Downside to Independence?

[Houstonian]

It seems that many PA's are now pushing for autonomy and independence for our profession, as NP's have always sought. I agree that NP's seem to be "winning the battle".

 

However, I wonder if there may be some unexpected consequences of seeking independence. Would we lose the freedom to easily switch fields? Part of the reason we can switch from one field to another (like neurology to orthopedics) is that we have a supervising physician who is independently board-certified in the field.

 

If we became independent/autonomous, would we need independent board-certification? Would this lead to a requirement for residencies?

 

If not, then how would our "scope of practice" be defined? Would it be limited to strictly primary care functions? What about PA's who choose to work in specialties?

 

We don't see family practice doctors switch from field to field like PA's do. However, one sometimes sees an "independent" Family Nurse Practitioners (FNP) working as a critical care NP for a thoracic surgeon.

 

I agree that physicians oftentimes really don't want to supervise PA's or take responsibility for the care they provide.

 

What about a model similar to that of physicians in residency training? Residents are "independent practitioners" and yet they still work under the supervision of their attending physicians/faculty physicians.

[EMEDPA]

lateral mobility in inpatient settings is going away anyway. credentialing committees and the joint commission are seeing to that. you have to have already done something to be able to do it again whether that be central lines, lp's, or stress tests. for a nw grad to get those skills will require postgrad training.

the pa of the future will likely complete a 3 yr pa program followed by a 1 yr specialty residency and a board/caq exam. that residency may or may not grant a clinical doctorate like the army and air force residency programs.

I don't see PAs ever becoming truly independent but I see a gradual loosening of the apron strings so our practice is more like NPs who have to have a collaborator of record.

[coloradopa]

It seems that many PA's are now pushing for autonomy and independence for our profession, as NP's have always sought. I agree that NP's seem to be "winning the battle".

 

However, I wonder if there may be some unexpected consequences of seeking independence. Would we lose the freedom to easily switch fields? Part of the reason we can switch from one field to another (like neurology to orthopedics) is that we have a supervising physician who is independently board-certified in the field.

 

If we became independent/autonomous, would we need independent board-certification? Would this lead to a requirement for residencies?

 

If not, then how would our "scope of practice" be defined? Would it be limited to strictly primary care functions? What about PA's who choose to work in specialties?

 

We don't see family practice doctors switch from field to field like PA's do. However, one sometimes sees an "independent" Family Nurse Practitioners (FNP) working as a critical care NP for a thoracic surgeon.

 

I agree that physicians oftentimes really don't want to supervise PA's or take responsibility for the care they provide.

 

What about a model similar to that of physicians in residency training? Residents are "independent practitioners" and yet they still work under the supervision of their attending physicians/faculty physicians.

Independence does indeed have consequences. Since the dependent part of the PA refers to scope. If we are independent we would indeed be limited by training. We are seeing this happen with NPs now. The ACNP is rapidly being required for the inpatient setting. We have two FNPs who have been in the ICU for more than 10 years that are required to go back to school for a post masters certification.

 

In terms of scope of practice this is the advantage of dependent practice. Our training is that of general medicine and surgery. Our scope is defined by our supervising physician. Resident physicians are in a different system. They are given progressive autonomy with the goal of producing a trained physician. Like every other non-physician provider in the hospital the residents are the responsibility of a licensed physician. Outside of a few tiny hospitals this applies to PAs and NPs in addition.

 

As far as PA post graduate programs they remain an interesting niche. However as someone who deals with post graduates on a daily basis, I can tell you that a post graduate program is a tremendously time intensive and costly proposition. Its unlikely that there will ever be enough post grad spots for more than a minority of PAs. We hire post grad trained PAs, transfers from other specialties as well as new grads into the ICU. Post grad PAs have some advantages at an opportunity cost.

[EMEDPA]

at least in em the postgrad opportunities are skyrocketing. just a few years ago there were a handful of programs. now there are 19 with several in the works. I just attended a workgroup for em pa postgrad programs. acep and the big em groups like team health and cep like these and are promoting them. the caq is being heavily promoted. with just 2 administrations of this test 2.5% of all em pas have passed it. they are starting to offer it several times/yr with more applicants at each test administration. within a decade I predict that all the better em jobs will require it. I have already seen ads for "preference to em residency grads and CAQ em diplomats."

[GREEN]

the pa of the future will likely complete a 3 yr pa program followed by a 1 yr specialty residency and a board/caq exam.

 

If this trend of longer schooling continues we'll eventually have "Physician Assistant Assistants" that will have the requirements we currently have.

[EMEDPA]

If this trend of longer schooling continues we'll eventually have "Physician Assistant Assistants" that will have the requirements we currently have.

at 8 yrs total it's still a savings of 3 yrs of school/debt vs md ( at min. 11 yrs).

[coloradopa]

at least in em the postgrad opportunities are skyrocketing. just a few years ago there were a handful of programs. now there are 19 with several in the works. I just attended a workgroup for em pa postgrad programs. acep and the big em groups like team health and cep like these and are promoting them. the caq is being heavily promoted. with just 2 administrations of this test 2.5% of all em pas have passed it. they are starting to offer it several times/yr with more applicants at each test administration. within a decade I predict that all the better em jobs will require it. I have already seen ads for "preference to em residency grads and CAQ em diplomats."

 

Lets say 20 programs, each with 4 post grad students. That's 80 per year. 2009 (latest data that I have handy) there were 5600 graduates. Lets say 10% (the traditional number) go into EM. That's 560. So you have 14% of PAs that can possible go into post grad programs. Personally I think that dramatically overestimates the number of people in programs (although it may also overestimate the number of people going into EM). Residency grads and CAQ diplomats means that the program doesn't want to be bothered with developing a program training new grads (IMO).

[EMEDPA]

I agree. no one wants to train new grads. the larger em groups like team health and cep are in the process of starting up in house residencies for all of their new grads. they have probably 200 sites nationwide. once they do this the #s look more like several hundred residency grads/yr. if all of their sites required completion of in house residency objectives.

[GREEN]

at 8 yrs total it's still a savings of 3 yrs of school/debt vs md ( at min. 11 yrs).

 

That's one way to look at it. You could also say that it's an extra 2 years of school/debt than most programs are today.

[LT_Oneal_PAC]

That's one way to look at it. You could also say that it's an extra 2 years of school/debt than most programs are today.

 

Residency wouldn't cost anything, as you get paid, and the average program is 28 months. So really it's adding 9 months of debt. For argument sake, will use the higher end "out of state" tuition average of 60k, according to PAEA. So it would add 20k, not including living expenses.

[coloradopa]

I agree. no one wants to train new grads. the larger em groups like team health and cep are in the process of starting up in house residencies for all of their new grads. they have probably 200 sites nationwide. once they do this the #s look more like several hundred residency grads/yr. if all of their sites required completion of in house residency objectives.

 

Possibly. I would guess that its regional. Nobody is looking at this in the South despite several other post grad programs.

[EMEDPA]

Possibly. I would guess that its regional. Nobody is looking at this in the South despite several other post grad programs.

Team health is out of TN and they are one of the groups pushing for this. CEP has sites in florida and they are as well.

[EMEDPA]

some groups are already requiring all their new hires to attend EM "bootcamps" as part of their orientation.