PAs vote for increased independent practice

[northernpsy]

I think all residents and early career docs should be aware that the midlevel turf war seems to be continuing to pick up steam. Apparently PAs have voted to start agitating for what they call "optimal team practice".

So what do they mean by that?

Optimal Team Practice reemphasizes the PA profession’s commitment to team-based care, and in an amendment offered on the floor of the House of Delegates, reaffirms that the degree of collaboration between PAs and physicians should be determined at the practice level. It also supports the removal of state 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. In addition, the new policy advocates for the establishment of autonomous state boards with a majority of PAs as voting members to license, regulate and discipline PAs, or for PAs to be full voting members of medical boards. Finally, the policy says that that PAs should be eligible to be reimbursed directly by public and private insurance for the care they provide.
...
Optimal Team Practice resembles, but is not the same as, full practice authority, which nurse practitioners have been pursuing and have achieved in 22 states and Washington, D.C. The primary difference is the PA profession’s commitment to team based practice. PAs would continue to collaborate with physicians and other qualified medical professionals as dictated by the patient’s condition and the standard of care, and in accordance with each PA’s education, training and experience.

PAs Vote to Advance Profession to Meet Modern Healthcare Needs - AAPA

As it is, about 20,000 new NPs are coming out of training each year and fighting hard for independent practice in numerous states. Now this.

I personally think this kind of thing represents a huge threat to our profession and we need to put pressure on the AMA and our state medical societies to start responding aggressively. To docs who have paid off their loans it might not be a huge deal to have incomes further driven down by a flood of lesser-trained, lower paid people doing the same work, but for those of us who are still getting established this could be a major issue that could define our most productive years.

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[WheezyBaby]

It's, more importantly, a patient safety issue. Their definition of team based care is farcical, particularly in combination with their desire for a separate board. Regardless, if I had to guess, they'll go the way of NP's

 

[cbrons]

Yes this is a huge problem and needs to be fought against with the utmost aggression.

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[cbrons]

I think this is also why the AMA needs to support the push for medical school graduates to function as PAs if they forgo residency (e.g. the Assistant Physician in Missouri). That might sound counter-intuitive, but here is a good argument why it would (ironically) help to suppress PA and NP independence pushes: No Residency? No Problem!

 

[Venice Beach]

They are very helpful to supervising physicians and very knowledgeable. But alone... way too dangerous.

 

[northernpsy]

They are already pushing a study to claim that there is "no difference" in the care NPs and PAs provide compared to primary care physicians:
No difference in care between PAs, NPs, physicians in community health centers - AAPA
Problem is, there is a lot more to providing good quality primary care than things like whether or not you counseled the patient on smoking cessation even though things like that are easy to measure.

Apparently right now PAs and NPs are willing to join forces against doctors, but it will be interesting to see if PAs and NPs end up turning against each other as they have to compete with each other for patients. At this stage, I consider NPs to be the biggest threat to our profession, since they are much further along in their efforts to become independent and it seems like there are few standards in regards to the quality of their training (some NP programs are 100% online classes without any in-person clinical experiences). However, now that PAs are heading in this direction, I expect the situation with PAs will deteriorate rapidly.

Which parts of our training and knowledge are superfluous exactly? Why can't physicians practice straight out of medical school if NPs are qualified to work independently after just taking some online classes? These are the kinds of questions that our medical leadership need to be raising with legislators. If we don't have jobs, none of the other issues on the AMA's agenda matter, so this issue should be priority #1 for them. Right now I don't think it is, because it seems to me like most docs don't yet see how serious this problem is becoming.

I am really quite concerned about what the medical field is going to look like in the next 10-15 years with the direction things are going in. Medicine is becoming watered down so much. They're trying to turn medicine into shift work based on algorithms that pretty much anyone can do (there are some NP programs that have 100% acceptance rates, so the selection process is a far cry from medical school). We are losing something really valuable all for the sake of turning healthcare into a "product" that can be mass-produced.

But as long as the NPs and PAs have decent Press-Ganey scores, no big deal, right?

 

[AdmiralChz]

Every time I hear about this sort of thing I remind people what PA is abbreviated from. PAs in this way always refer to themselves as the two letters rather than the long form - Physician Assistant. Check the press release, physician assistant is never spelled out. The name itself implies physician cooperation and collaboration, NOT independent practice. They (and NPs) have a vital role in the healthcare system, but independence is not one of them. There are too many dubious (and straight up for-profit) and highly inconsistent training programs which lack standardization beyond a single certifying exam at the end of school.

 

[northernpsy]

Every time I hear about this sort of thing I remind people what PA is abbreviated from. PAs in this way always refer to themselves as the two letters rather than the long form - Physician Assistant. Check the press release, physician assistant is never spelled out. The name itself implies physician cooperation and collaboration, NOT independent practice. They (and NPs) have a vital role in the healthcare system, but independence is not one of them. There are too many dubious (and straight up for-profit) and highly inconsistent training programs which lack standardization beyond a single certifying exam at the end of school.

Yes, isn't it ludicrous that physician ASSISTANTS have decided they can just take over the physician's job? Perhaps we have been part of the problem by not insisting on referring to PAs as our "assistants". I fully expect their next move will be to "rebrand" by changing what PA stands for before people start to question the assistant part.

 

[Apollyon]

Yes, isn't it ludicrous that physician ASSISTANTS have decided they can just take over the physician's job? Perhaps we have been part of the problem by not insisting on referring to PAs as our "assistants". I fully expect their next move will be to "rebrand" by changing what PA stands for before people start to question the assistant part.

Haven't people in the PA ranks pushed "physician associate"? I have heard that, but haven't done any research as to prevalence of this.

 

[northernpsy]

Haven't people in the PA ranks pushed "physician associate"? I have heard that, but haven't done any research as to prevalence of this.

Looks like you are right. Yale's physician assistant program already does call them "physician associates" : Home > Physician Associate Program | Medical Education | Yale School of Medicine

We NEED to pay attention to the language midlevels are using and combat it when they are misleading. Here's an example of misleading language being used for midlevels : I just found out that the University of Phoenix offers a 5 day long "residency" for their NP students!

Residency

About one year into your program you will participate in an intensive 5 day residency included in the NRP/571: Advanced Health Assessment II and Clinical Procedures.*

• • Online students – last 5 days of your course (Thursday – Monday) in Phoenix, AZ
  • Local Students – will occur between week 7 and week 8

• 
  

Nurse Practitioner Programs Online - Masters in Nursing - University of Phoenix


Everyone here who would consider someone who completed a five day "residency" after leisurely completing online classes one class at a time to have "intensive" training equivalent to your own, wanna raise your hand? Hm, anyone? Yet in 22+ states so far, these NPs are able to say that they are "equal, if not better" compared to actual physicians.
It infuriates me that this midlevel movement is intentionally trying to blur the lines between physicians and other healthcare workers to confuse people. Imagine that you're a patient waiting to see your doctor, someone in a white coat shows up in your hospital room, calls herself "Dr. Soandso", tells you she finished her "residency" recently - and unbeknownst to you, the person never went to med school at all but is just a nurse who took some NP classes online. You still get billed the same as if you saw a board certified physician, though! How is that okay? It's intentionally deceptive.

Now we have PAs starting to play games to mislead people about what they really are too. It's clear what an "assistant" is supposed to do. What is an "associate" supposed to do exactly? How many non-physicians will understand that the "physician associate" is not actually a physician?

Would lawyers tolerate it if there was a wide scale movement of people who never went to law school giving out legal advice and presenting themselves as if they were lawyers?

I think we need to start making websites where we can spell all of this out to patients to help them realize how they are getting misled and screwed over by this trend. People want to google stuff for their healthcare, so let's help them learn more about who is taking care of them. If you knew nothing about medicine, wouldn't you appreciate it if a doctor explained to you how to tell if the person who has their life in your hands is actually a physician or just some rando who did a couple online classes before getting turned loose to experiment on you?

 

[rokshana]

if they want to be independent, then fine, let them be independent...independent of me having to see their patients, independent of me co signing their notes, and most importantly independent of my med mal and i am not the buck...they are....