Just a note on the NP vs PA debate...

Alnamvet · Mar 27, 2004

I did not want to fuel this debate. In fact, I hadn't realized there was this much NP-PA hostility until I found this board. Honestly, I think it a trivial debate in the grand scheme of things.... HOWEVER... NPR (National Public Radio) covered a story 3/5/04 in Chicago on the US prision system and new lobbying to eliminate unlicensed persons (PAs) to provide health care for the inmates. The lobbying focus is that since there are no actual physicians to supervise PAs (unlicensed to practice independently) they should not be seeing state or federal inmates. As most would know on this board, I wonder who will replace those providers... hmmmm? I realize that there are plenty of NPs already working in the prison system but I think this would be a bold statement by the feds.

PA's are not licensed, but certified, therefore they (PA's) only demonstrate having successfully completed a PA program, and pass a certfying exam. NP's are licensed...big difference when it comes to admitting privileges, prescripted authority, independence, and degree of autonomy. :)

cmspa-c · Apr 29, 2004

Physician Assistants are licensed and certified in the state of California

smk1, LPN · Apr 29, 2004

But what about all the doctors offices that only have a PA-C running the place and doc just comes by for chart review later that week? how is this different than the prison system? as long as the PA-C is abiding by his supervisory agreement what is the problem? I could see a great argument to be made regarding paying for the services of both a MD and a PA when you could pay for just and NP, (mind you I am NOT saying that NP's are "better" just thinking that this makes sense financially.)

psychomachia · Apr 29, 2004

PA's are not licensed, but certified, therefore they (PA's) only demonstrate having successfully completed a PA program, and pass a certfying exam. NP's are licensed...big difference when it comes to admitting privileges, prescripted authority, independence, and degree of autonomy. :)

Here is a little info regarding "licensing" and PAs:

http://www.aapa.org/gandp/license.html

Standardization of Regulatory Terms: Licensure for Physician Assistants

--------------------------------------------------------------------------------

State laws that regulate physician assistant practice currently use three terms for the credential awarded by the state: licensure, certification, and registration. The category of licensure is the most appropriate.

A key recommendation from the Pew Health Professions Commission Taskforce on Health Care Workforce Regulation is that states should "use standardized and understandable language for health professions regulation and its functions to clearly describe them for consumers, provider organizations, businesses, and the professions."[1] The Taskforce specifically recommends that states use the term "licensure" for public or state regulation of health professions. An additional recommendation is that the term "certification" be reserved for voluntary private sector programs that attest to the competency of individual health professionals. Physician assistants are certified by the National Commission on Certification of Physician Assistants. Reserving "certified" to NCCPA certification and using "licensure" for the credential awarded by the state promotes clarity.

Licensure is the most rigorous method of regulation. In a licensed profession no individual may practice without permission granted by the state. Generally such permission is conditioned on the meeting of certain criteria, which may include registration, passage of an examination, and possession of certain educational and experience qualifications . This type of rigorous regulation of PA practice is already in place in every state, even though it may not be called licensure. Nearly all other health professionals are licensed by states. Licensing physician assistants holds the profession to rigorous standards and creates credential parity.

Many categories of health law refer to "licensed providers." These laws usually intend to include providers who have a specific state authorized scope of practice. Registration or certification as the state credential for PAs can create conflict with laws which fully intend to include physician assistants.

Managed care and third party payers also frequently refer to licensed providers. This may be in reference to reimbursable services, or providers who may order specified tests or therapies. Lack of licensure can create obstacles to PA utilization and reimbursement for services provided by PAs in managed care arrangements.

Discussions of the evolving roles of health care workers commonly use the term "unlicensed assistive personnel." This term usually describes medical assistants, nurses aides, and others not specifically credentialed by the state. Lack of licensure for PAs in specific states has led to instances where PAs were confused with UAPs. Licensure for the profession will avoid this potential problem.

Licensure does not imply nor create independent practice for physician assistants. The states that issue licenses to physician assistants also require PA licensees to practice with physician supervision. This is consistent with the profession's definition. Physician assistants are committed to practicing with supervision by licensed physicians. Although changing to licensure may be sought to assist with reimbursement issues, PAs do not seek direct reimbursement. The policy of the AAPA is that reimbursement for services provided by physician assistants should be made to the practice.

The American Academy of Physician Assistants recommends licensure for physician assistants. Currently PAs are licensed in 43 jurisdictions, certified in five, and registered in three.

References

1. Finocchio LJ, Dower CM, McMahon T, Gragnola CM and the Taskforce on Health Care Workforce Regulation. Reforming Health Care Workforce Regulation: Policy Considerations for the 21st Century. San Francisco, CA: Pew Health Professions Commission, December 1995.

Also with regard to the original post, I could not find any info about the NPR report. I'm curious if the elimination of "unlicensed" PAs was really about the unlicensed medical graduates (UMG) that work in the Bureau of Prisons. Here is some info from http://www.aapa.org/policy/unlicensed-med-grads.html:

A number of unlicensed physicians currently are employed as physician assistants in the federal correctional system. They are eligible for PA positions because the employment qualifications for PAs,[8 ] issued by the US Office of Personnel Management, were written in 1970 before national accreditation and certification mechanisms were in place. The Bureau of Prisons cannot easily remedy this situation because it faces a severe shortage of health manpower and a lack of certified PA applicants for employment. The Bureau of Prisons, however, is considering the development of an accredited PA educational program which would allow its unlicensed medical graduate/PA employees the opportunity to meet national PA educational standards and become eligible for NCCPA certification. Other federal agencies, such as the Department of Defense and the Veterans Administration, are not bound by the OPM criteria. They have set requirements for PA employment that meet or exceed the qualifications used in the private sector. In fact, the VA specifically prohibits the hiring of unlicensed physicians as PAs.[9]

And the issue of "admission" privileges is not one to promote the NP over a PA - I've taken many more admission orders from PAs than I have NPs, plus the NPs were giving orders for a PHYSICIAN, not themselves.

From http://www.advancefornp.com/common/editorial/editorial.aspx?CC=27756:

Despite the lure of more money and improving scopes of practice nationwide, only 1% of survey respondents own an independent practice. The percentage remains unchanged since 2001. "I've actually seen a decrease [in NP-owned practices] in North Carolina," Hill remarks. "Even some that had set up what I thought were pretty viable practices, I'm not sure they're in practice anymore. I think it's because so many of the managed care companies will not let nurse practitioners onto their provider panels."

Alnamvet · Apr 30, 2004

Here is a little info regarding "licensing" and PAs:
http://www.aapa.org/gandp/license.html
Standardization of Regulatory Terms: Licensure for Physician Assistants
--------------------------------------------------------------------------------
State laws that regulate physician assistant practice currently use three terms for the credential awarded by the state: licensure, certification, and registration. The category of licensure is the most appropriate.
A key recommendation from the Pew Health Professions Commission Taskforce on Health Care Workforce Regulation is that states should "use standardized and understandable language for health professions regulation and its functions to clearly describe them for consumers, provider organizations, businesses, and the professions."[1] The Taskforce specifically recommends that states use the term "licensure" for public or state regulation of health professions. An additional recommendation is that the term "certification" be reserved for voluntary private sector programs that attest to the competency of individual health professionals. Physician assistants are certified by the National Commission on Certification of Physician Assistants. Reserving "certified" to NCCPA certification and using "licensure" for the credential awarded by the state promotes clarity.
Licensure is the most rigorous method of regulation. In a licensed profession no individual may practice without permission granted by the state. Generally such permission is conditioned on the meeting of certain criteria, which may include registration, passage of an examination, and possession of certain educational and experience qualifications . This type of rigorous regulation of PA practice is already in place in every state, even though it may not be called licensure. Nearly all other health professionals are licensed by states. Licensing physician assistants holds the profession to rigorous standards and creates credential parity.
Many categories of health law refer to "licensed providers." These laws usually intend to include providers who have a specific state authorized scope of practice. Registration or certification as the state credential for PAs can create conflict with laws which fully intend to include physician assistants.
Managed care and third party payers also frequently refer to licensed providers. This may be in reference to reimbursable services, or providers who may order specified tests or therapies. Lack of licensure can create obstacles to PA utilization and reimbursement for services provided by PAs in managed care arrangements.
Discussions of the evolving roles of health care workers commonly use the term "unlicensed assistive personnel." This term usually describes medical assistants, nurses aides, and others not specifically credentialed by the state. Lack of licensure for PAs in specific states has led to instances where PAs were confused with UAPs. Licensure for the profession will avoid this potential problem.
Licensure does not imply nor create independent practice for physician assistants. The states that issue licenses to physician assistants also require PA licensees to practice with physician supervision. This is consistent with the profession's definition. Physician assistants are committed to practicing with supervision by licensed physicians. Although changing to licensure may be sought to assist with reimbursement issues, PAs do not seek direct reimbursement. The policy of the AAPA is that reimbursement for services provided by physician assistants should be made to the practice.
The American Academy of Physician Assistants recommends licensure for physician assistants. Currently PAs are licensed in 43 jurisdictions, certified in five, and registered in three.
References
1. Finocchio LJ, Dower CM, McMahon T, Gragnola CM and the Taskforce on Health Care Workforce Regulation. Reforming Health Care Workforce Regulation: Policy Considerations for the 21st Century. San Francisco, CA: Pew Health Professions Commission, December 1995.
Also with regard to the original post, I could not find any info about the NPR report. I'm curious if the elimination of "unlicensed" PAs was really about the unlicensed medical graduates (UMG) that work in the Bureau of Prisons. Here is some info from http://www.aapa.org/policy/unlicensed-med-grads.html:
A number of unlicensed physicians currently are employed as physician assistants in the federal correctional system. They are eligible for PA positions because the employment qualifications for PAs,[8 ] issued by the US Office of Personnel Management, were written in 1970 before national accreditation and certification mechanisms were in place. The Bureau of Prisons cannot easily remedy this situation because it faces a severe shortage of health manpower and a lack of certified PA applicants for employment. The Bureau of Prisons, however, is considering the development of an accredited PA educational program which would allow its unlicensed medical graduate/PA employees the opportunity to meet national PA educational standards and become eligible for NCCPA certification. Other federal agencies, such as the Department of Defense and the Veterans Administration, are not bound by the OPM criteria. They have set requirements for PA employment that meet or exceed the qualifications used in the private sector. In fact, the VA specifically prohibits the hiring of unlicensed physicians as PAs.[9]
And the issue of "admission" privileges is not one to promote the NP over a PA - I've taken many more admission orders from PAs than I have NPs, plus the NPs were giving orders for a PHYSICIAN, not themselves.
From http://www.advancefornp.com/common/editorial/editorial.aspx?CC=27756:
Despite the lure of more money and improving scopes of practice nationwide, only 1% of survey respondents own an independent practice. The percentage remains unchanged since 2001. "I've actually seen a decrease [in NP-owned practices] in North Carolina," Hill remarks. "Even some that had set up what I thought were pretty viable practices, I'm not sure they're in practice anymore. I think it's because so many of the managed care companies will not let nurse practitioners onto their provider panels."

A whole lot of recommendations...good information....but the fact remains, when it comes to prescriptive authority, independence of practice, AND independent admitting privileges (such as in Columbia Presbytarian), NP's are way ahead of the game. In fact, only NP's can be partners and/or own a medical practice in most states. And before I forget, there is an ER in Florida where I used to work, where NP's and PA's work...NP's in the Fast track see, treat, prescribe, and discharge patients, without needing the blessing of an MD; the PA's, however, have to have their charts reviewed, the MD has to have a face to face with the patient, and co-sign the prescriptions and charts, prior to patient discharge.

psychomachia · Apr 30, 2004

A whole lot of recommendations...good information....but the fact remains, when it comes to prescriptive authority, independence of practice, AND independent admitting privileges (such as in Columbia Presbytarian), NP's are way ahead of the game.

I think you're forgetting that PAs were never intended to compete against physicians, but to work for them. By comparing prescriptive and admitting privileges is like saying, "The fact remains, when it comes to 4 wheel drive ability and ground clearance a Hummer is way ahead of a Cadillac Seville." So why act like a PA that has to have a physician sign off his/her charts is somehow "lacking" in whatever point you're trying to make?? It's apples and oranges...so who cares??

Alnamvet · Apr 30, 2004

I think you're forgetting that PAs were never intended to compete against physicians, but to work for them. By comparing prescriptive and admitting privileges is like saying, "The fact remains, when it comes to 4 wheel drive ability and ground clearance a Hummer is way ahead of a Cadillac Seville." So why act like a PA that has to have a physician sign off his/her charts is somehow "lacking" in whatever point you're trying to make?? It's apples and oranges...so who cares??

Point being the PA has the c, like in certified...look it up guy...licensure vs. certification///if you don't know the difference, than I don't care. I am not tethered to an MD, and I don't know of any PA who isn't...y\to me, that makes a world of difference

Kabin · Apr 30, 2004

Interesting thread as I've been internally debating the PA/NP path for a few days now. I received a PA flyer from MidWestern University and it states that PAs need to sit for a recertification exam every 6 years. I have yet to hear anything similar for NPs.

psychomachia · Apr 30, 2004

Point being the PA has the c, like in certified...look it up guy...licensure vs. certification///if you don't know the difference, than I don't care. I am not tethered to an MD, and I don't know of any PA who isn't...y\to me, that makes a world of difference

I did look it up, guy, and here is the information I provided, like in, before...

The American Academy of Physician Assistants recommends licensure for physician assistants. Currently PAs are licensed in 43 jurisdictions, certified in five, and registered in three.

LICENSED in 43 jurisdictions....so what was your point again??

I do know the difference, which is not much when it all comes down to things like state practice acts, HMOs, and who you work for. Being "tethered" to an MD doesn't matter if the guy who gets your job is because you won't be...and let's face it...PAs and NPs are all pretty much fighting for the same jobs, or else these "I got privileges you don't...na,na,na, naaa,naaaa..." debates wouldn't occur, would they??

Alnamvet · Apr 30, 2004

I did look it up, guy, and here is the information I provided, like in, before...
Being "tethered" to an MD doesn't matter if the guy who gets your job is because you won't be...and let's face it...PAs and NPs are all pretty much fighting for the same jobs, or else these "I got privileges you don't...na,na,na, naaa,naaaa..." debates wouldn't occur, would they??

Not sure what it is you are trying to scream out, but let's just say anybody can be a PA, with or without a bachelors degree....only a Registered Nurse can be a NP, CNM, CNA, etc. A PA is just that...an Assistant to a MD/DO; just like a nursing assistant is an assistant to an RN or LPN. The only ones I see, besides yourself, who have issues, are the PA's themselves, who hate the term assistant, have been trying for years to get it changed...why even Yale calls their program the physician associate program, but not even Connecticut will allow the PA's tpo call themselves anything but physician assistants. PA's are assistants, they always have been, and always will be...they assist doctors with all the scut work, and all their work needs to be reviewed and approved by a supervising physician; anymore they are not...that's the way it's legislated, accept it, and forget it.

cmspa-c · Apr 30, 2004

PA's do indeed recertify every 6 years and must meet cme requirements. If I am not mistaken, physicians also recertify and meet cme req