PAs vote for no supervision, own medical boards

[cbrons]

(Copying a reddit post here)

The American Academy of PAs have officially voted to start a nation-wide push for independent practice rights. The way I interpreted it was essentially the right to practice medicine fully independently in any specialty just like any residency/fellowship-trained, board-certified physician. That is my interpretation, but I will give you the exact text of their resolution. They are calling for "Optimal Team Practice." What does that mean?:

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.

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

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[cbrons]

Works for me. Then I can stop signing their charts and taking on their liability.

And What if the MBAs who run the hospital start paying you a lower salary commensurate with PAs who can "do everything you can" for cheaper?

 

[bravotwozero]

Except it'll also strengthen the case for CMGs to replace you with a PA...


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[cbrons]

I suppose it might. And if it turns out they really can do everything I can, then I deserve to be replaced with an equal and cheaper alternative. And the current system of med school/ residency should be bulldozed into the ground.

And if on the other hand it turns out they couldn't actually do everything I could, the hospitals will tire of regularly dealing with patient complaints and paying out multi-million dollar settlements and will come running.

Whether they can or can't do everything you can as well as you can will be totally immaterial. They will (like the AANP) publish their garbage observational studies "proving" that their care is equal to yours. They will use that "proof" to replace you or drive your salary down.

Patients won't complain because 80-plus percent of the time they have no idea why they are even in the hospital let alone who is treating them. And in case you haven't heard, medical malpractice suits are very rarely about medical outcomes (at least according to Dr. Greg Henry). They could have worse outcomes all over the place, but if they are nicer/better-looking/sweeter-talking than you, they probably won't be sued any more than you.

 

[northernpsy]

Whether they can or can't do everything you can as well as you can will be totally immaterial. They will (like the AANP) publish their garbage observational studies "proving" that their care is equal to yours. They will use that "proof" to replace you or drive your salary down.

Surprise surprise, this is already on their website:
No difference in care between PAs, NPs, physicians in community health centers - AAPA

 

[RustedFox]

The MLPs that I work with can't even interpret an EKG, let alone RSI or place a central line.

K.

 

[HooliganSnail]

Whether they can or can't do everything you can as well as you can will be totally immaterial. They will (like the AANP) publish their garbage observational studies "proving" that their care is equal to yours. They will use that "proof" to replace you or drive your salary down.

Patients won't complain because 80-plus percent of the time they have no idea why they are even in the hospital let alone who is treating them. And in case you haven't heard, medical malpractice suits are very rarely about medical outcomes (at least according to Dr. Greg Henry). They could have worse outcomes all over the place, but if they are nicer/better-looking/sweeter-talking than you, they probably won't be sued any more than you.

I think that patients really do understand more than we give them credit for. They really do know that they did not actually see the physician, and in this era of high deductibles where people are paying more cost out of pocket, the consumer finds it unacceptable to pay to be seen by someone who is not a physician. There are exceptions sure, but generally, public opinion is with is. People want to see the doctor.

 

[HooliganSnail]

The MLPs that I work with can't even interpret an EKG, let alone RSI or place a central line.

K.

Agree. While I have worked with excellent PA's before, and I do mean quality, educated, intelligent people, they are not the average.

For every great PA, there are three "meh" ones, and one that is just dangerous.

 

[doctalaughs]

Incredible - medicine in the USA has truly become a race to the bottom.

We need to do similar garbage studies showing the difference between midlevels and physicians. It's pure propaganda (because you cant do an ethical study with real results), but you gotta fight fire with fire. For example, I see referrals from both PCPs and midlevels in primary care. I'm certain the number of ridiculous consult from the midlevels averages 2-3x the physicians. Waste of money and occasionally harm has been done. That is easily measurable and can be publicized.


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[RustedFox]

I think that patients really do understand more than we give them credit for. They really do know that they did not actually see the physician, and in this era of high deductibles where people are paying more cost out of pocket, the consumer finds it unacceptable to pay to be seen by someone who is not a physician. There are exceptions sure, but generally, public opinion is with is. People want to see the doctor.

I recently read thru the press ganey complaints at my one job site. "I never saw a doctor, just the NP" was the most common complaint.

 

[MelMcT2009]

Feels like a slap in the face. If this is allowed, med school shouldn't exist because they're essentially saying it's not necessary.

 

[bravotwozero]

I recently read thru the press ganey complaints at my one job site. "I never saw a doctor, just the NP" was the most common complaint.

Ha. Exactly this. Was going to say this but got beat to the punch.


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[RustedFox]

Ha. Exactly this. Was going to say this but got beat to the punch.


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Admin knows this, too. I can't imagine a situation where the C-Fux have no physician running the show (turbo-rural places notwithstanding, before Boatswain or whoever chimes in to remind us).

 

[doctalaughs]

Admin knows this, too. I can't imagine a situation where the C-Fux have no physician running the show (turbo-rural places notwithstanding, before Boatswain or whoever chimes in to remind us).

Sure a physician will always be "in charge" but do you want to "supervise" 4-6 PAs (ie take their liability) while they pay you a similar or token higher hourly wage while those same PAs brag they do the same thing? Look at anesthesia as a model just slightly ahead of the time curve where this is going.


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[RustedFox]

Sure a physician will always be "in charge" but do you want to "supervise" 4-6 PAs (ie take their liability) while they pay you a similar or token higher hourly wage while those same PAs brag they do the same thing? Look at anesthesia as a model just slightly ahead of the time curve where this is going.


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This has been covered before in the NP push for independence thread. I certainly don't vote for that practice model, and when the MLPs are on shift with me, they know: "It has to be done RF's way. It has to be written RF's way. Don't argue."

It bears repeating... physician assistant, assist the physician. Do as you're told.

 

[WilcoWorld]

I recently read thru the press ganey complaints at my one job site. "I never saw a doctor, just the NP" was the most common complaint.

Even better when these bad scores get attributed to the doc who was on at the time.

 

[doctalaughs]

This has been covered before in the NP push for independence thread. I certainly don't vote for that practice model, and when the MLPs are on shift with me, they know: "It has to be done RF's way. It has to be written RF's way. Don't argue."

It bears repeating... physician assistant, assist the physician. Do as you're told.

Easy to say when you have leverage like now.

Harder to say when fewer docs are needed, c-suite is only hiring "yes men" and physician assistants have renamed themselves "physician associates" (yes, this is a thing). Some PAs are now actually offended by the term midlevel.

It's almost like paralegals suddenly declared they can practice law independently, and renamed themselves "advance practice lawyers." It would be comical if it weren't real.


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[intubesteak]

This is probably a stupid question, but I'm going to ask anyways.

If an NP/PA is "practicing independently", and asks their "supervising" doc to help them out with a patient or something, can the doc (legally) just say "nope, you're on your own kid..."

This whole thing reminds me of deciding to be "independent" as an 18-year old. It sounded great until I needed my parents for....everything.

 

[RustedFox]

Easy to say when you have leverage like now.

Harder to say when fewer docs are needed, c-suite is only hiring "yes men" and physician assistants have renamed themselves "physician associates" (yes, this is a thing). Some PAs are now actually offended by the term midlevel.

It's almost like paralegals suddenly declared they can practice law independently, and renamed themselves "advance practice lawyers." It would be comical if it weren't real.


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I think we're miscommunicating something here.

The MLPs can call themselves whatever they want to call themselves. They can call themselves Nancy for all I care.

As long as my name is on the chart, then its done my way.

If my name is not on the chart? YOYOMF. Don't ask me for $hit.

Furthermore, I can't see C-suite justifying "we're only hiring PAs" when their number-one PG complaint is "I never saw a physician".

 

[HunterGatherer]

I recently read thru the press ganey complaints at my one job site. "I never saw a doctor, just the NP" was the most common complaint.

Well NP's have their doctorate degree and I'm sure PAs will do the same. I've been to a clinic as a first time patient before where medical staff introduced themselves as "Doctor" and when you look on the wall their credential plaques says "Doctorate of Nursing". No way I would have figured out she was an NP without that. There are no plaques hanging in the ED.

 

[RustedFox]

Well NP's have their doctorate degree and I'm sure PAs will do the same. I've been to a clinic as a first time patient before where medical staff introduced themselves as "Doctor" and when you look on the wall their credential plaques says "Doctorate of Nursing". No way I would have figured out she was an NP without that. There are no plaques hanging in the ED.

A doctorate degree for a physician assistant, is called a "Physician".

 

[doctalaughs]

I think we're miscommunicating something here.

The MLPs can call themselves whatever they want to call themselves. They can call themselves Nancy for all I care.

As long as my name is on the chart, then its done my way.

If my name is not on the chart? YOYOMF. Don't ask me for $hit.

Furthermore, I can't see C-suite justifying "we're only hiring PAs" when their number-one PG complaint is "I never saw a physician".

I think we are agreeing and I think your approach is admirable + the correct way to do things.

All I'm saying is your approach to dealing with midlevels will be harder for a new grad in a tight job market in 10 years if PAs get what they want. You can always say "my way or the highway" but it's not as easy when your job is less stable, the midlevels have more political clout, and there are docs lining up to replace you and let them do whatever they please.


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[Psai]

This is why I don't train them. Sure if they're on my team and ask me a question, I will answer but I won't go out of my way to teach them like I do for my medical students. If they want independence and don't want to play on my team, they can teach themselves. Not wasting my hard work and knowledge on people who don't deserve it.

 

[northernpsy]

This is why I don't train them. Sure if they're on my team and ask me a question, I will answer but I won't go out of my way to teach them like I do for my medical students. If they want independence and don't want to play on my team, they can teach themselves. Not wasting my hard work and knowledge on people who don't deserve it.

Good. I think part of the reason they've made it this far is because doctors enable them in many situations.
I have already been refusing to teach NP students. Now that PAs are playing the same dangerous game, I won't have anything to do with them either.

 

[DaTruMD]

And What if the MBAs who run the hospital start paying you a lower salary commensurate with PAs who can "do everything you can" for cheaper?

Then you go get an MBA and do something about it.

 

[KGflyboy]

A doctorate degree for a physician assistant, is called a "Physician".

I wish this were the case... unfortunately there really are programs now for doctor PAs. The school claims that this will somehow relieve the primary care shortage.

Can you imagine a conversation like this:

PA: Hi, I'm doctor Smith, your physician assistant.
Patient: So are you the doctor or the PA?
PA: Yes, I'm the doctor physician assistant

LMU ANNOUNCES A NEW MEDICAL DEGREE: DOCTOR OF MEDICAL SCIENCE - Lincoln Memorial University

http://www.lynchburg.edu/graduate/physician-assistant-medicine/doctor-of-medical-science/

 

[KGflyboy]

This is why I don't train them. Sure if they're on my team and ask me a question, I will answer but I won't go out of my way to teach them like I do for my medical students. If they want independence and don't want to play on my team, they can teach themselves. Not wasting my hard work and knowledge on people who don't deserve it.

I met a hospitalist in medical school who loved teaching medical students and adamantly refused to teach NP students. His words were "Me training NPs would be like a mother bear eating its own young."

 

[deleted109597]

It would be pretty easy to get this killed by having every physician group tell every PA/NP that their job is dependent on being a midlevel. Your body votes to have you be independent, hey, that's great. Go be independent, because you're fired.
Of course, we know that the CMGs won't do this, but that's how it would be. I fail to understand why we are the only country that this comes up in. It's just like the DO thing. The reason they exist is because MDs a hundred or so years ago were both in short supply, and killing people. DOs filled some voids, and gave backrubs instead of toxic untested medicines. Over time they essentially became equivalent except for the backrubs. But only here. In Australia, DOs are chiropractors, not doctors. They don't have midlevels, except for maybe midwives.
Sigh, yet another cluster**** of US healthcare.

 

[IH8ColdWeath3r]

It would be pretty easy to get this killed by having every physician group tell every PA/NP that their job is dependent on being a midlevel. Your body votes to have you be independent, hey, that's great. Go be independent, because you're fired.
Of course, we know that the CMGs won't do this, but that's how it would be. I fail to understand why we are the only country that this comes up in. It's just like the DO thing. The reason they exist is because MDs a hundred or so years ago were both in short supply, and killing people. DOs filled some voids, and gave backrubs instead of toxic untested medicines. Over time they essentially became equivalent except for the backrubs. But only here. In Australia, DOs are chiropractors, not doctors. They don't have midlevels, except for maybe midwives.
Sigh, yet another cluster**** of US healthcare.

DO here, largely agree with your sentiments regarding manipulation. Its only utility is in primary care and PM&R and the DOs who practice it end up doing an extra year in medical school and fellowships to augment their training, but >95% of my DO class wont utilize OMM. Their is a lot of VooDoo associated with it, especially some of the things that they teach. That being said, I took and passed the MD boards, Step 1 & 2, and I would venture to say that pre and post clinical training is on par with the MD students. Most of my rotations were at MD affiliated institutions and I had the same responsibilities as the other medical students on the service. I am in favor of one unified system and think medical education should be standardized across the board (to avoid the cluster**** and make sure everyone practicing is adequately trained), I think it is a bit unfair to compare my medical degree to that of a chiropractor.

 

[WilcoWorld]

DO here, largely agree with your sentiments regarding manipulation. Its only utility is in primary care and PM&R and the DOs who practice it end up doing an extra year in medical school and fellowships to augment their training, but >95% of my DO class wont utilize OMM. Their is a lot of VooDoo associated with it, especially some of the things that they teach. That being said, I took and passed the MD boards, Step 1 & 2, and I would venture to say that pre and post clinical training is on par with the MD students. Most of my rotations were at MD affiliated institutions and I had the same responsibilities as the other medical students on the service. I am in favor of one unified system and think medical education should be standardized across the board (to avoid the cluster**** and make sure everyone practicing is adequately trained), I think it is a bit unfair to compare my medical degree to that of a chiropractor.

You mad bro?

Sorry, after seeing your avatar, I couldn't resist.

 

[deleted109597]

DO here, largely agree with your sentiments regarding manipulation. Its only utility is in primary care and PM&R and the DOs who practice it end up doing an extra year in medical school and fellowships to augment their training, but >95% of my DO class wont utilize OMM. Their is a lot of VooDoo associated with it, especially some of the things that they teach. That being said, I took and passed the MD boards, Step 1 & 2, and I would venture to say that pre and post clinical training is on par with the MD students. Most of my rotations were at MD affiliated institutions and I had the same responsibilities as the other medical students on the service. I am in favor of one unified system and think medical education should be standardized across the board (to avoid the cluster**** and make sure everyone practicing is adequately trained), I think it is a bit unfair to compare my medical degree to that of a chiropractor.

I'll add inability to read to your description. I said they're equivalent in the US except for the backrubs. I'm not Australian. But until about a year ago, DOs could not practice in Australia. Why? Because osteopathy is chiropracty there. You want to get mad, complain to them. Or maybe read a little better.

 

[IH8ColdWeath3r]

I'll add inability to read to your description. I said they're equivalent in the US except for the backrubs. I'm not Australian. But until about a year ago, DOs could not practice in Australia. Why? Because osteopathy is chiropracty there. You want to get mad, complain to them. Or maybe read a little better.

Yeah, you're right I did misread. Sorry about that. No need to be jerk about it. Simply pointing out that I misread instead of "learn to read better" is equally as effective. I am not mad nor did I intend for my comment to come off as that. I was just merely pointing out that standardization in medical education is a good thing and that if NP/PAs want independence, they should take the same board and licensing exams that we take.

 

[tymont12]

So this statement sounds like an internal 'decision' by this PA society to promote independent practice. BUT, that doesn't mean it will actually happen. Are there state legislatures looking to make them independent?

 

[shoal007]

So this statement sounds like an internal 'decision' by this PA society to promote independent practice. BUT, that doesn't mean it will actually happen. Are there state legislatures looking to make them independent?

youd have to have your head in the sand to think this isnt going to happen. it will. im just hoping my 20 yr plan will work out. my hospital is losing money hand over fist right now. the suits are cutting everything to bridge the gap.

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[cbrons]

I recently read thru the press ganey complaints at my one job site. "I never saw a doctor, just the NP" was the most common complaint.

I imagine that was one reason they created the DNP degree, so they could identify themselves as "Doctor".

 

[RustedFox]

youd have to have your head in the sand to think this isnt going to happen. it will. im just hoping my 20 yr plan will work out. my hospital is losing money hand over fist right now. the suits are cutting everything to bridge the gap.

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What if the suits cut some suits? There's an idea, but c'mon now.

 

[WilcoWorld]

What if the suits cut some suits? There's an idea, but c'mon now.

Whoah! That's crazy talk.

 

[northernpsy]

I imagine that was one reason they created the DNP degree, so they could identify themselves as "Doctor".

The only reason, I'd say.
Now does anyone have any guesses as to why the University of Phoenix is using the term "residency" for its five day long skills course for 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

Right before that, they tell you, "By taking one class at a time you can move toward your goal in a way that fits into your busy schedule. You’ll enhance your skill level with courses that look into advanced anatomy, physiology, and pathophysiology along with the roles of an advanced practice nurse." Thank goodness they make it so easy. If it wasn't so easy, not just anyone could do it!

 

[WilcoWorld]

Now does anyone have any guesses as to why the University of Phoenix is using the term "residency" for its five day long skills course for NP students?


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

Looks like we need to add "Residency" to the Newspeak dictionary.

 

[doctalaughs]

The only reason, I'd say.
Now does anyone have any guesses as to why the University of Phoenix is using the term "residency" for its five day long skills course for NP students?


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

Right before that, they tell you, "By taking one class at a time you can move toward your goal in a way that fits into your busy schedule. You’ll enhance your skill level with courses that look into advanced anatomy, physiology, and pathophysiology along with the roles of an advanced practice nurse." Thank goodness they make it so easy. If it wasn't so easy, not just anyone could do it!

Even calling those 1 year specialization programs that midlevels sometimes attend "residencies" is insulting. 5-days is just comical.


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[shoal007]

Even calling those 1 year specialization programs that midlevels sometimes attend "residencies" is insulting. 5-days is just comical.


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better yet. fellowships

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[doctalaughs]

better yet. fellowships

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Well they are "advanced" practice providers so obviously they can skip residency and go right to fellowship based on their self-proclaimed expertise.




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[RustedFox]

Well they are "advanced" practice providers so obviously they can skip residency and go right to fellowship based on their self-proclaimed expertise.




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I wonder if that's why they do things that I would never have thought to do...

I just signed the chart of a kiddo that I actually saw with slam-drunk croup. Seems the MLP saw it fit to order Flu A/B, RSV, and Strep swabs, all while documenting a normal exam. No mention of a cough was made anywhere in the chart, nor was there a chest x-ray ordered.

I'm so glad I can learn from them!

 

[doctalaughs]

I wonder if that's why they do things that I would never have thought to do...

I just signed the chart of a kiddo that I actually saw with slam-drunk croup. Seems the MLP saw it fit to order Flu A/B, RSV, and Strep swabs, all while documenting a normal exam. No mention of a cough was made anywhere in the chart, nor was there a chest x-ray ordered.

I'm so glad I can learn from them!

That's nothing - I just saw a "sebaceous cyst" that an NP was watching for over year that turned out to be a melanoma now metastasized all over. Aw well, no biggie.


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[Psai]

That's nothing - I just saw a "sebaceous cyst" that an NP was watching for over year that turned out to be a melanoma now metastasized all over. Aw well, no biggie.


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kinda surprised that they've heard of a sebaceous cyst even if they didn't know what it is

 

[StandOrFall]

chiropracty

Reminded me of PB. Search for You asked: "Is this kind of dangerous ignorance typical of all chiropractors?" in this link.

The man was expert at deconstructing the silly smoke-and-mirrors nonsense that sometimes can flavor this debate. Still enjoy reading his stuff from time to time.

 

[doctalaughs]

kinda surprised that they've heard of a sebaceous cyst even if they didn't know what it is

Anchoring. You only know what 3 or 4 diagnoses look like when they present so you try to fit everything in those 3 or 4 or X categories.

Not to mention if you see things like a few times that does not make you an expert as some midlevels think. Once you've seen something 1000 times or more with all the atypical variants, thats when you might consider yourself competent. That is what they don't understand and why residency is as long as it is.


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[Perfect Hair Day]

This is why I don't train them. Sure if they're on my team and ask me a question, I will answer but I won't go out of my way to teach them like I do for my medical students. If they want independence and don't want to play on my team, they can teach themselves. Not wasting my hard work and knowledge on people who don't deserve it.

I love this response so much. Thank you for writing this

 

[intubesteak]

My wife is in PA school and she says this is about being equal to NPs in terms of employment. Apparently in some states being a PA can make it harder to get hired in some practices. At least this is what the AAPA is telling students.

 

[Darth Doc]

My wife is in PA school and she says this is about being equal to NPs in terms of employment. Apparently in some states being a PA can make it harder to get hired in some practices. At least this is what the AAPA is telling students.

It's true that being "independent practice" does make being a NP more favorable for some jobs (like minute-clinics) where there are no supervising physicians or when a physician doesn't want to look at the midlevel's charts.