I should remember what your take is on midlevel independence, and I believe you have been a PA and are a physician, if I'm not mistaken.
I think you get where I'm coming from. If there is bias on my part, its bias against the structure of the environment and the reality that they are placed in. My outlook on investment has a very conservative flavor to it: If I invest in something, its going to be something that, first and foremost, has the least potential for falling through vs the investment that has the most potential to soar. The same thing for the advice I would give someone. If a person is in an AA practice state and they are fine with the minute uncertainty that comes with the limitations of being an AA, then more power to them to achieve their goal, but at least entertain the downsides and risks.
To me, its like deciding whose name I should tattoo on my arm (if I did such things). I love my spouse and my kids, and I'm secure in the fact that my spouse loves me back. But no matter what, my kids will be my kids, and nothing changes that so why not ink up their names? However, spouses have been known to split at least 50 percent of the time, so no matter how much I want to avoid that, sometimes it's not avoidable. That's similar to the reservation that's always been with me when deciding between PA and NP (similar to what folks looking at CRNA and AA have before them). So if you get "branded" with the title and education of an assistant, you are in a profession that isn't even your own (even though it probably should be). And all along, you know it should be your own, because you see NP's and CRNA's doing just fine with their own profession. That's what it came down to for me. My workplace may require me to report to a physician, but at the end of the day, if I walk out the door to find a new job, my ability to practice or write a script doesn't instantly terminate once there isn't a physician willing to sponsor me. No physician can say to me "I'd hate for you to cross me, because then I'd revoke my supervision and you'd be toast until you found someone else to sponsor you".
Regardless of anyone's feelings about who should be allowed to practice independently, that genie is out of the bottle in so many states that it can't be capped. I don't think that midlevels being independent has unleashed a wave of obscene practices that take place outside of their scope of practice. There might be a few that play cowboy, but most want to keep their licenses. Its just a strange structure to have built in "master and apprentice" like formula that the "assistant" world has to deal with.
