AAPA's Push for Full Practice Authority

[Fox800]

Can we talk about this? I just threw up a little.

Full Practice Authority and Responsibility - AAPA News Center: NCCPA’s PANRE Proposal

http://news-center.aapa.org/wp-content/uploads/sites/2/2016/12/FAQ-Final_12_15.pdf

"The Task Force believes AAPA should adopt policy to do four things:
• Emphasize our profession’s continued commitment to team-based practice (AKA no hierarchy for clinical decision-making).
• Support the elimination of provisions in laws and regulations that require a PA to have and/or report a supervisory, collaborating or other specific relationship with a physician in order to practice.
• Advocate for the establishment of autonomous state boards, with a voting membership comprised of a majority PAs, to license, regulate, and discipline PAs (we want to do the same job as physicians but not have to be overseen by those pesky docs - just like the NPs have done).
• Ensure that PAs are eligible to be reimbursed directly by public and private insurance."

*Practice in the title. I cannot spell.

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[Cinclus]

Ummm, wut? They're physician assistants.

 

[deleted480308]

Et tu, Brute?

 

[deleted6669]

as mentioned in the other thread, if PHYSICIANS would hire PAs preferentially over NPs this would not be an issue.
we are doing this because PHYSICIANS don't want the liability of signing charts, so they hire NPs instead. a national survey of PAs found a vast majority losing job opportunities to NPs solely because of supervisory issues. this is not such an issue in EM as we are the non-physician provider of choice in the field, but in primary care PAs are losing out to NPs, despite the differences in our training.
this is a physician-created problem. you guys created the PA profession to work with you and then ignored us because supervision and signing charts is too much work.
Michigan has already enacted legislation reflective of this. physicians who work with PAs there are now known as "participating physicians" and specifically have no liability for the work done by PAs in their practices. physicians like this change.

 

[ajh1983]

as mentioned in the other thread, if PHYSICIANS would hire PAs preferentially over NPs this would not be an issue.
we are doing this because PHYSICIANS don't want the liability of signing charts, so they hire NPs instead. a national survey of PAs found a vast majority losing job opportunities to NPs solely because of supervisory issues. this is not such an issue in EM as we are the non-physician provider of choice in the field, but in primary care PAs are losing out to NPs, despite the differences in our training.
this is a physician-created problem. you guys created the PA profession to work with you and then ignored us because supervision and signing charts is too much work.
Michigan has already enacted legislation reflective of this. physicians who work with PAs there are now known as "participating physicians" and specifically have no liability for the work done by PAs in their practices. physicians like this change.

No, government created this problem by creating a shortage of physician providers over time and leveraging that gap by allowing nurses with a watered down masters degree to practice FAR beyond their proper scope of practice. PA are actually right where they should be.

 

[anonperson]

Everyone wants the respect, pay, and autonomy of a physician without actually being a physician and going through the same rigorous training.

Meanwhile, physicians idea to combat this is to add more maintenance of certification or fellowship years to combat this.

Makes you want to wash your hand of the whole system.

 

[Darth Doc]

as mentioned in the other thread, if PHYSICIANS would hire PAs preferentially over NPs this would not be an issue. We are doing this because PHYSICIANS don't want the liability of signing charts, so they hire NPs instead. PAs are losing out to NPs, despite the differences in our training.

I agree that the change is a direct result of NPs pushing their profession and being regulated by the nursing board instead of the physician board. The nursing board will let nurses do whatever the legislatures will let them. If PAs don't push in the same direction as NPs, they'll lose out on jobs they're equally or more qualified for.

I don't think PAs see themselves as equal to physicians; most of the ones I know don't. They do see the writing on the wall if they aren't competitive with NPs in a midlevel marketplace where employers are insurance and hospital administrators who look at graphs of cost/benefit analyses without any understanding of medical, PA or NP education.

Hospitals will stop hiring PAs if they can't legally do as much as NPs. It doesn't matter to administrators whether the jobs are done well or whether they're well trained for the job. They only care how much they can make off of the person being hired. If PAs can't compete in the job marketplace, they will cease to exist as a profession.

 

[deleted6669]

. PA are actually right where they should be.

losing jobs to NPs?

 

[Fox800]

losing jobs to NPs?

Patient safety trumps job security. Unfortunately, NPs weaseled their way to independent practice.

 

[deleted6669]

Patient safety trumps job security. Unfortunately, NPs weaseled their way to independent practice.

sorry, not willing to write off my profession and give all the non-physician jobs to NPs who are less qualified than I am.

 

[RustedFox]

Call me ignorant, but I didn't even know that this NP autonomy thing was actually happening. I don't have to sign off on their charts anymore?

Someone bring me up to speed. I'd love to not sign their charts. YOYOMF.

 

[deleted480308]

Call me ignorant, but I didn't even know that this NP autonomy thing was actually happening. I don't have to sign off on their charts anymore?

Someone bring me up to speed. I'd love to not sign their charts. YOYOMF.

some states have given them full private scope

 

[RustedFox]

as mentioned in the other thread, if PHYSICIANS would hire PAs preferentially over NPs this would not be an issue.
we are doing this because PHYSICIANS don't want the liability of signing charts, so they hire NPs instead. a national survey of PAs found a vast majority losing job opportunities to NPs solely because of supervisory issues. this is not such an issue in EM as we are the non-physician provider of choice in the field, but in primary care PAs are losing out to NPs, despite the differences in our training.
this is a physician-created problem. you guys created the PA profession to work with you and then ignored us because supervision and signing charts is too much work.
Michigan has already enacted legislation reflective of this. physicians who work with PAs there are now known as "participating physicians" and specifically have no liability for the work done by PAs in their practices. physicians like this change.

You say that if PHYSICIANS would hire PAs instead of NPs, then this would obviate the issue.

Sure, let me do the hiring/firing. Oh, wait... I can't. That's the CMG's turf. Another reason why CMGs need to die.

You seem to make the assertion that PA >>> NP frequently.

I gotta say, I've worked with a lot, and only very few of them are half-decent at medical decision making, documentation, etc.

If the general attitude of the Physician assistants was to... assist physicians, then I wouldn't be so critical. But instead, many of them seem to be more interested in arguing with me as to why they're just as good or better, or "right" when it comes down to the management of this patient, or why "they do it this way."

I would love to work with a true physician assistant. I want them to do what I want them to do, how I want it done, and document it how I want it written. No arguments.

I haven't seen one of those yet.

 

[deleted6669]

You say that if PHYSICIANS would hire PAs instead of NPs, then this would obviate the issue.

Sure, let me do the hiring/firing. Oh, wait... I can't. That's the CMG's turf. Another reason why CMGs need to die.

You seem to make the assertion that PA >>> NP frequently.

I gotta say, I've worked with a lot, and only very few of them are half-decent at medical decision making, documentation, etc.

If the general attitude of the Physician assistants was to... assist physicians, then I wouldn't be so critical. But instead, many of them seem to be more interested in arguing with me as to why they're just as good or better, or "right" when it comes down to the management of this patient, or why "they do it this way."

I would love to work with a true physician assistant. I want them to do what I want them to do, how I want it done, and document it how I want it written. No arguments.

I haven't seen one of those yet.

ok, keep hiring NPs with 1/4 the clinical training who respond only to nursing boards.

 

[RustedFox]

ok, keep hiring NPs with 1/4 the clinical training who respond only to nursing boards.

Read my post again. Slowly this time.

I can't hire or fire anyone.

 

[deleted6669]

Read my post again. Slowly this time.

I can't hire or fire anyone.

some/many physician groups are interviewing and hiring NPs preferentially over PAs. I didn't mean you personally. even in non-democratic groups physicians do the interviewing and hiring, not administrators. I work for such a group that fortunately prefers PAs over Nps.

 

[RustedFox]

Ultimately, I don't care whether its NP or PA or whatever as long as you do as you're told to the letter.

If you don't want to do as your told, then YOYOMF.

Maybe the NPs finally get their autonomous wish, and they're exposed for teh suck that a lot of them are. Lawsuits pile up, and they get back in line.

 

[Fox800]

Ultimately, I don't care whether its NP or PA or whatever as long as you do as you're told to the letter.

If you don't want to do as your told, then YOYOMF.

Maybe the NPs finally get their autonomous wish, and they're exposed for teh suck that a lot of them are. Lawsuits pile up, and they get back in line.

I'm stealing YOYOMF for my own use now.

 

[RustedFox]

I'm stealing YOYOMF for my own use now.

I got the expression from here, too.

Give them the rope to tie their own nooses, I say. I'm sick and tired of 30+ interruptions every shift because some NP says "Hey, I got one for yah."
If you can't handle a patient from H&P to dispo - then don't handle it. Drop it. GTFO.
The attorneys will eat them for lunch, and the problem will solve itself.

 

[Fox800]

I got the expression from here, too.

Give them the rope to tie their own nooses, I say. I'm sick and tired of 30+ interruptions every shift because some NP says "Hey, I got one for yah."
If you can't handle a patient from H&P to dispo - then don't handle it. Drop it. GTFO.
The attorneys will eat them for lunch, and the problem will solve itself.

That would be ideal. However, how do you see that playing out if the patient suddenly crumps in the ED? It would suck to be called in to bail out an NP/PA who had a pt who decided to crump and being held jointly liable for their own eff-up.

 

[deleted6669]

That would be ideal. However, how do you see that playing out if the patient suddenly crumps in the ED? It would suck to be called in to bail out an NP/PA who had a pt who decided to crump and being held jointly liable for their own eff-up.

no doc in my ED, so no worries....

 

[Fox800]

no doc in my ED, so no worries....

I think you've discussed ad nauseum that your practice set-up is quite atypical compared to most emergency departments in the United States. We get it. You have your own sandbox.

 

[RustedFox]

That would be ideal. However, how do you see that playing out if the patient suddenly crumps in the ED? It would suck to be called in to bail out an NP/PA who had a pt who decided to crump and being held jointly liable for their own eff-up.

So I'm liable but not liable ? They crump, they have to go clean it up. Just like I said in my above statement.... from greet to dispo. Can't handle it? Do as you're told, or GTFO.

 

[RustedFox]

no doc in my ED, so no worries....

Yeah, that's between you and the hospital, amigo. You're.... on your own, MF. Quite literally. I don't know who your SP is listed as, but I wouldn't take that gig.

 

[Status Sciaticus]

sorry, not willing to write off my profession and give all the non-physician jobs to NPs who are less qualified than I am.

If the concern is that NPs are taking more PA jobs, and you are concerned with patient safety, then shouldnt PA's lobby against NPs and bring them back under physician supervision instead of asking for autonomy and rights to practice independently?
The counterargument that if NP's are doing it so we should too is kind of like two wrongs attempting to make a right.

 

[Fox800]

If the concern is that NPs are taking more PA jobs, and you are concerned with patient safety, then shouldnt PA's lobby against NPs and bring them back under physician supervision instead of asking for autonomy and rights to practice independently?
The counterargument that if NP's are doing it so we should too is kind of like two wrongs attempting to make a right.

It's totally a "Me, too! Me, too!" argument. Thankfully I haven't had to work in an ED with NPs in it. A disturbing number of PAs I work with have this too cool for school, I'm-smarter-than-the-residents attitude at my program.

 

[Makati2008]

If the concern is that NPs are taking more PA jobs, and you are concerned with patient safety, then shouldnt PA's lobby against NPs and bring them back under physician supervision instead of asking for autonomy and rights to practice independently?
The counterargument that if NP's are doing it so we should too is kind of like two wrongs attempting to make a right.

I agree with this viewpoint but unfortunately many of our physician colleagues as well as the spineless politicians don't have the guts to make this happen. I sat in a meeting last year and heard some politicians saying they were afraid to make the nurses mad. Smh


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[sum dude]

Nuff said

 

[Fox800]

View attachment 217634

Nuff said

Awesome. PA needs to be added.

 

[doctalaughs]

sorry, not willing to write off my profession and give all the non-physician jobs to NPs who are less qualified than I am.

As I mentioned this push is quite transparently NOT solely to compete with NPs. If that was the case, then ONLY request a separate license unattached to a physician but keep yourselves under the purview of the board of medicine. That would solve any "preference" for NPs by docs due to (misplaced) ideas it might limit our liability.

By requesting a separate board managed purely by PAs it's very clear this is a blatant step to have full control over expanding scope of practice with zero input from physicians.

I thought PAs were better than the nurses but guess I was wrong. All misdirection, propaganda and scope-creep.


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[Status Sciaticus]

I agree with this viewpoint but unfortunately many of our physician colleagues as well as the spineless politicians don't have the guts to make this happen. I sat in a meeting last year and heard some politicians saying they were afraid to make the nurses mad. Smh


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This is precisely why physicians need to run for office and actually take active roles in health policy making. Unfortunately, this doesn't happen and the passive nature of physicians as a whole will result in our autonomy slowly eroding away. PACs are a good way to get your voice heard as well, but physicians largely dont donate to them either.
Also the whole idea of being barred from forming a physician union is definitely a handicap.

As I mentioned this push is quite transparently NOT solely to compete with NPs. If that was the case, then ONLY request a separate license unattached to a physician but keep yourselves under the purview of the board of medicine. That would solve any "preference" for NPs by docs due to (misplaced) ideas it might limit our liability.

By requesting a separate board managed purely by PAs it's very clear this is a blatant step to have full control over expanding scope of practice with zero input from physicians.

I thought PAs were better than the nurses but guess I was wrong. All misdirection, propaganda and scope-creep.


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What will their job title be lol? Not sure you can have a physician assistant without a physician to assist.

 

[doctalaughs]

This is precisely why physicians need to run for office and actually take active roles in health policy making. Unfortunately, this doesn't happen and the passive nature of physicians as a whole will result in our autonomy slowly eroding away. PACs are a good way to get your voice heard as well, but physicians largely dont donate to them either.
Also the whole idea of being barred from forming a physician union is definitely a handicap.



What will their job title be lol? Not sure you can have a physician assistant without a physician to assist.

Haven't you heard? They have been pushing for several years to be called "physician associates."


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[Status Sciaticus]

Haven't you heard? They have been pushing for several years to be called "physician associates."


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Physician associates that dont associate with physicians? LMAO.. this is going to go over well.

 

[Medic2PA-C]

Hey, guys. I signed up just to post here and I hope this post comes across with the appropriate amount of respect and decorum that this topic deserves. I've seen some comments from those tho purport to be physicians and it's really too bad they aren't taking this seriously or aren't mature enough to discuss this as an adult.

PAs are in no way under the impression that we are doctors or that our education is the same as a physician. At best we are 85% of a physician and it's our intended goal to work as a team with those physicians who will lead us. Perhaps after many years of experience a PA can rise to the higher levels of leadership but never to the very top. Achieving that requires an MD/DO.

The reason why PAs are pushing for more liberalized state laws and insurance reimbursement is due to the successful and extremely aggressive political and legislative efforts of the NP lobby. Despite having less education than PAs and not knowing what they don't know the NP lobby has succeeded in removing the administrative barriers that make the more attractive to hospitals, clinics, and physician-owned groups to hire and retain. Why hire a PA (who is better trained and knows when to call in their physician) when an NP can be paid less to do more and doesn't require numerous administrative hurdles to overcome?

Patient care is endangered by NPs and their complete lack of appropriate medical education who are taught they are the be-all-and-end-all of patient care. Contrast this to PA school (which I am in) where we are regularly taught to call in the physician or refer to a physician as the only appropriate thing to do. This may be very difficult when working in a rural area where there is no physician but the nice thing about the PA-MD/DO team is that there must always be a physician available via telephone to call and consult. Contrast this to NPs where they do not need to have any agreement with any MD/DO in order to practice. Scary stuff indeed.

I am a huge advocate of strengthening the ties between PAs and MD/DOs and in fact I even think it's a good idea to do away with PA-specific certification board in favor of the MD organizations (AAFP, ACEM, etc) making PA-specific certification exams. More integration and leadership by physicians is needed, not less. The more we PAs make our own certification and boards the less we find ourselves integrated with those who we rely on--physicians.

 

[deleted480308]

Hey, guys. I signed up just to post here and I hope this post comes across with the appropriate amount of respect and decorum that this topic deserves. I've seen some comments from those tho purport to be physicians and it's really too bad they aren't taking this seriously or aren't mature enough to discuss this as an adult.

PAs are in no way under the impression that we are doctors or that our education is the same as a physician. At best we are 85% of a physician and it's our intended goal to work as a team with those physicians who will lead us. Perhaps after many years of experience a PA can rise to the higher levels of leadership but never to the very top. Achieving that requires an MD/DO.

The reason why PAs are pushing for more liberalized state laws and insurance reimbursement is due to the successful and extremely aggressive political and legislative efforts of the NP lobby. Despite having less education than PAs and not knowing what they don't know the NP lobby has succeeded in removing the administrative barriers that make the more attractive to hospitals, clinics, and physician-owned groups to hire and retain. Why hire a PA (who is better trained and knows when to call in their physician) when an NP can be paid less to do more and doesn't require numerous administrative hurdles to overcome?

Patient care is endangered by NPs and their complete lack of appropriate medical education who are taught they are the be-all-and-end-all of patient care. Contrast this to PA school (which I am in) where we are regularly taught to call in the physician or refer to a physician as the only appropriate thing to do. This may be very difficult when working in a rural area where there is no physician but the nice thing about the PA-MD/DO team is that there must always be a physician available via telephone to call and consult. Contrast this to NPs where they do not need to have any agreement with any MD/DO in order to practice. Scary stuff indeed.

I am a huge advocate of strengthening the ties between PAs and MD/DOs and in fact I even think it's a good idea to do away with PA-specific certification board in favor of the MD organizations (AAFP, ACEM, etc) making PA-specific certification exams. More integration and leadership by physicians is needed, not less. The more we PAs make our own certification and boards the less we find ourselves integrated with those who we rely on--physicians.

You seem to say it's professionally frustrating and dangerous for patients to watch someone lobby for scope and autonomy beyond their training....but then simultaneously do the frustrating and dangerous thing

 

[Medic2PA-C]

You seem to say it's professionally frustrating and dangerous for patients to watch someone lobby for scope and autonomy beyond their training....but then simultaneously do the frustrating and dangerous thing

I maintain that the PA scope of practice should be determined by physicians at the practice level. The more a physician is comfortable with a PA's practice then the more the PA can do. NPs, however, have made an end-run around that by lobbying for and passing legislation that places patients in danger by removing the physician-lead component of NP practice.

 

[deleted480308]

I maintain that the PA scope of practice should be determined by physicians at the practice level. The more a physician is comfortable with a PA's practice then the more the PA can do. NPs, however, have made an end-run around that by lobbying for and passing legislation that places patients in danger by removing the physician-lead component of NP practice.

So you oppose PAs pulling the same dangerous end run?

 

[Medic2PA-C]

So you oppose PAs pulling the same dangerous end run?

Strongly. This attempt by the AAPA isn't an end-run to remove physicians from leadership, but rather removing administrative and legal barriers which make hiring and retaining PAs a major headache. Anything which removes a physician from leading clinical practice is something I strongly disagree with.

 

[deleted480308]

Strongly. This attempt by the AAPA isn't an end-run to remove physicians from leadership, but rather removing administrative and legal barriers which make hiring and retaining PAs a major headache. Anything which removes a physician from leading clinical practice is something I strongly disagree with.

Now you're being dishonest, this is pushing for Independance

 

[racerwad]

I maintain that the PA scope of practice should be determined by physicians at the practice level. The more a physician is comfortable with a PA's practice then the more the PA can do. NPs, however, have made an end-run around that by lobbying for and passing legislation that places patients in danger by removing the physician-lead component of NP practice.

In what scenario does a PA need to be able to do more? If such a scenario arises, isn't this exactly the time, by your own admission, that the supervising physician needs to get involved? Pretending that more independence is needed to mitigate some unknown clinical scenario is absurd. It is true that PAs and NPs do a fundamentally important service by providing care in areas that lack physician coverage. What the NPs have done and the AAPA is proposing is self-promotion and ego-stroking, not patient care.

...we are regularly taught to call in the physician or refer to a physician as the only appropriate thing to do. This may be very difficult when working in a rural area where there is no physician but the nice thing about the PA-MD/DO team is that there must always be a physician available via telephone to call and consult...

 

[F1rstGen]

Hey, guys. I signed up just to post here and I hope this post comes across with the appropriate amount of respect and decorum that this topic deserves. I've seen some comments from those tho purport to be physicians and it's really too bad they aren't taking this seriously or aren't mature enough to discuss this as an adult.

PAs are in no way under the impression that we are doctors or that our education is the same as a physician. At best we are 85% of a physician and it's our intended goal to work as a team with those physicians who will lead us. Perhaps after many years of experience a PA can rise to the higher levels of leadership but never to the very top. Achieving that requires an MD/DO.

The reason why PAs are pushing for more liberalized state laws and insurance reimbursement is due to the successful and extremely aggressive political and legislative efforts of the NP lobby. Despite having less education than PAs and not knowing what they don't know the NP lobby has succeeded in removing the administrative barriers that make the more attractive to hospitals, clinics, and physician-owned groups to hire and retain. Why hire a PA (who is better trained and knows when to call in their physician) when an NP can be paid less to do more and doesn't require numerous administrative hurdles to overcome?

Patient care is endangered by NPs and their complete lack of appropriate medical education who are taught they are the be-all-and-end-all of patient care. Contrast this to PA school (which I am in) where we are regularly taught to call in the physician or refer to a physician as the only appropriate thing to do. This may be very difficult when working in a rural area where there is no physician but the nice thing about the PA-MD/DO team is that there must always be a physician available via telephone to call and consult. Contrast this to NPs where they do not need to have any agreement with any MD/DO in order to practice. Scary stuff indeed.

I am a huge advocate of strengthening the ties between PAs and MD/DOs and in fact I even think it's a good idea to do away with PA-specific certification board in favor of the MD organizations (AAFP, ACEM, etc) making PA-specific certification exams. More integration and leadership by physicians is needed, not less. The more we PAs make our own certification and boards the less we find ourselves integrated with those who we rely on--physicians.

At best you are maybe 40% of a physician.....on a good day.....when the pathology is typical. I'm at the point in medical school where my educational level is roughly equal to a graduating PA and I will not hesitate to admit that I have only just scratched the surface of what it takes to be a GOOD physician. Residency is where a good bit of a physician's knowledge is attained and this is what sets them apart (in addition to their more thorough curriculum).

 

[Atlas Shrugged]

Strongly. This attempt by the AAPA isn't an end-run to remove physicians from leadership, but rather removing administrative and legal barriers which make hiring and retaining PAs a major headache. Anything which removes a physician from leading clinical practice is something I strongly disagree with.

Re-read everything you just wrote...

 

[Medic2PA-C]

At best you are maybe 40% of a physician.....on a good day.....when the pathology is typical. I'm at the point in medical school where my educational level is roughly equal to a graduating PA and I will not hesitate to admit that I have only just scratched the surface of what it takes to be a GOOD physician. Residency is where a good bit of a physician's knowledge is attained and this is what sets them apart (in addition to their more thorough curriculum).

I won't disagree! I said PA education is at best 85% of a physician. It might be way lower and it might also depend on the school. The tone of your post seems to think I am advocating for PAs to become independent like NPs. NO WAY! The physician is the captain of the ship. As a PA I might be able to be the senior guy on deck or in a department but certain things are only dealt with and decided by the captain/physician and you get your orders and priorities from the captain/physician.

I see physicians as the officers, PAs as the warrant officers, and nurses as the NCOs. NPs aren't part of the game, tho. They're just too dangerous.

 

[deleted480308]

I really, really hope this can continue with appropriate decorum and respect. Calling me "dishonest" is a personal attack and a violation of these forum rules. If you agree to abide by decorum and respect then I'll continue posting here. Otherwise I'll walk away and this would be a lost opportunity.

It is actually and literally dishonest to claim the PAs aren't pushing for independent practice. Do you still claim that?

 

[MSmentor018]

Hey, guys. I signed up just to post here and I hope this post comes across with the appropriate amount of respect and decorum that this topic deserves. I've seen some comments from those tho purport to be physicians and it's really too bad they aren't taking this seriously or aren't mature enough to discuss this as an adult.

PAs are in no way under the impression that we are doctors or that our education is the same as a physician. At best we are 85% of a physician and it's our intended goal to work as a team with those physicians who will lead us. Perhaps after many years of experience a PA can rise to the higher levels of leadership but never to the very top. Achieving that requires an MD/DO.

The reason why PAs are pushing for more liberalized state laws and insurance reimbursement is due to the successful and extremely aggressive political and legislative efforts of the NP lobby. Despite having less education than PAs and not knowing what they don't know the NP lobby has succeeded in removing the administrative barriers that make the more attractive to hospitals, clinics, and physician-owned groups to hire and retain. Why hire a PA (who is better trained and knows when to call in their physician) when an NP can be paid less to do more and doesn't require numerous administrative hurdles to overcome?

Patient care is endangered by NPs and their complete lack of appropriate medical education who are taught they are the be-all-and-end-all of patient care. Contrast this to PA school (which I am in) where we are regularly taught to call in the physician or refer to a physician as the only appropriate thing to do. This may be very difficult when working in a rural area where there is no physician but the nice thing about the PA-MD/DO team is that there must always be a physician available via telephone to call and consult. Contrast this to NPs where they do not need to have any agreement with any MD/DO in order to practice. Scary stuff indeed.

I am a huge advocate of strengthening the ties between PAs and MD/DOs and in fact I even think it's a good idea to do away with PA-specific certification board in favor of the MD organizations (AAFP, ACEM, etc) making PA-specific certification exams. More integration and leadership by physicians is needed, not less. The more we PAs make our own certification and boards the less we find ourselves integrated with those who we rely on--physicians.

85% is...um...well driven by a strong miscalculation. if education time/clinical experience is primary what you're basing this number on, then it's tremendously lower.

I remember the days of BS was all a PA needed. nurses got PhD, now you have to get a masters. Do you believe your masters degree makes you a better clinician? or does a PhD in pillow fluffing help you dx someone? On the other hand doctors haven't changed much. it's still 4 yr med school, residency. multiple letters make you a clinician not.

the NP/PA licensure board could easily say "hey we're not trained to run depts by ourselves, that's not our job. we work under doctors" but unfortunately the doctor shortage, lack of tort reform, political money, hospital pressures and our own weak ass associations have raised your associations expectations, entitlements and egos.

 

[shoal007]

At best you are maybe 40% of a physician.....on a good day.....when the pathology is typical. I'm at the point in medical school where my educational level is roughly equal to a graduating PA and I will not hesitate to admit that I have only just scratched the surface of what it takes to be a GOOD physician. Residency is where a good bit of a physician's knowledge is attained and this is what sets them apart (in addition to their more thorough curriculum).

let me fix that for you...

residency is where the majority of your knowledge and clinical skills get honed. medical school is good for those moments where its i remember something about that condition ( ie a rash in a stem cell transplant is probably not hives must comsider graft vs host dz)

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[goodoldalky]

It is pretty simple, neither PAs, nor NPs, nor any other BS, MA, PhD, DNP, PA-C, BA, EMT, MSSP, STSPT, PTPSM, WTF, keep going if you want, should be treating patients independently. You are not qualified. If you would like to do this, there is a very clear pathway with which to do it. If you do not want to do it, then you can be a PA, or NP, or whatever else you want to do, but in the interest of patient safety these fields should operate only under the direct supervision of a physician. To do otherwise, such as the VA has done with nurses, is to the detriment of the patient.

 

[tux4]

Throw a PA in charge of resus bays for a shift, we shall see how that 85% holds. PA = Paronychia Attendant.


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[doctalaughs]

Strongly. This attempt by the AAPA isn't an end-run to remove physicians from leadership, but rather removing administrative and legal barriers which make hiring and retaining PAs a major headache. Anything which removes a physician from leading clinical practice is something I strongly disagree with.

1. Most people posting here are attending physicians. This is really how a large number of doctors feel about the AAPA move.

2. If you really believe the above statement, you are either incredibly naive or haven't actually read the AAPA proposition. First, not one PA has explained to me how removing themselves from the board of medicine purview will help compete against NPs. Not ONE. Second, allowing complete independence means the just-graduated 23-year-old PA in the bottom 5% of their class ALSO has full practice independence. Think about that. And just because the NPs are doing it doesn't mean you guys should - isn't patient safety supposedly more important than a very questionable edge in job searches?


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[Makati2008]

85% is...um...well driven by a strong miscalculation. if education time/clinical experience is primary what you're basing this number on, then it's tremendously lower.

I remember the days of BS was all a PA needed. nurses got PhD, now you have to get a masters. Do you believe your masters degree makes you a better clinician? or does a PhD in pillow fluffing help you dx someone? On the other hand doctors haven't changed much. it's still 4 yr med school, residency. multiple letters make you a clinician not.

the NP/PA licensure board could easily say "hey we're not trained to run depts by ourselves, that's not our job. we work under doctors" but unfortunately the doctor shortage, lack of tort reform, political money, hospital pressures and our own weak ass associations have raised your associations expectations, entitlements and egos.

Spot on. I had a pre-PA that worked in our ED acting so cocky it's sickening. I'm like I've been where you are going and if you think PA school is hard try medical school.

Also I wouldn't put a "number" on how close we are to being physicians. It's more about depth of knowledge.

A green PA might see a sore throats and think strep or viral pharyngitis but forget the more deadly presentations that these can mask around as. This is taught to us from day 1 of residency.


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