Name and scope of NP/PA's

[zoidberg]

With all the talk of PA's wanting a new name and both parties wanting to practice their full scope in all states, I think it should be discussed together. I realize the nuances between the two groups, but one cannot deny how similar the two are in what most do on a day to day basis. NP's name is so well known it would be hard to change (never thought it was an issue until i saw another thread, but i think its not even a thought). PA's could change to physician associate because people would probably not notice, and i think it fits what they do better.

As far as both go, it seems with scope there is independence from physicians, and the extent to which they can practice medicine/nursing/whatever(another discussion). Here in the SC, PA's can practice medicine more freely (my impression) but must be in practice with a physician who has to be in the building a certain percentage, but the paperwork is hardly anything. NP's have freedom to see patients where they want, have do not have as much freedom to treat as they please, and have to follow protocols set out in collaboration agreement. I know its different in every state, so this discussion is not valid for everywhere (talking to you wyoming NP's) but i think the two groups should be discussed together.

I think both NP's and PA's are (for the most part) well educated and valuable to the community. I also think that NP's who trade independence to practice with an MD should have the increased scope(if they are trained) PA's have. Also, If a PA wishes to practice with more independently a collaborative agreement, it should be allowed, but with stipulations, such as not do things the PA would have done knowing there is a physician backing him/her up.

Any thoughts?

[SycamoreGuy]

Unless the PA spent all his time in PSYC or some other specialty and wanted to be independent, what good would he be in primary care? PAs really are a breed of their own. Equivalent to NPs in some aspects and completely different in others. It really makes me question the MDs that think they should be combined.

[myelin]

Rising tides raise all boats. I don't know if or how they can get out from under the stranglehold they are under, but if we could help them, I think we should.

I completely agree. But the only way they could do it (as far as I can tell) is to sever ties with the AMA, and how on earth would that ever happen?

[Psychcns]

I think PA's have their own license--is this correct?? They can only practice with MD supervision..How similiar is this to a APRN practicing with MD supervision.

There are 13 states where an NP can practice independently--- I think if PA's want independent licenses these would be the states to start lobbying in....

Do PA's have an easier time finding supervisors than APRN's in the states where APRNs cannot practice independently??

[zoidberg, BSN, RN]

A lot of urgent care centers here in SC have NO APRN's on staff. I think due to the supervision of PA's malpractice is next to nothing. The supervision is a little different for the two. PA's have to have an MD on site 75% of the time, but hardly have to have anything signed off by the supervisor. NP's can practice without an MD on site, but have to have their own malpractice, as well as two MD's to sign their license. Their also has to be a set protocol for what they can and cannot treat. Anything falling out of the protocol has to be referred to a MD. It is hard to get a MD to sign your license, so many work with an MD, that way malpractice is cheaper, and you always have someone to sign your license. Same treatment protocol, which makes PA's able to have a little more freedom with the actual treating of patients.

[AbeFrohman, BSN, RN]

The current thought model on how PAs can become independent is through CAQ (certification of additional qualifications), which has only come out in the last few years and there isn't one for every specialty yet. They are written by specialty PAs and MDs and are intended to resemble allopathic board certifications. These exams are only allowed to be taken after a residency or so many years of full time practice.

No PA is arguing for independence in say, neurosurgery, but many are grumbling that after residency/time in practice with a passing CAQ score, they should be independent in specialties such as FP, EM, outpatient settings, ect.

As a side note, it is commonly accepted by PA leaders that residencies in specialties will become the norm. Either through legislation (similar to degree creep how NPs need a Master's degree to practice in many states now), or by self-selection as jobs will start to only take residency trained PAs with a passed CAQ. It happened to the docs the same way. First, all you had to do was graduate med school, then legislation required an intern year. Now you can work in any specialty after an intern year legally, but no hospital will hire/credential you and you could be sued into oblivion.

Will independence for PAs ever happen? Who knows. More than likely the best they can hope for in this lifetime is collaborative practice and untie themselves from "supervision," and with no physician liability they will be able to demonstrate they can stand on their own two feet. It is hard to show that you are competent if the physicians are taking credit for you work through "supervision." No way to prove if it was a PA or the MD that did the heavy lifting. If any of it does, it will be much more slowly than NPs progress and it will likely be without the help of the AAPA. The House of Delegates for the AAPA won't even consider studying the cost/effect of a name change. Though a new organization, PAs for Tomorrow, has started just in the past month and is attempting to reach critical mass so that they may take on the issues the AAPA won't touch.