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| Bridging the Primary Care Gap for Good |
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by David Mittman, PA - June 8, 2010
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 Provided by Clinician 1
There has been a plethora of articles lately (many posted on Clinician 1) about how NPs and PAs will help solve the primary care shortage. Many articles say we are “new professions” which makes me chuckle. You know, both professions started in 1965; hardly new. But I guess we are new to one thing: people looking at us as a solution to a crisis. I am glad they are and I have some thoughts we need to talk about first and then two solutions.
Before we look to those solutions, let me tell you a little secret few people realize. Although the largest specialty for PAs is family practice, the profession has moved at a steady pace toward specialty practice. Dermatology, the surgical specialties and emergency medicine, ortho and others have sung a tune that more and more PAs want to dance to. The melody is one of more money and the many other reasons people pick specialty practice. I suspect NPs are also following, as many of the FNPs I know have also chosen specialty practice. If we want to solve the family practice/primary care crisis, we can’t do it by going into specialties. So, we PAs and possibly NPs have the same problem as physicians - how do we get well trained graduates to choose primary care over specialty practice?
The two easy ways, which we do not focus enough on, are getting students into rotations with NP and PA clinicians who are passionate about primary care and loan repayment. We need role models to show just how great family practice is and to tell students exactly why they smile most days when they go to work. The other no-brainer is loan repayment. The Association of Family Practice PAs (which puts on an awesome conference for NPs and PAs (http://www.afppa.org) should work with the AAPA and the AANP to have Congress include us in all future full loan repayment programs for clinicans choosing primary care.
The next solution will take much work, but should be considered as soon as possible.
Both the PA and NP professions should work TOGETHER to train a special clinician who would be a true expert in primary care. NPs have admitted that they need the DNP to practice at their optimum level (don’t know that I agree) while PAs do some fantastic postgraduate residencies (most in specialties). Let’s combine the two into a full one year 60 hours a week residency in primary care. This would be run by regional family practice departments in conjunction with PA and NP higher education. It would give us structured physician level training in “primary care” and at the end the graduate would get a new title PCP (Primary Care Practitioner). The NP program connected with this residency could award a clinical DNP also while the PA possibly a DPA. Also this new clinician would be allowed to practice independently/autonomously. The students would also get a stipend, so they would graduate without huge loans to worry about.
I realize this plan needs work. Getting a DNP that is not really clinical and concentrates in health policy or having a year shaved off medical school won’t get more of us into primary care. It might even get less of us there. Traditional education will give us more loans to worry about and will surely make specialty practice even more attractive. Today 75% of all NPs need to practice in collaboration/supervision with a physician and so do 100% of PAs. That too holds us back.
I think we need to think outside the box. Clinicians are needed for primary care. Why not have us become the “primary care” experts, do a residency and earn the designation; “Primary Care Clinician”?
Who Better?
Dave has been a PA, and later NP, leader for thirty years. He strongly believes that NPs and PAs must work together to insure a better future for both professions. Most recently Dave has been busy launching another dream; Clinician 1, the first internet community for PAs and NPs. In October 2008, Dave was honored by the New Jersey State society of PAs with its “Lifetime Achievement Award”.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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| Trudy FNP (Florida) |
on 27 Jun 2010 at 9:45 am |
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Hey, Dave, I love the idea of a Primary Care Residency.
I know you routinely scour the internet for articles either supporting or criticizing NPs/PAs, here are a few I thought you would be interested in:
http://www.Kevinmd.com/blog/2010/06/nurses-unappreciated-key-patient-care.html.
http://www.newburyportnews.com/opinion/x1358986383/Health-practitioners-set-record-straight.
http://www.indiancountrytoday.com/opinion/96318264.html.
http://forums.studentdoctor.net/showthread.php?t=719052
This last one will make you boil. Thanks for all your support! I love reading your articles. |
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| Karen, NP (Boston, MA) |
on 16 Jun 2010 at 11:53 am |
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Dave, I agree with you. I think it is important to encourage PA's and NP's to choose primary care, and it would be great if the government supported this with a loan repayment program, as many of us pay $500-$800 per month in student loan payments. I think a program focusing in primary care training for another year would benefit new NP's and PA's tremendously. It is true that NP programs do focus a lot on nursing theory... which has nothing to do with practicing primary care medicine. The doctorate "DNP" program is offered to NP's, and master level nurses working as clinical nurse specialists, as teachers, and in administration. So, this program does not primarily focus on increasing skills in primary care, it just enables a NP to put a D in front of their title. My view on this is apparent, by my last comment. With our loans being so exorbitant, and NP and PA programs costing at least $25,000 to $30,000 per year... adding more to this loan by having to obtain a "DNP" does not make sense for us. I would prefer to go through a primary care residency program, and afterward be able to proudly have the title FNP-PCP after my name.
Keep up the good work Dave.
I like the way you think. |
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| Elliott Rubin P.A-C (Arizona) |
on 15 Jun 2010 at 6:51 pm |
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I have been a practicing P.A since graduating in 1975 from Touro College P.A program. I started out in ER medicine then went to Family Practice with a group in Arizona. It seems that the expectations some employers have changed from doing the best for the patient to How many patients can you run through in a day. The bottom number in Medicine has turned to MONEY. How can we improve Health Care when a typical FP PA has to see a patient every 10 minutes?
I think we need to address this now, as it seems to get worse and worse.
I then practiced in a solo Urology Practice for 18 years and as time went on the problems became the same, more and more patients but not more time. What can we do? |
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| oriongrf (MD) |
on 15 Jun 2010 at 5:46 pm |
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| So, as a resident I get to come in late if I had a hard night?Or if my work day was extended I get the next day off? Seriously,it's a great idea.I did attend a surgical residency and still find myself using information from that program many years later. |
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| Janelle (Milwaukee, WI) |
on 08 Jun 2010 at 10:23 pm |
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| I'm a new graduate with an emphasis in adult primary care. The leap from school to practice seems to be widening. Speciality practice seems to be the only area interested in taking on a "new" graduate. Primary care is not interested in looking at new graduates. Not to mention the job market seems to have more jobs available in speciality practice. So, this is how I will be led down a road of speciality practice even though I had an initial interest in doing primary preventative care. So will I return to primary care after working in a speciality practice? Maybe but by then my primary skills will be lacking. |
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| Laura LaFlamme, CFNP (Albuquerque, NM) |
on 08 Jun 2010 at 6:06 pm |
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| Good letter. Thanks for your thoughts. I also think that a combo Primary Care and Psychiatry would be a good mix, since this specialty falls back on Primary Care often with less than optimal result. |
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| Dave Mittman, PA (Livingston, NJ) |
on 08 Jun 2010 at 5:50 pm |
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You must have gone to a great program.
Most of my NP friends felt they could have used more clinical training in their programs. PA training is very good also. I am not talking about that. I am not saying we are not good, or that we do not learn much AFTER, but structured training in primary care rather than non-clinical lectures is what I am talking about.
Possibly you are one of those people who thinks we can not improve upon NP education? If so, great.
Dave |
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| 60 hours a week? |
on 08 Jun 2010 at 5:15 pm |
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Are you kidding? Good decisions cannot be made with a 60 hour week....
NPs are already well-trained. |
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