exPCM

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I saw this posted on Sermo today:

Physician shortage being used as an excuse to expand ..

... midlevels scope of practice.

The physician shortage that Tennessee is facing has received a lot of attention. The problem is expected to worsen as millions of people are added to insurance rolls because of the implementation of health-care reform. One solution to the physician shortage already exists: increased use of physician assistants.

Physician assistants, also referred to as PAs, are highly trained health-care providers who have earned a master's of medical or physician assistant studies and are licensed to perform medical services under physician supervision. Following their receipt of a bachelor's degree at a college or university, PAs attend accredited physician assistant programs, which are typically 27 months long. After graduation, PAs are required to become board-certified through a written examination, similar to the process followed by their supervising physicians.

PAs are required to obtain 100 hours of continuing medical education every two years to maintain their certification. PAs interested in specializing in different medical specialties pursue continuing education opportunities in those areas to gain additional training and expertise.

As part of their comprehensive responsibilities, PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery and write prescriptions. PAs must meet the same standard of care required of physicians.

The supervising physician determines the PA's scope of practice using a written protocol, jointly developed by the PA and supervising physician. The protocol tool enables experienced PAs to maximize their abilities and allows the physician to limit the scope of practice for less-experienced PAs.

The PA profession is a relatively young profession. In the mid-1960s, physicians and educators recognized there was a shortage of primary-care physicians. To expand the delivery of quality medical care, Dr. Eugene Stead of the Duke University Medical Center in North Carolina put together the first class of PAs in 1965. He selected Navy corpsmen who received medical training during their military service and during the war in Vietnam, but who had no comparable civilian employment. He based the curriculum of the PA program in part on his knowledge of the fast-track training of doctors during World War II. Duke University graduated the first class of PA students on Oct. 6, 1967.

In 1980 the Tennessee General Assembly enacted the Physician Assistant Act, which established PAs as licensed health-care providers. The act has served as model legislation in other states. Across the nation, state legislatures are passing bills that expand the scope of practice of PAs to meet the demand for health-care providers. Business-savvy physicians see the benefit of using PAs to expand their practices and maximize the number of patients they treat.

The physician/PA practice model is the future of health care. In these times of change, PAs stand ready to provide Tennesseans with easily accessible, quality health care.
http://www.tennessean.com/article/20100409/OPINION03/4090325/1008/OPINION01/Bigger+role+for+physician+assistants+may+ease+doctor+shortage

Comment: Intersting comments to the article
A friend 3 weeks ago went to his PA complaining of cold sweats,back pain,arm pain, he was told he has heart burn! He had a massive heart attack the same day & died. The PA only gave this man a death sentence. Obama's & the progressives that push this debt of so called HCR has put this nation on the fast tract to the greatest depression like the world has never seen & it will be the Death of billions world wide. Look for higher taxes with less serverices accross the board. PA's are under trained,I know I have been thru the ringer with these self centered people. Cash talks when you need a read doc!

Nothing personal Ms Moffat but when I go to see a doctor I do not expect to be treated by either a DA or a Nurse Practitioner. I've been that route before and it almost cost me some toes. This isn't like going to the school nurse for an upset stomach.
 

Bobblehead

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The author of the article referenced is listed as Katherine Moffat. At the end of the article it states:

Katherine Pesut Moffat is executive director of the Tennessee Academy of Physician Assistants.
 

glade

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My big problem with mid-level providers is they decide when they want to be treated like doctors. In other words, when it comes to "diagnosing and treating illnesses," as stated in the article, they don't mind being doctor-equivalents based on their self-described rigorous training. But when it comes to medical liability, they quickly say "I practice under the auspices of an attending physician and only act as an extension of the physician." It's cherry-picking. In the same vein, they don't mind being viewed as authorities during the day, but when the sun sets suddenly they're just extenders and don't take call. Know what I mean?

It's like some of the nurses in our hospitals. When they want to boss around the junior residents, they talk about how they've been there for decades and have experience and a lot of knowledge that the residents could learn from. But if they don't feel like putting in a Foley or pushing IV medications, suddenly they're "just" nurses and not comfortable with this procedure, doctor. Again, it's cherry-picking.
 
Dec 19, 2009
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My big problem with mid-level providers is they decide when they want to be treated like doctors. In other words, when it comes to "diagnosing and treating illnesses," as stated in the article, they don't mind being doctor-equivalents based on their self-described rigorous training. But when it comes to medical liability, they quickly say "I practice under the auspices of an attending physician and only act as an extension of the physician." It's cherry-picking. In the same vein, they don't mind being viewed as authorities during the day, but when the sun sets suddenly they're just extenders and don't take call. Know what I mean?

It's like some of the nurses in our hospitals. When they want to boss around the junior residents, they talk about how they've been there for decades and have experience and a lot of knowledge that the residents could learn from. But if they don't feel like putting in a Foley or pushing IV medications, suddenly they're "just" nurses and not comfortable with this procedure, doctor. Again, it's cherry-picking.
This is exactly my issue with them too. Either (wo)man up and take responsibility for your actions based on your wonderful training, or agree to remain subordinates (I can't think of a better word in lieu, please don't flame me). And taking responsibility means being open to malpractice lawsuits just like physicians! You cannot have prestige and rights without duties and responsibilities.

Disclaimer:I have not experienced this in USA yet, but have seen similar issues in UK with senior nurses and surgical assistants.
 
Feb 20, 2010
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there are so many FMGs who are ready to work as physician assistants.government should think over this option and allow FMGs to work as PA , so that quality of PA will be better.
 

nedi292

applying for residency
Mar 30, 2010
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http://www.thepetitionsite.com/1/expanding-us-medical-residency-programs-programs

Please petition your governor and send to your friends this link

This petition is seeking for Congress to increase the number of Medical Residency positions in the US by a) funding more positions, and b) redefining residencies to allow more positions.

The Balanced Budget Act of 1997 froze the number of medical residents eligible for funding at 1996 levels, although various programs managed to increase residencies by obtaining grants and using alternative funding.
In 2006, there were 21,659 positions available. 19,349 graduating medical school seniors applied to the match (the system for filling the positions), leaving 2310 positions to be filled by US citizens who graduated from international medical school, and non-citizen graduates of international medical schools.

Since then, US Medical schools have been called upon to increase class size to provide for an anticipated physician shortage. In 2010 there were 22,809 positions (all information here is from The National Residency Match Program, advance data tables, 2010 Match), and 23670 seniors applying , leaving 861 without the possibility of a position. In fact, the situation is worse as 4704 positions went to US citizens who graduated from international medical school, and non-citizen graduates of international medical schools; leaving 4121 Graduating US Seniors without a position. The vast majority of this number have student debt and at the current level of available residencies they will never find a position as medical schools continue to increase class size.
A quick read of the 2010 residency statistics shows that there are over 6000 residency ready doctors living in the United States who cannot get a position. While some are advocating a moratorium on foreign doctors, we have to note that by bringing the best and brightest from the rest of the world improves our system.
Medical residencies are funded by the US government. In the short term we need congress to fund new programs for Primary Care (Internal and family medicine).
But, more importantly, we need congress to revisit the Public Health Service Act which funds residencies and directs how they operate. We need to expand the concept of residency so that prospective doctors can fulfill their requirements in other positions than at teaching hospitals. Clinics, treatment centers, and even private practices should be able to hire these qualified individuals and allow them to get credit serving a residency in this manner. Such a resident will not have the career flexibility of a traditional resident, but if the physician intends a career in primary care, why shouldn't he be able to do his residency in that setting?
Such programs would be cheaper and would provide openings for the thousands of un/under employed physicians in the Country. Small clinics and practices could hire qualified candidates on a limited license to work similar to Physician's Assistants, with a fully licensed doctor supervising them and taking responsibility for their training.
 

Maybeknot

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A quick read of the 2010 residency statistics shows that there are over 6000 residency ready doctors living in the United States who cannot get a position.
How many of those residency "ready" doctors want to go into primary care?
 

glade

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Be very careful what you wish for with regards to FMGs going into primary care. At our hospital, our primary care doctors are largely FMGs and they sort of practice medicine like you'd imagine it practiced in a foreign country. There's a lot of placing orders for imaging in lieu of ever seeing the patient until even 48 hours after admission, consults to other services so that they will evaluate the patient for the primary, and lengthy hospital stays. This stuff is accepted because the primary doctors control the patient flow to the specialists, which is only going to increase under the new health care policy in a few years. Think about it.
 
Dec 19, 2009
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In India, there used to be some incentive for rural service (cannot remember what it is). In UK, general practitioners have shorter length of training and higher pay compared to hospital based practitioners. Why cannot US government have a proposition that will forgive the medical school debt of AMGs who choose to do a Primary Care residency and serve rural areas? That could help alleviate physician shortage to some extent.
 

core0

Which way is the windmill
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there are so many FMGs who are ready to work as physician assistants.government should think over this option and allow FMGs to work as PA , so that quality of PA will be better.
Experience would show otherwise. The three experiments to allow FMGs to practice as PAs have all been fairly disastorous. Ontario is trying this now and will have a true comparator cohort. Bottom line is that few FMGs understand the concept of dependent practice and are willing to abide by its restrictions.

David Carpenter, PA-C
 

Maybeknot

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Why cannot US government have a proposition that will forgive the medical school debt of AMGs who choose to do a Primary Care residency and serve rural areas? That could help alleviate physician shortage to some extent.
This was something that Obama talked about starting during those health care "town hall meetings." It's a really good idea, which is why the government has been doing it since 1972.

http://en.wikipedia.org/wiki/National_Health_Service_Corps
 

fab4fan

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My big problem with mid-level providers is they decide when they want to be treated like doctors. In other words, when it comes to "diagnosing and treating illnesses," as stated in the article, they don't mind being doctor-equivalents based on their self-described rigorous training. But when it comes to medical liability, they quickly say "I practice under the auspices of an attending physician and only act as an extension of the physician." It's cherry-picking. In the same vein, they don't mind being viewed as authorities during the day, but when the sun sets suddenly they're just extenders and don't take call. Know what I mean?

It's like some of the nurses in our hospitals. When they want to boss around the junior residents, they talk about how they've been there for decades and have experience and a lot of knowledge that the residents could learn from. But if they don't feel like putting in a Foley or pushing IV medications, suddenly they're "just" nurses and not comfortable with this procedure, doctor. Again, it's cherry-picking.
My big problem is when I'm sick I want to see a physician, as in MD/DO, not a PA, NP, DNP, QRST, WTH.

OK?