their scope.

PAs with CAQs will be practicing with full practice authority and the CAQ is part of their "doctorate" training.

Doctorate PA programs are encouraged.

All PA programs confer the Master of Medical Science degree. Not a hodge podge of initials that we have now for Masters degrees.

 

Another idea: All PA schools confer the MMS degree and PAs are THE PCPs of the brave new world of the ACA. Physicians no longer become PCPs and are only allowed to be specialists (since they are soooo much smarter than us)

PAs become the new "family physician". We are Physician Associates.

[Guest JMPA]

I don't think we will ever see PAs working for DCs or NPs....aside from the fact that no self respecting pa would do it the medical(MD) board will retain some degree of control

Why not? There are evidently some PAs who feel that new murmurs should not only be ignored but listening to heart sounds should be ignored.

[physasst]

Until there is a separate PA board that is completely separate from the medical board then we will never be like the NPs. They might loosen up the rules a little bit, but there's no way we get complete independence like the NPs have.

 

The only way the nursing boards got there was because their state boards have complete independence from medical boards. That doesnt exist for PAs in any state.

 

I don't see us ever having separate PA boards. Not while the medical boards still exist. For this reason, I don't see DNP's (who cares if they have "doctor", they're still an NP) ever supervising PAs. They aren't under the medical boards auspices (though I've always felt that they should be) and therefore would never be allowed to supervise a PA.

 

My predictions:

 

1. Terminology will change from supervisory to collaborative. Team practice will become the norm. Private practices will become rare, and begin to vanish (likely a good thing) as PAs and physicians become employees and salaried employees.

 

2. Providers will nearly all be salaried and bonuses will be almost non existent. Salaries will drop between 5-7% when compared to today (factoring in inflation).

 

3. Healthcare teams will consist of one physician with 4-5 PAs or NPs within a specialty. PAs and NPs will manage most (99%) illnesses independently with the physician focusing on the sickest patients and acting as a resource when needed. PAs and NPs will be considered interchangeable by most organizations and payors.

 

4. Practice variance will be much more constrained than now. New payment mechanisms and quality metrics will dictate that providers change their practice patterns. Shared decision making and the use of both clinical and patient decision aids will be the norm. It will be expected to follow guidelines within a specialty or be able to make the case for why not, and face possible reduced compensation. Patient satisfaction will be tied to reimbursements, and patient compliance will also be factored (I know...I'm wishing here).

 

5. Technology will change dramatically. VR software and interactive programs will make patient intake different from today. Patients will fill out intake forms using skip logic on tablets, these will be downloaded upon entry into the room, and new software will automatically check medications, doses, diet, etc. When you enter the room, the computer will greet you, and bring you up to speed on the patients complaint, and recent history with you right there. Decision tools will be built in and will trigger with reminders regarding a differential and recommended testing. Once a diagnosis is reached, these same tools will provide a recommended treatment based on the patients genomics and decision guidelines. Genomics will reach a new high. Documentation will occur while the patient is in the room with the computer monitoring you and listening to your questions and exam. A chart will automatically populate at the end of the visit for you to review, revise if needed, and then vocally sign. A tricorder device will be in beta.....

 

Those are my thoughts...

 

Mike

[Contrarian]

The "Assistants" are supervised and work under/for the "Doctors"...

Having a profession specific terminal Doctorate Degree will allow for independence/practice autonomy and the ability to tell Physicians to "GFTS" when they try to stifle these other "doctors" and their practice of their craft.

 

Seeing DNP, Naturopathic, Podiatry, Chiropractic Physician Assistants will be wierd.

[discogenic]

residency is a structured learning experience with goals and expectations for certain exposures and procedures mastered.

a job isn't. you could be an em pa for 20 yrs and never put in a chest tube or a central line while every em pa resident will have done lots in just 1 yr.

 

Understanding that there's no real way to calculate this, how many years of clinical experience does a 1-year residency equate to? Let's say two students graduate PA school at the same time. Student A enters private practice, while Student B enters a well-crafted 1-year residency. After 1 year, are their skills equal? Does one have an experience advantage? If yes, by how much?

 

I ask because as an older student I'd like to hit the ground running when it comes to someday getting a job. Employers all seem to value experience (reference: jobs ads that say "no new grads"), so if investing 1 year into a residency will effectively equate to several years of 'regular' practice experience, that might be a good investment.

 

Any thoughts?

[Contrarian]

I've heard 2-5 based upon the Location and quality of the residency...

 

YMMV

[EMEDPA]

depends on the quality if the job. probably 5 at a great job. some non-residency folks will never get the skills a resident gets as they never get exposure or permission to perform certain tasks.

[discogenic]

depends on the quality if the job. probably 5 at a great job. some non-residency folks will never get the skills a resident gets as they never get exposure or permission to perform certain tasks.

 

Just so I understand what you're saying, is a 1-year residency as valuable as 5 years at a really great job?