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| Goodbye to the 0s: You Will Be Missed |
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by Dave Mittman, PA - December 8, 2009
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 Provided by Clinician 1
I have a challenge for you. You know that’s the way I am. I can’t leave well enough alone.
It just dawned on me that we will be entering the 10s (teens?) and leaving the 0s. Another decade gone and a new one to come. I would say the 0s were pretty good for us PAs and NPs. Yes, there were minor set backs but none nationally. Most of the states did well with new legislation and record numbers. The 0s saw a continuation of the expansion of NP and PA programs which are producing more of our brands of clinicians than ever before. We were also introduced to graduates that we felt were not as good as we were, and experience levels before school seemed to have fallen (do we all secretly feel like that?), on a positive note these new grads entered into a healthcare system that knew what their initials meant and were willing to pay them more than ever before for their skills. Even as we went into the most serious recession in decades, it seemed that the PA and NP professions were recession proof. The 0s also saw both professions used in war time. Both NPs and PAs were used in different capacities as full clinicians over these years and innovatively so.We broke many barriers. We continue to serve as excellent practitioners for our troops. Even across international boundaries we saw the PA and NP become newly introduced professionals able to practice in a number of new countries. Best still, the decade is ending with both professions being looked at as a significant piece of the primary care delivery puzzle. Even this new concept of retail health is taking hold. It would seem that this strange decade of the 0s has generally been good to both our professions.
So what will the 10s bring. They start in three weeks or so. Will this be the decade of the doctorate? Will it be the decade we set up primary care residencies to augment our clinical training so we can take on more primary care responsibility? Or possibly will this be the decade that Congress passes a law bringing in 40,000 foreign physicians to provide primary care and we are powerless to stop them? Not wanting to be cynical, but to many we still are “just nurses” and “assistants”. We need to work on that in whatever ways are effective. I personally hope this becomes the decade where PAs finally change our name to our birth name (Physician Associate) and shed the assistant moniker? Is there a possibility that national healthcare passes and somehow relegates us to a secondary role? Will NPs and PAs work together for the common good of both professions or will those that feel the other profession should just go away win out? Will we work out some of the silly territorial thinking that has kept us from becoming all that we can be? Will we even see organized medicine look at us as allies in a war that centers on keeping patients healthier? One can dream can’t they?
That is my challenge to you. Let us know how you feel about the next ten years. More importantly, take a few minutes out to consider what you can do to make your profession better in the 10s. And if I can ask a favor, let’s try to work together when we can. Let’s make this decade the “Decade of the NP and PA professions”.
Again soon,
Dave
 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”.
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| Pam Swaim (Danville, IL) |
on 28 Jan 2010 at 11:00 am |
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| The bridge from PA to MD would be a blessing and a dream come true if there was a smooth transition from PA to MD. We have been trained and practice via the medical model. It is sad that the medical profession cannot see that there is a wealth of potential future physicians in the disguise of PA's. |
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| Anonymous (Ogden, UT) |
on 26 Jan 2010 at 3:13 pm |
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| Just a math error I find very common is that the decade began in 2001 and ends in 2010, much like to 19th century was from 1901 to 2000. There was no zero year or decade. So the new decade won\'t began until 2011. Just hopefully interesting trivia but a common miconception. |
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| Time for a Bridge Program PA to MD (PA to MD land) |
on 13 Jan 2010 at 8:37 am |
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As a former PA who became an MD I propose the following for PA's to consider in regards to formulating a PA to MD bridge program. This should be a goal for 2010 and beyond. Since there is a push to increase the seats of medical students at the already established medical schools and another mild push to recruit foreign MD's to make up the
current primary care shortage in Medicine, I think
PA's would be successful approaching it this way;
1) Don't create more PA programs but instead focus on
opening up maybe 4 medical schools.
2) Staff those schools with faculty but primarily
administrators who from day one are in agreement with
the PA to MD bridge concept.
3) At one time there was a Fifth pathway for Foreign
Medical Graduates to enter MD residencies here in the
U.S.(I will not waste time explaining this program) I
think a similar 5th pathway concept could be used for
PA's also wanting to get MD degrees and enter into
residency training.(The FMG did not have to graduate
from his/her medical school to enter U.S residency
training under the 5th pathway) I have some ideas on
how this could be approached also.
I think the creation of a new PA to MD bridge program
could only be successful at a new medical school. Too
many "old school" administrators, professors etc....at
the established medical schools. Residency training is
all that really counts, keep in mind that a lot of
DO's(Osteopathic) physicians while educated at DO
schools will do residency at Allopathic,MD, training
programs.
If DO's can go to their own established schools but
get residency training at MD programs, I think the PA
to MD bridge program could follow suit and simply
follow an already established precedent
BTW a lot of my MD associates will not tell you but the tragic events of the Fort hood shooting involving a foreign medical graduate(MD) and the bombing attacks in England where foreign MD's were part of that terror plot in the process of getting visas/medical licenses to practice in the U.S has a lot of people wondering if flooding primary care with FMG MD's is good for national security. Maybe PA's/NP's could offer a "respectable" proposal. |
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| Bess Pods (Cromwell, CT) |
on 08 Jan 2010 at 6:34 pm |
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| I am sure this will send my head flying and I must be back in the 80's, but have we let the MD's do just what they wanted? Push us to practice with speed, less listening, quick decisions and often missed pt messages, so we can see close to the 40-50 pt/day they see. Are we lossing what made NP's NP's - esp with the RN experience (no offense to the excellent NP's & PA's that were not RN's 1st) MD/'s convinced us we were not cost effective, ordered too many tests, etc.....so now we emulate them and they still will run us down, instead of preserving the unique practice we delivered....... |
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| T. Russell (Georgia) |
on 08 Jan 2010 at 4:02 pm |
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| For what it's worth coming from a healthcare recruiter, you as PAs have much to be excited about in the new decade! In my role as a recruiting consultant, I meet with program directors, group/practice administartors and hospital administration on a regular basis to discuss their hiring plans. With the looming reform talks many facilities are turning to the professionalism and competence of PAs to help assist with delievering high level healthcare to their patients. I do believe that the stigma of being an 'assistant' is rapidly becoming an antiquated mindset. In patient satisfaction surveys PAs often get the highest satisfaction ratings for delievering sound care and exhibiting exceptional bedside manner during the patient's experience. You are and will continue to be a valued asset to the healthcare delievry team. KEEP UP THE GREAT WORK!! Thank you for all you do. |
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| Geraldine Jones (Fort Myers, FL) |
on 05 Jan 2010 at 2:17 pm |
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| i was paid $15,000 to $20,000 less as a PA at the VA in Fort Myers than the NP's and I could do nothing about it! Have other PA's working/or were working for the VA experienced this? There should be a class action suit against the VA for this! |
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| Wm.D.Joachim,PA (Oklahoma) |
on 30 Dec 2009 at 6:33 pm |
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Thank you for the article. There is so much to be thankful for in this day and age when there are so many of you out there who are just getting started in a wonderful profession. Being a PA has allowed many of us to do the things in life that we otherwise may never had the chance to do and that is to
practice medicine. Never would I have ever imagined just how far one could ecpect to go as a PA. Those who paved the way for me, the Bill Stanhopes, and Roger Whitakers and
many others from the very first program at Duke to the very first program here in Oklahoma will never be forgotten by those of us who were fortunate enough to know them. And
many of those who have born the brunts of criticism, and cold shoulders in the profession of medicine have very quietly
and professionally trudged on. Our program confers the degree of Physician Associate, and for several years has become a Masters degree program. When our program at the OUHSC campus began, there were few courses for the
PA student, but rather most courses were with the Medical Students with a 5% grade difference. My own class graduated five courses short, prep courses for the major ones we had to take with the Medical Students, and 8 months
clinical of an MD degree according to the Professor I asked why we didn't get to take Neuro-Anatomy with the Medical
Students. We celebrated our 30 years in the Medical Practice
this year. I will tell you that you have entered into a tremendous awesome career. I will also admit to you that I am
looking forward to reaching the end of my career in the next 5 to 7 years when I will be 75 years old. Allow me to wish you all a Happy New Year. and keep up the good work each of you do daily. If the present politicos in Washington have their way, it may have far reaching changes for our profession as we have known it. |
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| Randy Nelson, PA-C (Minneapolis, MN) |
on 30 Dec 2009 at 12:56 pm |
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| I agree with the MD above! I recommend that all NP's and PA's work on furthering our profession by earning our DNP and DPA degrees. PA's also need to get rid of "assistants" and make it "associate". |
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| JoAnn M. Kargul FNP-BC (Colorado) |
on 30 Dec 2009 at 12:37 pm |
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| Barriers to practice are still present. I graduated from Pace University #1 in my class in 1997, taught at the Masters' level, and successfully started and operated my own practice without a physician for 7 yrs. plus worked in other areas. I am licensed in NY, NM, and CT and am ANCC certified with a current DEA #, yet, CO states I am not qualified for prescriptive authority because I didn't have a seperate course in Pathophysiology in 1997! (Note: I received an A in Pharmacology) My instructor called the BON and explained it was integrated but to no avail! My choice was to take a course or practice in another state. I was told that NP's are not well liked in CO and the rules are the rules. Work must be done to allow national certification that means something! |
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| Deborah S. Barron P.A.C. (Shreveport, LA) |
on 30 Dec 2009 at 10:00 am |
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| I totally agree with Barbara Kramer, CPNP-PC. I have felt this way since I graduated in 1999 and started practicing. I have been looking at ways to further my eduacation to acheive the respect and apprectiation that we deserve. My patients ask me all the time, "When are you going to become a doctor?" |
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| susana (san jose california) |
on 29 Dec 2009 at 4:59 pm |
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| What a note. I am with you Dave. Susana |
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| D.Hill (Atlanta, GA) |
on 22 Dec 2009 at 5:04 pm |
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The key is "all together". When I started I had to call in prescriptions, and no one had ever heard of "P.A." The changes made were done by a few select active in the profession. I hope all new grads will make the commitment to at least play a small role in progressing the profession. If you new grads don't know how just seek out the old guys.
The best is always yet to come.
Just take good care of the patients and everything else will be alright.
D.Hill, P.A.-C |
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| anonymous PA to MD (California) |
on 22 Dec 2009 at 12:23 pm |
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I think the PA profession should evaluate this question from the standpoint of how will patients affected by a looming shortage of primary care practitioners respond to the lack of independant, competant and doctorally trained primary care practitoners?
Stop fooling yourselves, the AMA and Physicians are a politically motivated group concerned about running the health care industry as a "free market business" for which those at the top of the food chain command top dollar, top lifestyle and top respect. This is why so many FMG's and IMG's want to leave their countries and practice medicine in the U.S. If PA's want to tie their survival, advancement and acceptance in the medical community based upon the opinion of MD's, good luck with that. DO's,(doctor of osteopathic medicine), were once in this second class position and have elevated themselves to the position of "Physician". Patients don't want to see an "assitant" anymore, they want to see a "Doctor". The great disconnect here is that we have an administrative AAPA who is clueless as to what happens at the clinical level. In my practice we have a podiatrist, psychiatrist, psychologist, an NP who is working on her DNP(Doctorate of Nursing Practice)and then there is the PA. One year from now my office staff will have all "Doctors" working here and one "assistant". Would you like to put yourself in the place of that one assitant? What is interesting to me is that the MPAS degree, with 1-2 year clinical residencies is already a more rigerous program than the DNP training program which doesn't have hospital based clinical training as part of its curriculum. PA's with certificates have spent more time in the hospital doing the 1 year clinical rotation and some having completed a 1-2 year residency than a DNP.
Has the AAPA actually looked at the DNP training curriculum? Look up any DNP training program and then ask yourself where is the "beef" in the arguement against PA doctoral degrees. I was a PA, but got tired of glass cielings, ostrication at professional conferences and doing "urgent care". I now call the shots as a "Doctor" which has resulted in better patient care evidenced by the growth of my practice, something I could never accomplish from the position of an "assitant". PA's owe it to America to step in and take care of the tired, poor, actue and chronically ill primary care patients who for financial reasons are overlooked by a political organization concerned
with preserving the "free market system" of health care in
America. THINK ON THESE THINGS. |
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| Barbara S Kramer, CPNP-PC (Newark, DE) |
on 18 Dec 2009 at 10:40 am |
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| I enjoyed your article on the 0's, but I was taken aback by your comment about "national healthcare" relegating us to a secondary role. The way I see it, if a healthcare bill passes (any healthcare bill, at this point!), it will finally allow millions of uninsured to recieve health coverage, and, in turn, create a need for many more clinics, ambulatory care centers, etc., peopled by NPs and PAs. Family medicine, pediatrics, and ambulatory care will be crying out for more practitioners, and with the MD shortage, especially in these generalist areas, they will be looking for us! |
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