Utah NP's win independent practice and right to open pain clinics

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drusso

drusso

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Religious conservatives love them some pain clinics apparently. Unanimous? Is Utah going to be the next Appalachia?
 
Ferrismonk said:
You start to wonder if perhaps we have it wrong. Perhaps we are OVERtrained...
Click to expand...

I do wonder about this too. Why would anyone go to medical school if we can go to nursing school, do a NP course and open our own clinic? Is there a suggestion that physicians and nurses know the same?
 
Iamnew2 said:
I do wonder about this too. Why would anyone go to medical school if we can go to nursing school, do a NP course and open our own clinic? Is there a suggestion that physicians and nurses know the same?
Click to expand...
because you want to be a doctor, and not a nurse?
 
Iamnew2 said:
I do wonder about this too. Why would anyone go to medical school if we can go to nursing school, do a NP course and open our own clinic? Is there a suggestion that physicians and nurses know the same?
Click to expand...
To me it's not about what you can do legally/financially, but about the medical knowledge needed for what we do. I work with NPs and CRNAs and while there is an obvious gap between our knowledge bases, 90% of the time it doesn't really make a clinical difference.

In the anesthesia world, any CRNA can put in a spinal anesthetic (maybe not as smooth?), control blood pressure using the 4 main drugs in our cart (maybe they choose number #3 when I would have chosen #2?), and intubate/extubate (maybe a little rougher wakeup? higher incidence of sore throat?). Are these worth double the education?

In the pain world, treatment algorithms have been established and we are forced to follow them by insurance companies. Trying to deviate from them to provide faster/better treatment, decrease cost of care, provide safer medication choices, and give the patient what you think it best is met with fierce resistance. Try OTC treatments, do some PT, get an XRay, order an MRI, schedule an ESI, return to office...

Don't get me wrong, I'm glad I'm a physician and wouldn't do it any other way, and I'm certain I know much more than my APP colleagues, but is the time I spent learning how to deliver a baby, how to treat otitis media, and how to treat malaria make me a better pain doctor? In little ways, yes, but was it necessary? Probably not.
 
Ferrismonk said:
To me it's not about what you can do legally/financially, but about the medical knowledge needed for what we do. I work with NPs and CRNAs and while there is an obvious gap between our knowledge bases, 90% of the time it doesn't really make a clinical difference.

In the anesthesia world, any CRNA can put in a spinal anesthetic (maybe not as smooth?), control blood pressure using the 4 main drugs in our cart (maybe they choose number #3 when I would have chosen #2?), and intubate/extubate (maybe a little rougher wakeup? higher incidence of sore throat?). Are these worth double the education?

In the pain world, treatment algorithms have been established and we are forced to follow them by insurance companies. Trying to deviate from them to provide faster/better treatment, decrease cost of care, provide safer medication choices, and give the patient what you think it best is met with fierce resistance. Try OTC treatments, do some PT, get an XRay, order an MRI, schedule an ESI, return to office...

Don't get me wrong, I'm glad I'm a physician and wouldn't do it any other way, and I'm certain I know much more than my APP colleagues, but is the time I spent learning how to deliver a baby, how to treat otitis media, and how to treat malaria make me a better pain doctor? In little ways, yes, but was it necessary? Probably not.
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I understand where you're coming from. In a lot of discussions it comes up that the midlevels "don't know what they don't know". the reason for that is the lack of depth and breadth of training compared to what we receive as physicians.

Even though I'm not an expert in dermatology or ob/gyn or cardiology etc, the fact that I've studied these subjects and rotated through these specialties makes it possible for me to get patients where they need to be because I've at least had some education. this allows us to expand our differential and think outside our specialty.
 
Seems like the only mid level safe specialty will be rads and path. even surgery is a bit risky because i can forsee a future where simple surgeries are performed by midlevels while the attending just swings by to make sure everything went okay.
 
scoopdaboop said:
Seems like the only mid level safe specialty will be rads and path. even surgery is a bit risky because i can forsee a future where simple surgeries are performed by midlevels while the attending just swings by to make sure everything went okay.
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There are rads and path PAs out there. It’s just a matter of time.
 
Agast said:
Religious conservatives love them some pain clinics apparently. Unanimous? Is Utah going to be the next Appalachia?
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I trained out there. I found it comical that a lot of patients abstained from drinking but had no problem consuming oxy and xanax because it was medically directed.
 
I see that more with NP and non doctors, but our colleagues are not immune to the need to have extra titles.

much more prevalent in individuals who are vested in organizations
 
gaseous_clay said:
You practice in Oregon, which has allowed this type of thing for some time now. What’s it like there? Are you seeing patients leave your clinic to go to one of these NP-run practices? Are NPs allowed to perform injections?
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The mid-levels are more or less feral. The naturopaths prescribe methadone and do stem cell procedures because "Regen is Natural." Hospitals love employing NP's because of the vig on the SOS.

The future of American Health Care is in Oregon. All of this has been facilitated by weak MD/DO lobby and lazy pain professional societies. Pain doctors should have stepped up a decade ago.
 
I've worked with a lot of NPs in the field and despite years of experience they still need help with some very basic evaluation and management decisions. Exams are poor, and they overutilize imaging. They tend to have blinders too. Non radiating butt pain is always an SI joint, for example. I'm not worried about competition from NPs. Patients are mostly not stupid and given the choice of a competent and reputable doctor, that's who they're going to chose. What worried me is the $hitstain from the state diminishing the prestige of the field (what's left of it after the opiate crisis, anyway).
 
scoopdaboop said:
Seems like the only mid level safe specialty will be rads and path. even surgery is a bit risky because i can forsee a future where simple surgeries are performed by midlevels while the attending just swings by to make sure everything went okay.
Click to expand...
I was a med tech (now called Medical Scientist apparently) before medical school. In the lab, the MT did the peripheral smears before the pathologist looked at them. We've also had cytotechs for a long time which will do the processing and preliminary exam of tissue slides. Path is nowhere near exempt.
 
Ferrismonk said:
I was a med tech (now called Medical Scientist apparently) before medical school. In the lab, the MT did the peripheral smears before the pathologist looked at them. We've also had cytotechs for a long time which will do the processing and preliminary exam of tissue slides. Path is nowhere near exempt.
Click to expand...

www.empoweredpas.com

A Day in the Life of an Interventional Radiology PA: Edward Mathes, PA-C

If you love procedures, pay attention. Edward Mathes is a PA who works in the field of Interventional Radiology (IR) and was kind enough to answer some questions for our
www.empoweredpas.com www.empoweredpas.com


 
Ducttape said:
I see that more with NP and non doctors, but our colleagues are not immune to the need to have extra titles.

much more prevalent in individuals who are vested in organizations
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Yeah, but I think our colleagues draw the line at about 8 letters.
 
gaseous_clay said:
There are rads and path PAs out there. It’s just a matter of time.
Click to expand...
Pathology assistants (not physician assistants it’s different training) don’t read slides, their is no threat to take over the role of pathologists, they only gross, cut frozen sections and assist with autopsies. They are extremely helpful to pathologists but not in line with APP practicing at the same level as clinical physicians independently. There is also a massive shortage of them.
 
Ferrismonk said:
I was a med tech (now called Medical Scientist apparently) before medical school. In the lab, the MT did the peripheral smears before the pathologist looked at them. We've also had cytotechs for a long time which will do the processing and preliminary exam of tissue slides. Path is nowhere near exempt.
Click to expand...
Ferrismonk said:
I was a med tech (now called Medical Scientist apparently) before medical school. In the lab, the MT did the peripheral smears before the pathologist looked at them. We've also had cytotechs for a long time which will do the processing and preliminary exam of tissue slides. Path is nowhere near exempt.
Click to expand...
Med techs aren’t going to replace pathologists. Pathologists still need to review any abnormal smears, those prelims reads you mention are often wrong from what I’ve seen. Independent sign out from med techs would be disasterous. Med techs won’t be eligible to hold a CLIA license either, unless they get a PhD in a relevant field. There is more to running a clinical lab than reading peripheral smears and pap smears. Med techs are in line with RNs for more patient facing specialties. Pathology’s assistants are more in line with physicians assistants but as they don’t sign out cases aren’t going to be independent from pathologists. Pathology is an unattractive fields for other reasons, but in terms of being taken over by mid levels I don’t see that happening.
 
I don't ever see an NP or PA doing an Epidural, CESI, RFA, Vertiflex, SCS, etc. We are actually pretty lucky. Although one time, as a resident, I was rotating in a private practice. It was a large group, with PAs, Physicians, etc. One day I walked past the fluoro room before I was leaving for the day, and I saw the PA was in the fluoro room for a LONG time with a patient who was clearly saying "OUCH" and was in some significant pain. He came out for a second, lead glasses and all, and said "I'm trying to do a caudal right now on this patient." I just looked and said okay hope that works out for you, and left for the day. Not even sure if that was legal in my state or what. Just seemed insane.
 
drusso said:
The mid-levels are more or less feral. The naturopaths prescribe methadone and do stem cell procedures because "Regen is Natural." Hospitals love employing NP's because of the vig on the SOS.
What goes around, come
The future of American Health Care is in Oregon. All of this has been facilitated by weak MD/DO lobby and lazy pain professional societies. Pain doctors should have stepped up a decade ago.
Click to expand...
The pain societies that have any political power are too busy training pain docs to creep into the scope of surgeons. As a result, the surgeons won't advocate for us or show any loyalty. They will hire NPs and PA to do what we do. What goes around, comes around.
 
IDPathDoc said:
Med techs aren’t going to replace pathologists. Pathologists still need to review any abnormal smears, those prelims reads you mention are often wrong from what I’ve seen. Independent sign out from med techs would be disasterous. Med techs won’t be eligible to hold a CLIA license either, unless they get a PhD in a relevant field. There is more to running a clinical lab than reading peripheral smears and pap smears. Med techs are in line with RNs for more patient facing specialties. Pathology’s assistants are more in line with physicians assistants but as they don’t sign out cases aren’t going to be independent from pathologists. Pathology is an unattractive fields for other reasons, but in terms of being taken over by mid levels I don’t see that happening.
Click to expand...
Agree with this. Pathology requires way too much book-learning AND experience for any midlevel to even want to encroach on the field. With respect to the midlevel issue, pathology is in great shape compared to most specialties.
 
DOctorJay said:
I intend to if I see evidence it’s occurring.
Click to expand...

Do the hospitals really give a crap? More facility fees for them. PA does a procedure while radiologist does another simultaneously. More for them - right? After all they are putting PAs and NPs in the ED. Cleveland Clinic has NPs doing endoscopy.

I have given up believing that anyone gives a darn about the quality of care. It is all about the quickest and cheapest way to generate $$$.
 
NJPAIN said:
Do the hospitals really give a crap? More facility fees for them. PA does a procedure while radiologist does another simultaneously. More for them - right? After all they are putting PAs and NPs in the ED. Cleveland Clinic has NPs doing endoscopy.

I have given up believing that anyone gives a darn about the quality of care. It is all about the quickest and cheapest way to generate $$$.
Click to expand...
Well said.
 
NJPAIN said:
Do the hospitals really give a crap? More facility fees for them. PA does a procedure while radiologist does another simultaneously. More for them - right? After all they are putting PAs and NPs in the ED. Cleveland Clinic has NPs doing endoscopy.

I have given up believing that anyone gives a darn about the quality of care. It is all about the quickest and cheapest way to generate $$$.
Click to expand...

We need ALL of our specialty societies to step up and oppose scope of practice creep.
 
So, reviving this. Our local 'Interventional Procedures Practitioner" is now advertising in local newspapers. The 'fellowship" from TCU is 15 course hours of distance learning with a lab. The advertisements say she is doing even RFA, I have not been able to get my hands on procedure notes to confirm.

Is insurance reimbursing for this crap? How do they have malpractice coverage? Anyone with good experience on how to combat this? Or should I quit moaning and go get my nursing license to pad my credentials 🙂
 
Crybaby said:
So, reviving this. Our local 'Interventional Procedures Practitioner" is now advertising in local newspapers. The 'fellowship" from TCU is 15 course hours of distance learning with a lab. The advertisements say she is doing even RFA, I have not been able to get my hands on procedure notes to confirm.

Is insurance reimbursing for this crap? How do they have malpractice coverage? Anyone with good experience on how to combat this? Or should I quit moaning and go get my nursing license to pad my credentials 🙂
Click to expand...
Does your state have a pain society you can ask for assistance? Maybe they need to mount their own ad campaign.
 
There are no shortcuts or free lunch. We have now had 3 midlevels come through. In each case I think a big reason for them joining was to learn procedures and then take that skill elsewhere. I told them if they wanted to do USGI they had to learn the gross anatomy and US anatomy backwards and forwards and show me b/f they could do it on a pt. Their interest died there.

Our training means something. We are not overtrained. If fact, we all need to get better at all times (which is why we read, study, and do CME). The only reasons there is specialty creep from midlevels is they want more $$ and a shortcut to it, and the hosp, insurance companies, and government think they can save money so they are greenlighting it.

Pts will suffer the consequences and we need to remain vigilant and speak up
 
specepic said:
There are no shortcuts or free lunch. We have now had 3 midlevels come through. In each case I think a big reason for them joining was to learn procedures and then take that skill elsewhere. I told them if they wanted to do USGI they had to learn the gross anatomy and US anatomy backwards and forwards and show me b/f they could do it on a pt. Their interest died there.

Our training means something. We are not overtrained. If fact, we all need to get better at all times (which is why we read, study, and do CME). The only reasons there is specialty creep from midlevels is they want more $$ and a shortcut to it, and the hosp, insurance companies, and government think they can save money so they are greenlighting it.

Pts will suffer the consequences and we need to remain vigilant and speak up
Click to expand...

Greed is the common pathway to the bottom.
 
Crybaby said:
So, reviving this. Our local 'Interventional Procedures Practitioner" is now advertising in local newspapers. The 'fellowship" from TCU is 15 course hours of distance learning with a lab. The advertisements say she is doing even RFA, I have not been able to get my hands on procedure notes to confirm.

Is insurance reimbursing for this crap? How do they have malpractice coverage? Anyone with good experience on how to combat this? Or should I quit moaning and go get my nursing license to pad my credentials 🙂
Click to expand...
What state is this? Utah again?
 
specepic said:
There are no shortcuts or free lunch. We have now had 3 midlevels come through. In each case I think a big reason for them joining was to learn procedures and then take that skill elsewhere. I told them if they wanted to do USGI they had to learn the gross anatomy and US anatomy backwards and forwards and show me b/f they could do it on a pt. Their interest died there.

Our training means something. We are not overtrained. If fact, we all need to get better at all times (which is why we read, study, and do CME). The only reasons there is specialty creep from midlevels is they want more $$ and a shortcut to it, and the hosp, insurance companies, and government think they can save money so they are greenlighting it.

Pts will suffer the consequences and we need to remain vigilant and speak up
Click to expand...
Well said…. We can’t give up. I’ve recently written all my major pain societies as well as my state representatives letting them know the gravity of the situation. If we don’t stand up for and protect our specialty no one will. It’s insane that doctors are being replaced by NPs at the rate they are. It’s very sad and scary. You all need to join the Physicians for patient protection fb group and purchase “Patients at Risk “ written by one of the founders. It’s all very eye opening. Speak up now or you better have a good 5 year plan
 
Working on that 5 year plan. The battle is clearly lost. Best we can hope for is to slow the decline of medicine by a tad. Pay off those loans while you can.
 
sylvanthus said:
Working on that 5 year plan. The battle is clearly lost. Best we can hope for is to slow the decline of medicine by a tad. Pay off those loans while you can.
Click to expand...
Spoken like an Anesthesiologist.
 
Agast said:
Does your state have a pain society you can ask for assistance? Maybe they need to mount their own ad campaign.
Click to expand...
Thanks, will reach out
 

FLORIDA | Board of Medicine


New Legislation Affecting Physician Assistants



HB 431, presented during the 2021 Legislative Session, was signed by the Governor and took effect on July 1, 2021. The bill amended sections 458.347 and 459.022, Florida Statutes, regarding the practice of physician assistants (PAs) under the supervision of allopathic and osteopathic physicians, respectively.
The bill:
  • Increases the number of PAs a physician may supervise from four to 10;
  • Removes the requirement that a PA notify a patient of the right to see a physician prior to the PA prescribing or dispensing a prescription;
  • Authorizes a PA to procure medications and medical devices, with exceptions;
  • Repeals authorization for the Department of Health (Department) to issue prescriber numbers to PAs and eliminates the need for PA prescriber numbers on prescriptions;
  • Authorizes a PA under the supervision of certain practitioners to prescribe up to a 14-day supply of Schedule II psychotropic drugs to minors;
  • Except for a physician certification, authorizes a PA to authenticate any document if the document may be authenticated by a physician;
  • Authorizes a PA to supervise medical assistants;
  • Amends provisions related to program approval for the education and training of PAs and allows trainees to perform medical services rendered within the scope of an approved program;
  • Amends the licensure requirements for PAs based on the date a PA graduated from an approved program as defined in the bill by specifying which PA education and training programs are approved for PA licensure;
  • Authorizes a PA to satisfy the continuing education requirement on controlled substance prescribing through a designated course;
  • Removes the requirement that PA licensure applicants seeking prescribing authority provide course transcripts;
  • Removes the requirement for a PA to notify the Department in writing within 30 days of employment or after any change in supervising physician, which eliminates the need for the supervision data form;
  • Removes the requirement for a PA to notify the Board of Medicine/Board of Osteopathic Medicine of his or her prescribing supervising physician(s) or to complete the Application for Changes to the Prescribing License;
  • Requires supervising physicians to report to the Board of Medicine/Board of Osteopathic Medicine the delegation of prescribing authority to a PA, which may be done using the form located at https://flboardofmedicine.gov/forms/pa-prescribing-notification.pdf;
  • Maintains the requirement that supervising physicians report to the Board of Medicine/Board of Osteopathic Medicine the delegation of dispensing authority to a PA, which must be done using the form located at https://flboardofmedicine.gov/forms/pa-disp-form.pdf.
  • Requires the revision of rules related to the formulary and the application for licensure, which will be amended by the Physician Assistant Council and the Board of Medicine.


...




Florida Board of Medicine
4052 Bald Cypress Way | Bin C-03
Tallahassee, Florida 32399-3253
https://flboardofmedicine.gov/​
 
So pretty much give them free reign
 
Nodolor said:
So pretty much give them free reign
Click to expand...
if you are asking about FL, im not clear if these new rules apply to when the NP is being supervised by a physician or solo. I dont have an NP so im not up to date on legislation....the above was sent by email as an FYI. But it looks like NP's under supervision of MD.

The bill amended sections 458.347 and 459.022, Florida Statutes, regarding the practice of physician assistants (PAs) under the supervision of allopathic and osteopathic physicians, respectively.
 
Doctodd said:
if you are asking about FL, im not clear if these new rules apply to when the NP is being supervised by a physician or solo. I dont have an NP so im not up to date on legislation....the above was sent by email as an FYI. But it looks like NP's under supervision of MD.

The bill amended sections 458.347 and 459.022, Florida Statutes, regarding the practice of physician assistants (PAs) under the supervision of allopathic and osteopathic physicians, respectively.
Click to expand...
Ya, but with a supervising ration of 10-1, not sure how you can prevent them from going rogue to a point
 
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