Something to consider being 200k in debt and working with PAs

[MacGyver]

Did you know?

That in North Carolina, PAs "supervision" requirements are:

1) One meeting with MD every 6 months
2) No onsite MD required
3) NO chart review

In California,

1) Chart review is required ONLY for sched 2-3 narcotics.

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[primadonna22274]

I'm guessing something peeved you off today. See my lengthy reply to the other thread you posted on this.
Lisa PA-C

Did you know?

That in North Carolina, PAs "supervision" requirements are:

1) One meeting with MD every 6 months
2) No onsite MD required
3) NO chart review

In California,

1) Chart review is required ONLY for sched 2-3 narcotics.

 

[deleted6669]

"Chart review is required ONLY for sched 2-3 narcotics."-mac

actually mac it's for sch 2 only. if you are going to bash us at least get your facts straight. that's right, if a ca pa says" I will never write for anything stronger than vicodin es" they still need a supervisor of record but never have ANY chart review requirements. pisses you off, doesn't it......

 

[OnMyWayThere]

How does the malpractice issue work with PAs? Isn't the doc supervising responsible if something goes wrong?

 

[deleted6669]

pa's typically get their own malpractice policy as a paid benefit of employment with fairly high limits( 6 million or so).
typically a lawsuit names everyone possibly involved:
pa, md,clinic, hospital, etc so it is likely the doc would be named as well, especially if It was a case of under-supervision or gross negligence.
in a multi-doc practice a suit would typically name a single doc and the entire clinic so all the other docs have a stake as well financially even if they are not personally singled out.

 

[primadonna22274]

It's also common for PAs to be listed as a "rider" on the clinic's malpractice policy. I work in a group practice of 15 providers. In fact, our diabetes nurse educator and dietitian are listed as well, although I doubt their limits are as high. My rider is the standard $2/6 million occurrence-based policy. It's a covered benefit e.g. the group pays the premium. If I were to leave, I would be wise to purchase (on my own) tail coverage for any claims that were to be made AFTER I left. I'll have to check this out to be sure. I know my friend just left a large clinic and had to purchase tail insurance ON HER OWN...at a cost of like $20k. Ouch. I could purchase supplemental insurance on my own but haven't felt the need to do that, nor can i afford the several thousand dollars a year it would cost me.
But I agree--it's uncommon for a PA to be sued independently. I haven't been (knock on wood) but statistically we all will at some point. Better have good insurance.
Lisa PA-C

pa's typically get their own malpractice policy as a paid benefit of employment with fairly high limits( 6 million or so).
typically a lawsuit names everyone possibly involved:
pa, md,clinic, hospital, etc so it is likely the doc would be named as well, especially if It was a case of under-supervision or gross negligence.
in a multi-doc practice a suit would typically name a single doc and the entire clinic so all the other docs have a stake as well financially even if they are not personally singled out.

 

[group_theory]

Actually, the more insurance coverage you have, the more likely you'll be the main target of a lawsuit (or the more outrageous the claims will be from the plantiff's attorney)

Malpractice Lawyers go after those who have the most money - not those who is the most culpable. If a nurse screws up, the lawyer will probably go after the physician since the physician's malpratice insurance has more money than the nurse's malpractice insurance (if the nurse has any insurance at all). They want the money. In WI, if a resident screws up, the lawyers will go after the resident and not the attending because of a state cap on damages that applies only physicians, not physicians-in-training.

If your policy has a limit of $1 million, then the lawyers will seek damages up to 1 million dollars. If your policy has a limit of $3 million, they will try to find a way to justify seeking damages up to $3 million. Why don't lawyers seek more than the upper limit on the insurance policy? If that happens, then the physician will be forced to file for bankruptcy, which will greatly reduce the amount that the plantiff can collect (depending on how good/crappy the bankruptcy lawyer is)

 

[DeLaughterDO]

I don't know how much this matters, but (the way I understand it) since the physician/physician group writes (or tells the lawyer what to write) the contract with the PA - if the physician requires 100% oversight (a little over the top, I know, but it gets the point across) for employment, that is what the PA will have, right? And, if, after a year or two, the physician wants to decrease that to 10% (because the physician now trusts the PA and knows he/she does good work), it is the physician's prerogative. Just because the state mandates something, does not necessarily mean that is all that is occurring.

Food for thought - feel free to bash me now, as I am a lowly RN turned medical student who has little knowledge of the intricacies of medical practice management...

jd

PS - if you don't agree with the policy, just don't hire physician-extenders or work in a group that does. Problem solved.

 

[deleted6669]

"PS - if you don't agree with the policy, just don't hire physician-extenders or work in a group that does. Problem solved"

AND DON'T REFER TO GROUPS THAT USE PA'S, AND DON'T LIVE IN A SMALL TOWN, AND DON'T GO TO A RURAL ER.....

 

[Apollyon]

Did you know?

That in North Carolina, PAs "supervision" requirements are:

1) One meeting with MD every 6 months
2) No onsite MD required
3) NO chart review

Just like the biggest steak isn't always the best one, I wouldn't use NC as an example. The NC Med Board treats PAs HORRIBLY; I have trouble understanding why any PA would want to work in the NC medical environment.

 

[deleted6669]

Just like the biggest steak isn't always the best one, I wouldn't use NC as an example. The NC Med Board treats PAs HORRIBLY; I have trouble understanding why any PA would want to work in the NC medical environment.

what are you talking about? a pa has twice been president of the nc medical board........and they have the best practice laws in the country. as a pa in nc you can run a solo office and just have to have 2 thirty min meetings a yr with a doc without chart review.I have several friends who work in both primary care and em in nc, and if you will excuse the slightly vulgar tone, it is a pa wetdream.

 

[Apollyon]

what are you talking about? a pa has twice been president of the nc medical board........and they have the best practice laws in the country. as a pa in nc you can run a solo office and just have to have 2 thirty min meetings a yr with a doc without chart review.I have several friends who work in both primary care and em in nc, and if you will excuse the slightly vulgar tone, it is a pa wetdream.

All I know is what I've seen and been told. In 2002, they fired all but 1 of their investigators, and have now clamped down on PAs (among others), and people I've talked to (who are new to the state) speak of long waits for licenses, inordinately tight enforcement of requirements, and Draconian punishments for errors, compared to MD foul-ups. And I can give you the names of 20 PAs and MDs right now that would not take a spot on the Board no matter what you offered them - not indifference, but active opposition.

 

[svalentePA-C]

All I know is what I've seen and been told. In 2002, they fired all but 1 of their investigators, and have now clamped down on PAs (among others), and people I've talked to (who are new to the state) speak of long waits for licenses, inordinately tight enforcement of requirements, and Draconian punishments for errors, compared to MD foul-ups. And I can give you the names of 20 PAs and MDs right now that would not take a spot on the Board no matter what you offered them - not indifference, but active opposition.

As a NC PA i have to say that I was thinking of moving not to long ago, and then my wife said why would you want to kick the prom queen out of bed so you can hook up with the hog queen? good analogy really. NC is an exceptional place to be for PA's. I received my license 7 days after i graduated. The board actually scheduled their monthly meeting for 3 days s/p graduation so we wouldnt have to wait another month for our license. thats right kiddies they meet every month to approve licenses not quarterly or semiannually like some states.

 

[deleted6669]

As a NC PA i have to say that I was thinking of moving not to long ago, and then my wife said why would you want to kick the prom queen out of bed so you can hook up with the hog queen? good analogy really. NC is an exceptional place to be for PA's. I received my license 7 days after i graduated. The board actually scheduled their monthly meeting for 3 days s/p graduation so we wouldnt have to wait another month for our license. thats right kiddies they meet every month to approve licenses not quarterly or semiannually like some states.

washington is also a great state to work in. got my license in about a week. and the license you get is the same one they issue the docs.it just says john doe, pa-c is licensed to practice medicine in the state of washington instead of jon smith, md.also I applied to volunteer at a free clinic and they approved my addition of a new sp and practice site in 1 day.
oregon has one of the worst pa boards in the country. they clump us in on a special subgroup with accupuncturists and are incredibly obstructive and draconian in punsihments and fines.last yr when they sent out renewal notices they sent them out the day the money was due back at the board. california is easier than oregon but not as easy as washington.
washington loves pa's and hates np's. the reverse is true in oregon.

 

[primadonna22274]

ALSO true.
I was the OSPA Secretary for 3 years and saw first-hand how much garbage we put up with just to be able to practice. Still, Oregon is better than a lot of other states, and it's a gorgeous day here for the 4th...makes it hard to imagine living anywhere else.
Lisa

washington is also a great state to work in. got my license in about a week. and the license you get is the same one they issue the docs.it just says john doe, pa-c is licensed to practice medicine in the state of washington instead of jon smith, md.also I applied to volunteer at a free clinic and they approved my addition of a new sp and practice site in 1 day.
oregon has one of the worst pa boards in the country. they clump us in on a special subgroup with accupuncturists and are incredibly obstructive and draconian in punsihments and fines.last yr when they sent out renewal notices they sent them out the day the money was due back at the board. california is easier than oregon but not as easy as washington.
washington loves pa's and hates np's. the reverse is true in oregon.

 

[mx_599]

Did you know?

That in North Carolina, PAs "supervision" requirements are:

1) One meeting with MD every 6 months
2) No onsite MD required
3) NO chart review

In California,

1) Chart review is required ONLY for sched 2-3 narcotics.

just interested how this works. Not taking any sides or anything. In some of the situations where the PA is very autonomous and more or less on their own, what incentive does a physician have to be affiliated with the PA if that physician can get sued?

 

[GrandMasterB]

I vote for beach boys Kokomo (sp) for your lyrics game.

 

[mx_599]

I vote for beach boys Kokomo (sp) for your lyrics game.

nope...hint, Sade

 

[deleted6669]

just interested how this works. Not taking any sides or anything. In some of the situations where the PA is very autonomous and more or less on their own, what incentive does a physician have to be affiliated with the PA if that physician can get sued?

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

 

[svalentePA-C]

when you can be the SP of an autonomous PA and make 5-10 grand a month to do nothing but allow us to work under your license...does that make $ cents $ to you?

 

[mx_599]

when you can be the SP of an autonomous PA and make 5-10 grand a month to do nothing but allow us to work under your license...does that make $ cents $ to you?

oh yes...definitely. I didn't know.

Thank you

 

[Paws]

Well, I am with the original post-er. Despite emedpa's earnest entreaties, I would not feel comfortable having a pa working under me who I did not work very closely with. If I am going to be responsible for someone's work in a supervisory capacity, then I am going to want to know just what is going on. The pa's I know work very tightly with their docs, they do not run whole departments all by themselves as emedpa has described.

 

[timtye78]

I find it humerous how PAs and Nurses post very rarely (appropriately so) on Student Doctor Network until someone makes an inquiry about the profession or even jokes about them. Do you have assignments to patrol the student physician discussions to ensure we are 'playing nice' or what?

Yes, thank you we all know that rural areas are staffed by many PAs/RNPs and so on and so on. Thank you for augmenting the income of physicians. I do remember that PA is short for "Physician Assistant," so thanks for doing your job that you trained for. Although I did hear that someone somewhere has deemed this title not prestigious enough, so there are new versions of what PA stands for in some places. I am sure someone will inform me in a hurry.

Hey guess what: MD/DOs also staff many rural clinics. Another thing, if the American people in rural areas were so concerned about access to medical care maybe they should move closer to a decent hospital. Maybe they should offer better incentives to practice other than going to HS basketball games together and paying your student loans off. (Loans are definitely feasible in a large metro area as well).


Med Students: There is a reason why there are so many PAc and RNP in Primary care medicine. You can draw your own conclusions.

 

[Mike MacKinnon]

Dr Tim

As a Canadian Nurse I had never heard of a PA until i came to the states to practice. The first time i met one and they told me they were a "physician assistant" i said " Isnt that what I am?". Hehe. In anycase, in Canada NP's are used exactly how they were meant to, primary care in underserved areas. PA's do not exist. This makes sense to me.

Noone on this forum would be silly enough to suggest that any patient would choose a physician extender over a physician. All other things being equal i would always choose he/she who is better educated. How it is that in the States, with such high liability, you allow physician extenders to work so independantly I have no idea. Particularly i find exception with PA's since they are often under-educated (24 months at many schools) with little to no hospital/medicine experience required to be practicing so liberally.

I apologise in advance to those PA's and NP's who go far and above all expectations and do a wonderful job in their practice. There are certainly some who have taken it upon themselves to become as good as most physicians. However, the problem is that the Physician extender programs are often a setup for failure. If the person isnt a A type presonality (which there is a suggestion many are not since they didnt goto Med school), you can slide through and be no less than a threat to patients. Again, i have to say this is especially true for the PA schools where no previous meaningful medical backround or experience required.

My confusion revolves around why physicians are not taking a more active role in policing this environment. As a future physician, i would not at all be comfortable signing charts of someone i may not know well. In the litegous society we find ourselves in, why open another door?

Anyway, it seems that physician extenders have a place, I am just not sure if they are being used appropriately. Personally, I am an A type personality. I want to know what I dont know. Going to PA school or NP school will not fill that requirement. It comes right down to highest level of education, and for me thats med school.

Good luck all.

I find it humerous how PAs and Nurses post very rarely (appropriately so) on Student Doctor Network until someone makes an inquiry about the profession or even jokes about them. Do you have assignments to patrol the student physician discussions to ensure we are 'playing nice' or what?

Yes, thank you we all know that rural areas are staffed by many PAs/RNPs and so on and so on. Thank you for augmenting the income of physicians. I do remember that PA is short for "Physician Assistant," so thanks for doing your job that you trained for. Although I did hear that someone somewhere has deemed this title not prestigious enough, so there are new versions of what PA stands for in some places. I am sure someone will inform me in a hurry.

Hey guess what: MD/DOs also staff many rural clinics. Another thing, if the American people in rural areas were so concerned about access to medical care maybe they should move closer to a decent hospital. Maybe they should offer better incentives to practice other than going to HS basketball games together and paying your student loans off. (Loans are definitely feasible in a large metro area as well).


Med Students: There is a reason why there are so many PAc and RNP in Primary care medicine. You can draw your own conclusions.

 

[primadonna22274]

Hi Mike,

You're a bit misinformed re: no PAs in Canada. Canada's been working on incorporating the PA model for several years now, as well as the UK. We're taking over the world....

And most of my PA colleagues would take issue with being inappropriately compared to NPs in training and scope. We're not NPs. I'll let you figure that one out on your own as I have no interest in educating the masses today.

Going back to my pleasant little part of the world on the PA forum...

Cheers,

Lisa PA-C

Dr Tim

As a Canadian Nurse I had never heard of a PA until i came to the states to practice. The first time i met one and they told me they were a "physician assistant" i said " Isnt that what I am?". Hehe. In anycase, in Canada NP's are used exactly how they were meant to, primary care in underserved areas. PA's do not exist. This makes sense to me.

Noone on this forum would be silly enough to suggest that any patient would choose a physician extender over a physician. All other things being equal i would always choose he/she who is better educated. How it is that in the States, with such high liability, you allow physician extenders to work so independantly I have no idea. Particularly i find exception with PA's since they are often under-educated (24 months at many schools) with little to no hospital/medicine experience required to be practicing so liberally.

I apologise in advance to those PA's and NP's who go far and above all expectations and do a wonderful job in their practice. There are certainly some who have taken it upon themselves to become as good as most physicians. However, the problem is that the Physician extender programs are often a setup for failure. If the person isnt a A type presonality (which there is a suggestion many are not since they didnt goto Med school), you can slide through and be no less than a threat to patients. Again, i have to say this is especially true for the PA schools where no previous meaningful medical backround or experience required.

My confusion revolves around why physicians are not taking a more active role in policing this environment. As a future physician, i would not at all be comfortable signing charts of someone i may not know well. In the litegous society we find ourselves in, why open another door?

Anyway, it seems that physician extenders have a place, I am just not sure if they are being used appropriately. Personally, I am an A type personality. I want to know what I dont know. Going to PA school or NP school will not fill that requirement. It comes right down to highest level of education, and for me thats med school.

Good luck all.

 

[deleted6669]

As prima noted above canada is now actively training pa's both in their own programs(military) and through u.s. programs with rotations in canada.outside of the military, pa's can work in manitoba as"clinical assistants" in a role similar to the pa role here in the u.s.
difference between pa and np training in a nutshell. clinical hrs:
typical pa program=2200 hrs of clinical time(full year) with rotations in all major specialties(similar to ms3)
typical np program < 1000 hrs with most less than 800 hrs and some as few as 300 hrs in very few specialties.
the common arguement is that"np's were nurses 1st so they don't need time in clinicals". last time I checked being a nurse does not train one how to do clinicain level duties, it trains one how to be a nurse. even if you accept this arguement, an rn who goes to pa school( 30% of all pa's are former rn's) would get more training than a similar nurse doing an np program, so who would you rather see? also consider that the vast majority of pa's do not enter the field as a first career but after time as a resp. therapist, rn, paramedic, etc

 

[Mike MacKinnon]

Prima: Im from canada. Only the military uses them and the ones in manitoba are used as CNS are.

Emedpa:

First off. I love reading your posts. You present yourself very professionally and very articulately. If you apply yourself in your practice in the same way (as im sure you do) im sure you are an excellent PA and someone I would love to work with. I do see your points and i agree with them. What I get concerned about are the people who goto PA school without the medical backround. I have had a few bad experiences with some who, before PA school were dieticians, hospital volunteers etc. They dont come out prepared from my perspective.

I also agree that this will all change in the near future. Soon i would expect to see PA's have a much more stringent entrance expectation just as we are seeing all the programs go to masters prepared.

I also agree NP is different with a different focus. Personally, I have no interest in either but see the utility of both. I respect the decisions made by others but have decided for myself med school is the correct route.

Again, keep your posts comming, they are excellent.

As prima noted above canada is now actively training pa's both in their own programs(military) and through u.s. programs with rotations in canada.outside of the military, pa's can work in manitoba as"clinical assistants" in a role similar to the pa role here in the u.s.
difference between pa and np training in a nutshell. clinical hrs:
typical pa program=2200 hrs of clinical time(full year) with rotations in all major specialties(similar to ms3)
typical np program < 1000 hrs with most less than 800 hrs and some as few as 300 hrs in very few specialties.
the common arguement is that"np's were nurses 1st so they don't need time in clinicals". last time I checked being a nurse does not train one how to do clinicain level duties, it trains one how to be a nurse. even if you accept this arguement, an rn who goes to pa school( 30% of all pa's are former rn's) would get more training than a similar nurse doing an np program, so who would you rather see? also consider that the vast majority of pa's do not enter the field as a first career but after time as a resp. therapist, rn, paramedic, etc

 

[primadonna22274]

Mike:

We're also concerned about the young, inexperienced PA epidemic. We've been discussing it vigilantly on the PA forum. Actually, though, I think the master's degree push has fueled the change in PA demographics as more younger bachelor's degreed 20somethings are finding PA an attractive way to go. I know I did, and Emed and his cronies have already intimated to me that I probably wouldn't have made the cut if they had been interviewing for my program.

But it's not hopeless: at least I was smart enough to realize how little I knew and went right into family practice and have stayed there for 5 years, growing in autonomy as I knew more and my supervising physicians were more comfortable with my care. I've done my "residency" now, so to speak, and feel competent enough to comment on what PAs need to know and how we should be trained.

I worry about inexperienced PAs and NPs being turned loose on an unsuspecting population with little oversight, say in a prison or rural area where they're "it". My first year I NEEDED my supervising doc a LOT and I called her when she wasn't there...I dreaded her being on vacation although I worked in a group practice with 12 other family docs down the hall (just not necessarily ones I wanted to talk to). I consult very little now, as most experienced PAs will tell you, and just as often the other docs consult with me. That's a nice feeling.

You seem a reasonable person. I appreciate that. I think the most we can hope for is to all provide competent and compassionate care to the people we serve; there are plenty of patients to go around.

Lisa

Prima: Im from canada. Only the military uses them and the ones in manitoba are used as CNS are.

 

[Mike MacKinnon]

Lisa

Well said we are totally on the same page. Obviously you are not part of the problem but a perfect example of the solution. You recognized what you needed and sought it out.

I think the future will change how admissions are done for PA's and that will make all the difference. Even if they added a requirement similar to what you decided you needed, that would be perfect.

All in all this was an excellent discussion!

Mike:

We're also concerned about the young, inexperienced PA epidemic. We've been discussing it vigilantly on the PA forum. Actually, though, I think the master's degree push has fueled the change in PA demographics as more younger bachelor's degreed 20somethings are finding PA an attractive way to go. I know I did, and Emed and his cronies have already intimated to me that I probably wouldn't have made the cut if they had been interviewing for my program.

But it's not hopeless: at least I was smart enough to realize how little I knew and went right into family practice and have stayed there for 5 years, growing in autonomy as I knew more and my supervising physicians were more comfortable with my care. I've done my "residency" now, so to speak, and feel competent enough to comment on what PAs need to know and how we should be trained.

I worry about inexperienced PAs and NPs being turned loose on an unsuspecting population with little oversight, say in a prison or rural area where they're "it". My first year I NEEDED my supervising doc a LOT and I called her when she wasn't there...I dreaded her being on vacation although I worked in a group practice with 12 other family docs down the hall (just not necessarily ones I wanted to talk to). I consult very little now, as most experienced PAs will tell you, and just as often the other docs consult with me. That's a nice feeling.

You seem a reasonable person. I appreciate that. I think the most we can hope for is to all provide competent and compassionate care to the people we serve; there are plenty of patients to go around.

Lisa

Prima: Im from canada. Only the military uses them and the ones in manitoba are used as CNS are.

 

[deleted6669]

What I get concerned about are the people who goto PA school without the medical backround. I have had a few bad experiences with some who, before PA school were dieticians, hospital volunteers etc. They dont come out prepared from my perspective-MIKE

agree with above. have seen them too and equally afraid of what they will do to the profession.