drusso

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Welcome to the future of socialized, Biden-care...elections have consequences...


"On Nov. 12, the Department of Veterans Affairs (VA) issued an interim final rule that confirms VA healthcare professionals may practice in a manner consistent with the scope and requirements of their VA employment, notwithstanding any State license, registration, certification, or other requirements that unduly interfere with their practice. This rulemaking also confirms the VA’s authority to establish national standards of practice for healthcare providers in order to standardize practice in all VA medical facilities."
 

Ducttape

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Trump is in office now.

don't blame Biden for the rules made by the current administration - which appears to be putting as many new rules as to stymie the next administration.
 
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SSdoc33

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Welcome to the future of socialized, Biden-care...elections have consequences...


"On Nov. 12, the Department of Veterans Affairs (VA) issued an interim final rule that confirms VA healthcare professionals may practice in a manner consistent with the scope and requirements of their VA employment, notwithstanding any State license, registration, certification, or other requirements that unduly interfere with their practice. This rulemaking also confirms the VA’s authority to establish national standards of practice for healthcare providers in order to standardize practice in all VA medical facilities."

SMH. as far as i know, this development happened during the trump regime. if you paint EVERYTHING as a political issue, you will lose half of your support, when you should have 100% support from physicians on this issue
 
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hyperalgesia

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Welcome to the future of socialized, Biden-care...elections have consequences...


"On Nov. 12, the Department of Veterans Affairs (VA) issued an interim final rule that confirms VA healthcare professionals may practice in a manner consistent with the scope and requirements of their VA employment, notwithstanding any State license, registration, certification, or other requirements that unduly interfere with their practice. This rulemaking also confirms the VA’s authority to establish national standards of practice for healthcare providers in order to standardize practice in all VA medical facilities."
It doesn't seem that controversial, to allow them to practice within their scope, etc. Independent practice is obviously NOT within their scope, at least not in normal situations.

I'm not that worried about the VA because it's always under a political microscope. One issue from a veteran and all hell breaks loose.
 
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Agast

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Trump Administration never seemed particularly pro-physician and this is just another instance of it.
 
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Are you just joking about this being Biden’s fault? Please tell me you aren’t that delusional. This rule is terrible but it’s not Democrat or Republican. Anesthesiologists have been fighting this battle with the VA for years.
 

Agast

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Politicians don’t care about midlevel creep because they assume they’re wealthy/important enough to always have access to a doctor. You won’t see changes until they realize it has an affect on their own lives.
 

Ferrismonk

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Honestly, sometimes I feel like we're the old Lincoln Continental that everyone loved and liked. Big, beautiful, and expensive. Now everyone wants a prius. Something to get from point A to B as cheaply and convenient as possible.

Perhaps we're dinosaurs from a different era and medicine has become so evidence/algorithm based that you don't really need 13+ years of training to do what we do anymore.

No doubt there is a difference in medical understanding, but it may not actually be something the public values (at least enough to pay for) anymore.
 
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SSdoc33

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Are you just joking about this being Biden’s fault? Please tell me you aren’t that delusional. This rule is terrible but it’s not Democrat or Republican. Anesthesiologists have been fighting this battle with the VA for years.
He will NEVER admit a mistake.
 
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Ducttape

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Why do YOU think this is happening?
AAPA advocacy staff pushed hard at both the VA and the White House to ensure the rule was issued before the current Presidential term ends Jan. 20, 2021.


yes, elections have consequences... and this one is a consequence of the 2016 election.
 
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SandmanMD

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SMH. as far as i know, this development happened during the trump regime. if you paint EVERYTHING as a political issue, you will lose half of your support, when you should have 100% support from physicians on this issue
So true. We need to focus on protecting our field of practice. Playing political blame games is just shooting ourselves in the foot.
 
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TikiTorches

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Politicians don’t care about midlevel creep because they assume they’re wealthy/important enough to always have access to a doctor. You won’t see changes until they realize it has an affect on their own lives.
Politicians also get lots of money from mid-level lobbies. Psychologists can prescribe in a few states! Nurses have alot of money and lobbying power too
 
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TikiTorches

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Honestly, sometimes I feel like we're the old Lincoln Continental that everyone loved and liked. Big, beautiful, and expensive. Now everyone wants a prius. Something to get from point A to B as cheaply and convenient as possible.

Perhaps we're dinosaurs from a different era and medicine has become so evidence/algorithm based that you don't really need 13+ years of training to do what we do anymore.

No doubt there is a difference in medical understanding, but it may not actually be something the public values (at least enough to pay for) anymore.
Patients just want it their way, like burger king 👑
 

TikiTorches

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Va has massive problems with overprescribing opioids. Will these mid-level be able to prescribe those?
 

hyperalgesia

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Where I work at a VA, things have massively changed with opiate prescribing. If you want a pt to be on opiates you have to jump through hoops all day, with mandatory PDMP monitoring, labs, regular consents, reminders, F/Us, etc. Opiate prescribing for chronic pain has almost come to a halt.

The big thing now at all the meetings is how do we prevent veterans from going to private pain docs and get started on unsustainable doses of opiates, soma, benzos, etc.
 

TikiTorches

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Where I work at a VA, things have massively changed with opiate prescribing. If you want a pt to be on opiates you have to jump through hoops all day, with mandatory PDMP monitoring, labs, regular consents, reminders, F/Us, etc. Opiate prescribing for chronic pain has almost come to a halt.

The big thing now at all the meetings is how do we prevent veterans from going to private pain docs and get started on unsustainable doses of opiates, soma, benzos, etc.
Yes and these same vets try to get Stimulants from private psychiatrists.
 
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cowboydoc

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Where I work at a VA, things have massively changed with opiate prescribing. If you want a pt to be on opiates you have to jump through hoops all day, with mandatory PDMP monitoring, labs, regular consents, reminders, F/Us, etc. Opiate prescribing for chronic pain has almost come to a halt.

The big thing now at all the meetings is how do we prevent veterans from going to private pain docs and get started on unsustainable doses of opiates, soma, benzos, etc.
Times have changed from when I was seeing vets on methadone 45mg TID for chronic pain.
 
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ateria radicularis magna

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Where I work at a VA, things have massively changed with opiate prescribing. If you want a pt to be on opiates you have to jump through hoops all day, with mandatory PDMP monitoring, labs, regular consents, reminders, F/Us, etc. Opiate prescribing for chronic pain has almost come to a halt.

The big thing now at all the meetings is how do we prevent veterans from going to private pain docs and get started on unsustainable doses of opiates, soma, benzos, etc.

Are private pain docs still doing high dose opioids? Are they doing soma or benzos? No one in my mid sized group is doing any of this (>10 Drs). No private practice pain doctor in my large city is doing any of this (I review pmps for all patients so I know the prescribing practices of all the pain docs and anyone else who prescribes opioids)...hmm, actually maybe there is one. I just don’t see the upside in any sense.
 
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ateria radicularis magna

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Is the va an enjoyable place to practice? How many patients do you see per day? Any Med management? Ketamine infusions? Lots of vacation, no? All the best equipment, right? Seems awesome.
 
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lobelsteve

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Are private pain docs still doing high dose opioids? Are they doing soma or benzos? No one in my mid sized group is doing any of this (>10 Drs). No private practice pain doctor in my large city is doing any of this (I review pmps for all patients so I know the prescribing practices of all the pain docs and anyone else who prescribes opioids)...hmm, actually maybe there is one. I just don’t see the upside in any sense.
In my area there are still several. I turn down consults if on >90meq or has seen more than one local pain group.
 

Agast

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There are absolutely private docs doing high dose opioid regimens garnished with benzos. You don’t know about it until they retire or get shut down because their clients have no reason to go elsewhere.
 

clubdeac

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Is the va an enjoyable place to practice? How many patients do you see per day? Any Med management? Ketamine infusions? Lots of vacation, no? All the best equipment, right? Seems awesome.
Totally depends on which VA you're at but the short answer is NO. I worked there for 6 years. Interestingly my depression resolved once I left ;)
 
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clubdeac

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One thing to remember is that the VA already granted FPA to NP's last year or the year before so granting this to PAs is no different, albeit still completely egregious.

I keep saying this but we really need to start doing something about practice creep. We need to put a stop to this madness
 
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hyperalgesia

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Totally depends on which VA you're at but the short answer is NO. I worked there for 6 years. Interestingly my depression resolved once I left ;)
To be fair, the location change could not have hurt...
 
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TikiTorches

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One thing to remember is that the VA already granted FPA to NP's last year or the year before so granting this to PAs is no different, albeit still completely egregious.

I keep saying this but we really need to start doing something about practice creep. We need to put a stop to this madness
Too late. Horse is out of the barn
 

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Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare

Amazon product
I strongly encourage everyone to read this book. Kindle version only $10.
 
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