MD shortage prompts UDM to shorten PA program

Trauma Columnist · Mar 9, 2006

Yes, and as the APN practice act in IL sundowns in 2007 (meaning it must be re-written), it will be very important for all of us to stay very informed. I belong to the both the Emergency Nurses Association (based in Chicago) as well as the Illinois Society of Advanced Practice Nurses (based in Springfield).

mango-lo-maniac · Mar 9, 2006

Actually, this information regarding the PA in Illinois, is not entirely accurate, mango-lo-maniac.
The PA in Illinois, must have a phycian delegate prescriptive authority in order to receive a license for said presicriptive authority. The delegating physician must supply his/her license number and controlled substance number. And, the delegating physician can at any time, terminate the delegated prescriptive authority. And, the PA must have a contract with a physician in a supervisory capacity with all supervision within the physician scope of practice consistence with the PA education and experience.
So, the PA may not be actually practicing under said physician license, but is totally dependent upon that physician for prescription privileges and/or practice guidelines.

Please don't think I intend to start an NP vs PA thing. I have no problem with the NP profession nor the NPs I work with. We treat each other as colleagues and get along very well.

I don't want to hijack the thread either, so I'll just post my source of information. PAs are dependent practitoners; no way around that. We are licensed in most states, though, which is what I intended to address. I'm no lawyer, so maybe I misinterpret the IL PA Practice Act, but this is where I got my information from.

Section 1350.55 Prescriptive Authority
a) A supervising physician may delegate limited prescriptive authority to a physician assistant. To prescribe Schedule III, IV, or V controlled substances under this Section, a physician assistant must obtain a mid-level practitioner controlled substances license.
b) Written Guidelines.
2) The written guidelines shall be signed by both the physician and the physician assistant and a copy maintained at each location where the physician assistant practices along with the physician assistant's state controlled substance license number and the Drug Enforcement Administration (DEA) registration number.

Trauma Columnist · Mar 9, 2006

Mango-lo-maniac - may I ask which state you practice in? I gather you are a PA. What specialty if I may ask? Just curious...thanks.

mango-lo-maniac · Mar 9, 2006

Trauma, PM to you

patnshan · Mar 13, 2006

Illinois is not a great state to practice in as a PA. There are some states that are better for PA's, some are better for NP's. In Wisconsin, I'd say it's pretty friendly to both professions. We have many dual job postings popping up all the times. Most departments in our academic center hire either or.

As for the OP, the solution to the shortage should not be to shorten the schooling. I think that this is a terrible mistake. We are already expected to know a lot, rightfully so for the job we do. I am not sure what the solution is, but it is most certainly not to make the programs shorter or easier.

Thanks,

Pat, PA-C, MPAS, RN

Hospitalist Physician Assistant

Selke · Mar 13, 2006

....
As for the OP, the solution to the shortage should not be to shorten the schooling. I think that this is a terrible mistake. We are already expected to know a lot, rightfully so for the job we do. I am not sure what the solution is, but it is most certainly not to make the programs shorter or easier.
Thanks,
Pat, PA-C, MPAS, RN
Hospitalist Physician Assistant

True -- shortening any educational time, whether for PAs or APRNs, is a mistake. This would be like offering a 5 year degree for BSN-MSN-APRN -- although with the condensed nursing programs out there now, who knows, this may actually be offered. I wonder what they change in the curriculum?

I've noted quite a few RNs who became PAs, like yourself. I wonder if this is for the same reason I considered it: didn't care for nursing school and didn't want to return to it, wanted to work in advanced practice, and perceiving PA as an alternative option? Problem is, APRNs have independent licenses, unlike PAs, which swayed me, and the fact that there are no PA midwifery programs. I did hear from someone on another listserv that Stanford at one time did have a "midwifery" or OB PA program, but no longer.

patnshan · Mar 13, 2006

I've noted quite a few RNs who became PAs, like yourself. I wonder if this is for the same reason I considered it: didn't care for nursing school and didn't want to return to it, wanted to work in advanced practice, and perceiving PA as an alternative option? Problem is, APRNs have independent licenses, unlike PAs, which swayed me, and the fact that there are no PA midwifery programs. I did hear from someone on another listserv that Stanford at one time did have a "midwifery" or OB PA program, but no longer.

I didn't like nursing school. I thought it was a HUGE amount of "fluff" with very little substance. I also didn't like the professors at the university who were NP's, hadn't touched a patient in years, and were teaching us. They achieved critical acclaim in the nursing frontier for writing papers on hand washing and one's response to the color green in the hospital room:D

Having an MD to work with allows me to sleep better at night. I know what I know, and know what I don't know. If a patient is particularily complex or particularily difficult (socially I mean:)), I can kick it "upstairs". I also believe that neither NP's or PA's have enough education to work without a MD or DO backup when needed. I don't mean in house, I mean available in some shape or form. It also gives the lawyers somebody with bigger pockets to sue:D

I also chose PA based on my perceived (or real depending on your opinion) difference in the rigorousness (is that a word?) of the education. I looked at PA and NP programs at various universities, comparing their cirriculums. I saw a glaring difference, especially in the amount of clinical rotation time. I just precepted an NP student for three days in a week. That was her entire IM rotation!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! As an example, we did 8 weeks, full time on the medicine wards for IM.

I know programs are different across the spectrum, as are the preparation of the applicants to these programs.

If I had to do it now, given that I am married and have kids, I would go NP. I could do the same job I am doing now, despite IMHO, being less prepared for it. I could work full time and do it. I would have SIGNIFICANTLY less school loans to pay back than I do now. I had to quit work and dedicate my whole life to PA school for two years. I couldn't do that now.

Pat, PA-C, MPAS, RN

Selke · Mar 13, 2006

I didn't like nursing school. I thought it was a HUGE amount of "fluff" with very little substance. I also didn't like the professors at the university who were NP's, hadn't touched a patient in years, and were teaching us. They achieved critical acclaim in the nursing frontier for writing papers on hand washing and one's response to the color green in the hospital room:D
.....
Pat, PA-C, MPAS, RN

I think we're on the same page here :) We could have done without the fluff (I think of my nursing school as like high school) and with more solid pathophysiology and pharmacology courses, and even more clinical time, with MUCH LESS emphasis on care plans. In fact, elminiate the care plans altogether and teach diagnosis and treatment plans -- in real life, one has to learn how to do this out of nursing school in order to evaluate medical care, make suggestions to the MD, manage pt's course of treatment, &c. I have percieved more depth and rigor to PA programs. Do they teach "medical theory?" (Thinking of "nursing theory.") Of course if medical school was a realistic option for me I would have taken it.

The faculty in my specialty MSN program actually practice as health care providers, which is a huge bonus. They publish, but they also precept students in their clinics.

Again, PA programs don't lead to midwifery, which I think should be a separate profession from medicine or nursing, but that's another topic.

patnshan · Mar 14, 2006

Again, PA programs don't lead to midwifery, which I think should be a separate profession from medicine or nursing, but that's another topic.

You are right. The highly specialized programs such as midwife and CRNA have the edge here. But then again, you are locked into a specific type of practice unless you want to go back to school again. That's the beauty of FNP or PA, you can do anything you want at any time. Switch gears when it suits you.

Pat