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| Let’s Take the AAFP Up On Their Challenge |
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by David Mittman, PA - January 10, 2011
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 Provided by Clinician 1
The AAFP issued a challenge to NPs and PAs. Well, not specifically to PAs but they did mention PAs also.
In their latest newsletter (http://www.aafp.org/online/en/home/publications/news/news-now/inside-aafp/20110106yrinrev.html) they again railed against retail health, NP and PAs and expanded scope of practice. They noted they are now “forced to demand” that the National Board of Medical Examiners CEASE comparing NPs and PAs (the PA mention part) to family physicians. OK, we get it, no comparisons.
So what do they propose next? They tell us they are so concerned with comparisons that they are now calling for an AAFP funded study comparing the practices of NPs and family physicians.
“The AAFP Congress of Delegates was concerned enough about the issue to call for a study comparing the practices of primary care physicians and nurse practitioners. Specifically, delegates adopted a resolution calling on the Academy to fund a Robert Graham Center study to evaluate the quality of existing studies that compare the two groups of health care providers, including in terms of health care outcomes and cost-effectiveness of care provided.
“We’re in competition nose-to-nose with independent nurse practitioners,” said delegate John Cullen, M.D., of Valdez, Alaska. “In states like mine, nurse practitioners can hang their own shingles with very little clinical experience, and the public doesn’t understand that.”
And predictably they next bring up patient safety and quality-like those are huge issues to be worried about. They again neglect to look at the evidence. They neglect to hold out their hand in friendship or to see a way out of this crisis without the “us against them” mentality. They are so sure of themselves that they are willing to bet it all on a study.
As a PA I feel slighted. Its time my profession was also studied. I am more than confident a few good family practice PAs can show them that we also are wonderful primary care clinicians. The real question is what they would do if we “midlevels” turn out to be as good as they are. Now, I am not saying that we are all the same, just that PAs and NPs will turn out to be quite competent in primary care. What we know, we do well. So, now is as good a time as any; let’s go and get it over with.
Let’s do that study.
Anyone want to bet on the results?
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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| Campbell MSN FNP-BC RN (Brooklyn, New york) |
on 19 Jan 2011 at 6:52 am |
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A Physician Extender is a specially trained and certified to provide basic medical services under the supervision of a licensed physician. Physician Extenders may order tests and make referrals related to the Member’s medical needs. Physician Extenders function as an agent of the physician.
Physician extenders include Nurse Practitioners, Physician Assistants, Certified Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, and Registered Nurse First Assistant.
All individuals who meet these classifications practice within their scope of practices within their specific states and should have the same focus quality patient care and striving for positive patient outcomes to decrease mortality. We all need to collaborate regarding our patient’s there is not one individual that can say that they know how to treat every disease, and that they are sure of the diagnosis with every clinical presentation. I feel that we all have to work as a team, put our heads, our knowledge, and clinical expertise together for the betterment of the patients.
The study would be most beneficial if the ultimate goal was to use the results to take a look at the education and training requirements in the NP & PA programs. This way when graduates of both programs begin to work they will have a certain level of confidence that they were provided with a sound educational background. There will be no need for a competition.
So you see the definition of a physician extender alone should be enough to let those individuals know that they are not physicians, but on the other hand it should let the physicians know that they need to embrace us as members of the health team. We are all aiming for the same common goals. |
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| Gina NP-C (CA) |
on 18 Jan 2011 at 7:51 pm |
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| wow........I can see how emotionally hurt the OHio, PA could be from NPs credibility. Many things you mentioned in your comments are not necessarily true. First of all, if you had enough knowledge about PA evoloution you wouldn't be writing like you did. PAs can come from ANY degree( computer, enginereeing, construction, ............and God knows what esle) background and sit for a 2 year PA program. whereas NPs come from a long Nursing background with direct quality patient care. As far as I konw nurses have to have at least 12 months of experience before they can enter the NP program. Why do you think is it that until very recently the PAs were not approved to prescribe Meds mostly narcotics, even now a few states including Florida still does not allow you to prescribe them. Many states medical boards require PA notes/ orders to be co-signed by a physician within 24 hours, whereas NPs have the autonomy and trust they deserve in their clinical documentation and orders for the most part. I am not trying to hammer the PAs here just trying to tell you (Ohio PA) that we all are mid-levels at the end of the day and unfortunately not allowed to practice on our own and the sad part is that we are always going to be needing each other to jump higher in our profession as something as simple as botox/ fillers injections has to be done with a supervising physician on board. So, please come down off your horse and lets take the tough health care road together. |
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| tinahfnp (Portland, Oregon) |
on 15 Jan 2011 at 1:57 pm |
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| Nurses masquerading as physician extenders? What the heck does that mean? I don't see my self as extending another profession. I utilize the medical model (and I was trained, very well thank-you) as well as nursing, spiritual and other models to provide holistic healthcare and advocacy for my clients. You can keep as much distance as you need. The CLINICIAN has been a collaborative effort. Our focus is patient care. I am proud to associate with PAs, MDs, DOs, NDs and others who provide care and guidance. I am not interested in a turf war. |
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| Ohio PA (OH) |
on 12 Jan 2011 at 9:54 pm |
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Hey Dave, I've got an idea! Instead of running behind the NP's and FP docs, pulling on their coattails whining "me too, me too "- " I feel slighted", how about putting on your PA "hat", throwing away your NP garb and tackle the AAFP head-on. Let the NP's and FP's waste their time and money on their ridiculous studies. Why not sit down with the Dr. Cullen's in AAFP and hammer out the real issues, making a case for PA's. PA's and FP's have some common ground in this battle. We both stand to lose jobs to lesser trained ,lesser regulated practitioners. Say what you may about quality of care rendered by NP's, the facts remain that they are not trained in a medical model thus cannot be considered extensions of physicians and their continuing education/ recert requirements are much less stringent than the physician or PA requirements. The reality is that they are nurses masquerading as "physician extenders". Too bad that Dr.Cullen didn't recognize this 10 years ago.
Apparently, the AAFP is experiencing a wake-up call. This appears to be a perfect opportunity to make these FP's aware of the significant differences between PA's and NP's, not the least of which is absence of competition between the FP and the PA- the PA is a dependent practitioner that can make a physician's quality of life alot better.
This is clearly the time to distance ourselves from the nursing profession. Nurses/ NP's have everything to gain from clinging to our coattails, obscuring the clear differences between PA's and NP's. The information that you have presented in this article, Dave, illustrates more clearly than ever that we as PA's have nothing to gain from an association with NP's. |
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