No I am not missing the point. That is what nurses are always trying to do, again you are not the captain of the ship. Even thought the BON throws millions of dollars at lobbying for independence doesn't make it right. Money talks. Period.I think you are missing the point of state boards. They are responsible for maintaining established professional standards of care, and overseeing what takes place within the bounds of their practice. You are inadvertently taking the conversation to a different place where we are... essentially arguing apples to oranges. No, I don’t think that RNs need physicians leading their regulatory boards, which is why you don’t see that happening often at all. As an RN, the physician wasn’t my boss. They weren’t in my organizational structure, and weren’t the final arbiter of whether the care I provided was within the bounds of the nursing practice act.
Cause the captain is the man person and the leader. There is always a leader, you just think it is you for some reason. I understand referrals, but again you think you are so well educated that you don't need to have the MD/DO by your name or the 15,000+ clinical hours of training as a psychiatrist does to practice, but you are perfectly fine with taking care of people with 600 - 1,000 clinical hours and we a lot less "butt in seat training" and all the advanced clinical classes that medical students take. I have a lot of autonomy and the collaborating physician comes by a few hours a month, but now the new laws are passed we will be setting that time on the practice level, so I am not sure if I will ever see him, whatever we decide together. I don't need my hand held, I just like having the back up to call him when I need him. I have called him 3 times this year. Is there something wrong with that? I have also discussed 5 cases with him in person when he is here. Is that bad that I discuss things as a team approach to help protect my patient and help them with the best treatment plan? Physicians do this, why can't PAs and NPs do this? You feel the need that you never need to speak with anyone about a patient because of your training? I agree with most of my PA fellows and they agree we need OTP which we are getting in a lot of states by change of laws. I don't think a colleague to ask questions or ideas off of is "red tape." Please answer me this question: who do you talk with when you have questions/concerns/comments/etc about clinical things? Also, do you truly believe that your that well trained that you don't need anyone around to bounce ideas off of? Do you NOT see the lack of training (didactic and clinical hours) you have compared to MDs/DOs? How can you tell me that you never need anyone when you look at the objective evidence. Please help me understand where you are coming from. I would love to hear your answering to the following questions.Why do you keep ranting on about having a captain for a ship? There are such things as referrals to specialists. I get patients referred from physicians, and physician specialists get referrals from me if it needs to happen. The key is getting patients the care they need. I’m fine with providing that care. By all means, keep a physician in the loop for yourself, and run every case by one that you can. You clearly are clamoring for someone to hold your hand, and you are in the perfect career for that. The problem is that so many of your fellow PA professionals see that kind of onerous red tape as dissatisfying, and would disagree with you that that needs to be the status quo. If you were independent, it probably wouldn’t change much about how you practice, because you have argued several times that you operate with a great degree of autonomy. What independence would do for you is give you significant latitude professionally to not be tethered to an antiquated agreement to practice under a physician. When you have practices 20 years, why would you need to arrange supervision/collaboration/participation with a brand new physician so you can feed your family?
Some captives are content with captivity.
Thanks for not answering my questions and yes born and raised in the good ole USA. Of course people ask you questions, I have never said anything about that nor that people shouldn't, just the fact that you think you should be independent and can practice "safely" for your entire career without backing. So, why would a MD/DO go to school for psych when you can do it via a NP degree? What is the benefit of all their training since you think you are perfectly trained to manage all psych cases?I can bounce ideas off of one of my physician coworkers if I need, just like they bounce ideas off of me. Everyone does that. Physicians do that among themselves, and with us. It’s not at all uncommon for me to have primary care and internal medicine docs asking me questions from time to time about psyche meds and approaches to care. Most recent it was an ER doctor asking about an approach to managing psychosis in a patient that was going to be in the ER a while. It’s not a big thing that needs to be formalized by law.
Is my training adequate? It seems to be. I do, in fact, have a boss who certainly knows more than me. The feedback I’m getting is positive in regard to my competency.
Are you a native English speaker? I’m just asking because it seems like there is a disconnect with how you are comprehending the conversation. It’s not a bad thing, but I think it might be interfering with how you are processing things that you are reading.
Of course you cannot know everything think. Do you think the orthopod takes every thing cases for every adult and peds? NO! Or how about a hand surgeon doing HIPS? NO!Ok, let’s review all the questions you ask verbatim. I actually did answer them, but because you lack the ability to comprehend critically, ill go through and quote your question directly. This is for your benefit. After we do this, you need to personally reflect upon why I would wonder if you either don’t speak English as your first language, or else have a problem with reading comprehension.
Q: I don't need my hand held, I just like having the back up to call him when I need him. I have called him 3 times this year.Is there something wrong with that?
A: No. in fact, having a physician be forced into a contractual agreement with you just so you can call him 3 times a year is a collosaal price to pay for needing to ask just 3 questions. You need to be independent so he has less liability, and so you can have more autonomy, because you just indicated it is clearly something that you both deserve. THANK YOU FOR MAKING MY POINT FOR ME!
Q: Is that bad that I discuss things as a team approach to help protect my patient and help them with the best treatment plan?
A: I think I made it clear that it wasn’t bad, but disagree it needs to be codified in law that it take place, especially if it’s rare that it ever happens. You have evidence that seems to support my view, because you noted that you rarely see your supervising physician. THANK YOU FOR MAKING MY POINT FOR ME!
Q: physicians do this, why can't PAs and NPs do this?
A: I indicated that I don’t frequently confab with physicians... but can do so when I need to. And again, this happens even though I’m independent, and don’t actually have to do it.
Q: You feel the need that you never need to speak with anyone about a patient because of your training?
A: I indicated that I do speak to other providers... if I need to. But it’s not mandated by law that I do this if I don’t need to.
Q: Please answer me this question: who do you talk with when you have questions/concerns/comments/etc about clinical things?
A: I made it clear that I talk to other providers if I need to. However, I do so when I need to, and not as a formality as part of a legal requirement that I be supervised.
Q: Also, do you truly believe that your that well trained that you don't need anyone around to bounce ideas off of?
A: I said that I do bounce ideas off of other providers, just as you do. The difference is that for some reason you need a legal requirement to force you to do this, whereas I do it purely out of concern for my patients, and do it when I need to, Vs needing to be required to be supervised by a physician.
Q: Do you NOT see the lack of training (didactic and clinical hours) you have compared to MDs/DOs?
A: I don’t know that I’ve ever said that I have as many hours of training in any regard compared to a physician.
Q: How can you tell me that you never need anyone when you look at the objective evidence.
A: I’ve never said that I never “need anyone”. I clearly stated that “I bounce ideas off of my physician coworkers if I need”. I do so without the need of any formal agreement forcing me to be supervised by a physician.
Q: I would love to hear your answering to the following questions.
A: What I think you meant to say was “I would love to hear your answers to the *previous* questions”. What I’m noticing is that I am answering your questions, but you are not “hearing” them.
So there you go. Again... thank you for illustrating to others your absurdity. You do a service to me by just being you, and showing that to everyone that reads your words.
*bonus question!*
Q: So, why would a MD/DO go to school for psych when you can do it via a NP degree? What is the benefit of all their training since you think you are perfectly trained to manage all psych cases?
A: Ask a physician that, I guess. I know that one physician I trained with said that they would never recommend their kids follow their footsteps when they could just go to NP school. Not everyone self flagellates themselves like you do, and looks down upon their own training.
I never said that I was “perfectly trained to manage all psyche cases”. I know psychiatrists that don’t believe even they are perfectly trained to manage all psyche cases, so they will frequently punt things like ped psyche to other providers.
I don't look down on my career, you just think I am because you are "independent" and assume we are inferior or think we are inferior. That's the mind set you have is having a collaborating physician is inferior and not good. I am very happy with my career chose and if I wanted to go to medical school I could have went, I picked PA over MD because I wanted to live my life and enjoy my family. No regrets here.
Sure that sounds good to refer out or punt to the ED, but how many times can one do that. Again, you don't know what you don't know. So, when and what do you punt or wait? Maybe you are waiting and it truly is a emergency? That is where a physician comes in mind. I for OTP and not independence (like most PAs). Again your mind set is that of a physician and their training. You don't have the education for that so quit thinking like you do.I don’t think you are inferior (well, I have no idea if you personally are inferior.... you are doing a good job of placing doubts in my head, but I won’t go there). In reality, I think that PAs should pursue independence. Having a collaborating physician isn’t a bad idea if it’s not required, otherwise, it is placing your ability to work in your profession into the hands of another. I don’t think that is the best model for practice anymore. Your training is probably excellent, so why not be untethered?
You bring up a good point... what if I have a question, and there is no provider available? Well... what does a physician do? In an emergency, he or she sends a patient to the ED. If it’s something that can wait, then they have to get back to them at a later time. If it’s something outside of the purview of their expertise, they refer out. Well.... so do I. I have no problem doing that. Patient comes first, and certainly over my own ego. And I’ve found that folks appreciate that.
Sure that sounds good to refer out or punt to the ED, but how many times can one do that. Again, you don't know what you don't know. So, when and what do you punt or wait? Maybe you are waiting and it truly is a emergency? That is where a physician comes in mind. I for OTP and not independence (like most PAs). Again your mind set is that of a physician and their training. You don't have the education for that so quit thinking like you do.