"Same Time Next Year" Article
Title: “Same Time Next Year”
Author: Wendell S. Wharton, Jr., P.A.
Once again it’s about time for our annual PA reunion. This annual PA “Family/Class” Reunion is officially referred to as the Annual Physician Assistant Conference sponsored by the American Academy of Physician Assistants, AAPA, which this year will be held in Philadelphia from May 26 to 31. This will be the 35th AAPA annual conference.
I can still remember my first AAPA conference in Las Vegas in 1978. I attended the House of Delegates sessions including the debates in the Reference Committee meetings and as many continuing medical education lectures as I could cram into my schedule. I thought that was the reason that PAs went to the conference. I was shocked to later learn that the conference is a vacation for some and an annual rendezvous for others. There were a lot of parties, large and small, and too many private one-on-one parties to count or mention.
First, let me say that there is nothing wrong with combining the annual conference with vacation time. Not all PAs get two weeks of CME time plus two weeks of vacation time off with pay. So combining CME and vacation time is a matter of necessity. Additionally, one can travel to some interesting places and write off part of the expenses for travel, hotel, meals, and some entertainment as income tax deductions. Depending upon how you spread out the CME sessions that you attend the entire stay may be deductible.
Secondly, there is nothing wrong with seeing your old classmates again and going to the CME sessions with them. You studied and learned together when you were in the PA program so in a sense it will be like “old times”. You can find out what is new in your friend’s life and you can update them on changes which have occurred in yours. With the growing popularity of various Alumni Receptions it is even easier to meet up with old classmates and even some of your former faculty members that are now colleagues.
My surprise was learning about the renewing of old romantic relationships at the conference and the number of times that this occurs. Years ago I saw the movie “Same Time Next Year” about a couple that had a romantic interlude once each year. They were each married to someone else but saw their “old flame” once each year and approximately the same time of the year. I just did not know that so many PAs were doing the same thing with the AAPA annual conference as their hook-up site and cover or excuse for being away from their family.
I know that I am a bit old fashioned but I guess that I was a lot more naïve than I previously thought myself to be. I know that everybody does not go to the conference for the CME. A number of PAs have said that they will only go to the conference if it is being held in a city that they want to visit or a city that is a good vacation site for the individual or their family. A few, and I mean a very few, go to the conference for the politics and to debate the professional issues.
However a large number of PAs go to the conference solely for the renewing of old friendships. In my naïve state I assumed that these friendships were truly platonic in nature but I have learned that there is a romantic and intimate basis for many more than I would have imagined.
Why do you attend this annual event, “are you part of the ‘Same Time Next Year’ crowd also?” Don’t be surprised if you ask you colleagues why they attend the AAPA Conference and learn that their reason for going is not the same as yours.
PA Retirement Article
Title: PA Retirement
Author: Wendell S. Wharton, Jr., P.A.
How many more years will you practice medicine? What will you do when you when you stop practicing medicine, retire or start another career? Have you planned and prepared for the later years, the “golden years” of your life? These are questions that most of us do not think about until we are nearing the end of our fifties or the beginning of our sixties. We tend to deal with life according to the decade we are currently involved with at our present age.
During our first decade, newborn to 10 years of age, childhood, we are focused on fun, playing, the things that we want, and wanting to grow up. When we are forced to think about what we want to do with our life or what we want to be when we grow up, our answers usually reflect some “pie-in-the-sky” career or profession with little bases in reality. There is no knowledge of what it takes to make our dreams a reality. We are simply enchanted with whatever it is for whatever reason. We do absolutely no planning for the future.
When we enter our second decade, from 10 to 20 years of age, teenagers, we think that we know everything. We are usually more concerned with what our friends think and say than what any adult says. We begin to prepare for our future because we are forced to go to school and get an education. Most of us just want to get out of school and begin our lives without having a clue as to exactly what that entails. We enter college with only a vague idea of what we are preparing for. Most of us change our major course of study several times before graduation. We lay down a foundation but have no idea of what we are building. Poor planning for the future.
During the third decade of our life, from 20 to 30, young adulthood, the prime of life, we finish college, get a job and begin a career. We are focused on consumption, enjoying the moment and not concerned about the future. We have finally begun to run this race of life but we have no idea where we are going and we think that it is a sprint, never realizing that it is a marathon. We may give some thought to starting a family but our thoughts are usually self-centered and focused on the present or the immediate future. We assume that our job or career will provide for our needs and wants but we don’t plan or prepare for the future.
Life has a way of slapping us in the face during our fourth and fifth decades, the 30’s and 40’s, we are in our prime career wise and with respect to revenue generation, but we are stuck in a rut. We have dreams of where we want to go but no idea of how to get there. Our money comes in and goes out so fast that we look back and wonder where it went. We start to see the early signs of aging but refuse to accept that fact that we are getting old and that life is passing us by and that our dreams are starting to fade because we won’t take the necessary steps to make them a reality. We complain about our situation, everything that is wrong is always someone else’s fault. By this point in life we have changed jobs and maybe careers several times searching for who knows what and not finding it. We are in denial and don’t plan for the future.
In our 50’s we recognize that retirement is just around the corner and like a deer frozen in the headlights we are stunned. We are in the same sad state of affairs as all of those people who gave us advice that we did not listen to or follow. Over the years we have made more money than they did but we are no better off and maybe we are in worse shape with respect to assets and debts. We know that we should have done something in the past and we should do something now about our current life situation but we don’t know exactly what to do. Advice is everywhere and now there is so much information regarding financial, investment, career, retirement and end of life planning that we are overwhelmed. Plus now we are sandwiched financially between taking care of our parents and paying college tuition for our kids. We still do not plan for our future because we say that we have no money left to plan to spend.
Now we enter our 60’s and are faced with the fact that our career is about over, retirement is staring us in the face, and the end of life is fast approaching. Unfortunately, most of do not have enough set aside to be able to afford to retire so we begin to accept the fact that we will have to work past the age of 65. The question now becomes “what kind of work will you do?” Again I ask “how much longer will you practice medicine?” What will you do when you with your life after medicine? You may not want to hear this but a lot of people die within a year or two after they retire. Theories suggest that they just lost the will to live because their life had no real purpose outside of their job or career.
Not that conventional wisdom is always correct but the prevailing popular opinion is that the current generation of baby boomers and the following generation may have to work longer, retire later in life, and continue to work at least part time during their retirement years. It is being said that we may have to redefine retirement in the future. The days of retiring, living off of the company pension and social security, going fishing and shopping are the dreams of previous generations. We may have to start “new careers” at the time when we thought that our working career was finished. However these “new careers” will be treated entirely differently and have a different focus than our earlier careers or medicine. We will be doing things that we enjoy and getting paid for doing it while working a lot less than forty hours per week. These will be more like paid part time hobbies or time spent volunteering to help others. The bottom line is that we will remain busy and very active during “retirement” and working less while enjoying it more.
This will not happen by accident, however, we should give some serious though now to exactly how we will spend our post retirement years while making provisions for our desired life style and health care needs. “If you don’t know where you are going, then any road will take you there.” But if you don’t plan for your post career years you probably will not be very happy with them. This is not the time to worry about being politically correct, think about what you can be happy doing and start developing a plan to make it happen.
Personally, I would like to work another twenty years practicing medicine, gradually decreasing the number of days per week and hours per day to four hours per day for three days per week. I would also like to teach a class two to three hours per week. I really like what I do and in retirement I just would like to work half the number of hours and make twice the amount of money.
Reflections of A PA Dinosaur Article
Title: Reflections of a PA Dinosaur
Author: Wendell S. Wharton, Jr., P.A.
I often find it amusing when I hear young people talk about “the good old days” by starting a comment with the phrase “back in the day…” The funny part is that frequently they are referring to something which happened five years ago. So I thought that just for the fun of it I would submit a little quiz on the history of the PA Profession for you to ponder. In order to answer these questions you may have to enter the “Way Back Machine” for a little time travel. If you were a practicing PA during the time when any of these events occurred, or a serious student of PA history, attempt to associate a year with each of them.
1. Do you remember when PAs were taught to gather the patient’s history, perform an appropriate physical examination, then report their findings to a physician who would make an assessment or come up with a list of differential diagnoses, decide which tests should be ordered and what the treatment plan should entail?
2. Can you remember when the Physician Assistant profession was an individual’s second or third career and not their first one?
3. When was the last time that the majority of the PA graduates and students were male?
4. Do you remember when it seems like every PA had at least four years of prior experience in a health care career before they entered PA school?
5. Do you remember going on a job interview and having to teach the physician how to spell “PA” because they did not have a clue regarding who we were or what we could do?
6. When was the last time that there were more PA students in PA school than there were graduate PA practicing medicine?
7. Do you remember when it was legal for PAs to be educated and trained in a state but graduate PAs could not practice within that state? (Hint: this occurred in more than one state)
8. Do you remember the PA practice of medicine before there was an NCCPA examination?
The answers to the quiz will be posted in the News and Events section of the website next week if there is a request for them.
I am not so sure that the “good old days” were really all that good. I do not want to go back to any particular year in the past and repeat it.
Let's Debate The Hot PA Topics Article
Title: Let’s Debate The Hot PA Topics
Author: Wendell S. Wharton, Jr., P.A.
Should all PAs be required to possess a Master’s degree in order to practice medicine? Should all non-Master’s degree granting PA programs be closed? Should all PAs be required to be recognized or certified in a medical or surgical specialty? How many years of clinical experience should be required before a PA could obtain specialty recognition? Should all Postgraduate PA programs be accredited by the ARC-PA? Is Primary Care Medicine really dead as a medial specialty? Is NCCPA recertification really benefiting anyone but the NCCPA? How many PAs should be educated and trained each year to meet US health care provider manpower needs? At what age should PAs and MDs be forced to retire from clinical practice? Should AAPA ever be allowed to make a health care policy without first consulting with the AMA of AAFP?
Why is it that those of us that are addicted to politics and those with passions for certain issues only get to express our feelings and opinions on the issues to our elected leaders once each year at the AAPA conference on the floor of the House of Delegates, HOD, or Reference committee. With all of the electronic advantages that are available now which we enjoy, why can’t we provide the AAPA with our input at various times throughout the year?
The Delegates can be sent informational updates on the progress made on resolving some issues and may even vote between the annual HOD sessions. Just imagine how much smoother things could go on the floor of the HOD if all of the hot topics were debated or discussed before the conference. Then the list of “pros and cons” could be longer, the “whereas sections” could address all of the angles, and maybe get some “wordsmithing” done before the House convenes. The problem is that the HOD has now become so efficient as compared to the past that some individuals do not see a need for improvement. My position is that if we get more information to more people we could make even better decisions because the decision makers would be better informed. Each year it seems that approximately one third of the Delegates to the HOD are first-timers and new to the process and the issues.
Additionally there are some non Delegates who would like to know which issues will be discussed before we get to the conference and we would like to offer our input into the decision making process before the resolutions are finalized. Would the AAPA consider developing a means of getting some pre-conference input from the rest of us on these and other issues? Our representative form of government was designed for a time when it was not possible to get input from all of the people, process it in a timely manner, and present it to the decision makers. Thanks to the current electronic devices, software and the internet AAPA could conceivably hear from every PA who wanted to comment on an issue and summarize the input before the HOD met to consider an issue or to provide input to the appropriate committee which is considering the issue.
The list of questions posed at the beginning of this article includes some of the “hot topics” which are likely to be discussed during the next HOD session. The point of this article is “why do we have to wait until May of each year to discuss the current ‘hot topics’ facing the profession?”
Rather than bore all of the members who really could care less about politics and the making of AAPA policies, I would not suggest putting this is the AAPA News, but create an “e-news” could be developed for those wanting this info and the ability to offer comments and opinions on the issues. I am sure that there would be some cost associated with this “e-news” subscription, we would not want the AAPA to “go into the red” implementing this project so a fee could be charged. Consideration should be given to the establishment of a blog page on the AAPA website for comments on these and other professional issues. This suggestion may even improve the existing reference committee process.
What is happening with all of the issues that the HOD referred to committee? Actually, in 2006 only two resolutions were referred to committee from the floor of the HOD because the Delegates were unwilling to make a decision based upon the limited data available to them at that time. Other resolutions were assigned to the “appropriate body” within the Academy for implementation. None of these will be heard from again until the 2007 HOD in Philadelphia. Are annual updates really the best that we can provide regarding the progress on these issues?
Hopefully the AAPA will update its old system before some new organization is created which does a better job of keeping its finger on the pulse of the PA profession.
Are PAs Really The Answer? Article
Title: Are PAs Really The Answer?
Author: Wendell S. Wharton, Jr., P.A.
What’s wrong with the health care “system” in this country and how can we fix it? Our health care “system” presents a complex problem with multiple components and issues involving many different view points. From my perspective, I don’t think that PAs are really the answer to the multitude of problems which plague our health care “system” even if we only focus on the health care provider issues. We are being touted as the answer to the health care manpower problem when we are only a small part of a huge problem.
Let me state for the record that I am a PA and I am very happy with my profession and my role as a health care provider. However, there are a number of problems with our health care “system”, so many in fact that it is difficult to state them succinctly. Additionally, within the current “system” we share some of the same issues that our physician colleagues are faced with, so creating more PAs will not solve the problem. So as not to overwhelm you, let me just list a few of the issues that come to my mind to give you an idea of the complex nature of the health care problem solely with respect to health care providers.
The issues are:
1. Manpower shortages issues for MDs and PAs,
US and world wide;
2. Maldistribution issues for MDs and PAs,
regional,
inner city versus rural,
decreasing number of primary care specialists;
3. Diversity issues for MDs and PAs,
gender and cultural;
4. Medical education and residency training issues for MDs and PAs,
appropriate numbers of schools and class size,
staffing and funding for clinical training facilities,
program costs;
5. Foreign/International graduate issues for MDs and PAs,
US and world wide, and
Brain drain issues.
As a profession let’s not just have a “knee-jerk” reaction to this current reported shortage of physicians by increasing the number of PAs that we educate and train, let’s go to the table and sit down with the national and state wide policy makers and discuss the system’s problems while looking at the “big picture”. Let’s be ready to make the difficult and controversial recommendations that are needed. Let’s offer our opinions and stick to our principals this time and not back down again from that which is right when some big power opposes us, as we have done in the past.
It is my opinion that as a medical specialty, Primary Care is dying and so is its largest sub-specialty, Family Medicine. The question that I think we should address is, “Will Primary Care survive as a medical specialty?” A number of our physician colleagues have said the same thing. An article in the New England Journal of Medicine also addresses this issue and the author’s opinion is that Primary Care is dying. (See: NEJM 8-31-06 www.content.nejm.com/search )
Are we as PAs really the solution to the problem? The number of physicians entering Primary Care is decreasing. Is increasing the number of PA students per program or increasing the number of PA programs the answer? I ask this question in light of the fact that the number of PAs in Primary Care in also decreasing. Data from the American Academy of Physician Assistants, AAPA, reveals a decreasing trend away from Primary Care with respect to PA employment based upon their annual survey. (Go to the AAPA website home page, under the About AAPA & PAs tab, see PA Data & Statistics at: www.aapa.org ) Only 38 percent of us are in Primary Care with only 27 percent of us practicing in Family Medicine. We seem to be following the same path as our physician colleagues away from Primary Care, so again I ask the question, “Are we as PAs really the solution to the problem?”
Our health care “system” has plenty of other issues which are beyond our ability to solve them with just an increase in our numbers. Not to mention the nursing, allied health, ancillary care and administrative support personnel shortages. There are access to care issues, scope of care issues, medical practice issues, unrealistic patient expectation issues, escalating health care cost issues, third party payer related issues, and limited resource distribution issues with the denial of care based upon the age of the patient. This is one of the best, if not the best, health care system in the world, for the wealthy and the well insured. I remember when PAs could be cash paying patients or at least have the best private insurance. Today a large number of PAs and MDs have less than ideal HMO plans for their own medical insurance.
When we consider the current HMOs versus fee for service versus PPOs versus a government run system, which will be the best system for patient care and will we help shape the decision with our input into the process? Given the apparent global physician shortage, are we making the problem worse with our self serving attention only on our country? Will we make it easier for FMGs/IMGs to enter the US work force now as health care providers?
We do not exist in a vacuum. We need to remove our blinders and break out of our tunnel vision pattern and start to focus on “the big picture” with respect to the future of our patient care system and enter into discussions which address solutions to the current and predicted or anticipated problems.
Are Your PA Colleagues Really Your Friends? Article
Title: Are Your PA Colleagues Really Your Friends?
Author: Wendell S. Wharton, Jr., P.A.
Why are your former friends no longer your friends and why did your previous friendships end? The truth is that they probably were never really your friend to begin with, or your relationship was based upon some assumptions that you made about the individual and not upon the facts.
Most of the people that we call our “friends” would be much more appropriately referred to as co-workers, colleagues, associates or acquaintances. They are individuals with whom we share or shared a particular activity and or belief. Our “so-called” friendships are based upon shared activities or beliefs. Some outside force, cause or activity brings you together, keeps you together and whenever that outside force which kept you together is no longer a common bond between the two of you, the “friendship” dies.
A forced association with a person or a companionship of convenience is not a friendship. A forced relationship based on frequent encounters because of some shared situation or common interest is not a friendship. It is my contention that most of our PA colleagues are not our friends. Just because you happen to like someone that you work with, talk with, or went to school with does not make that person your friend.
If you think that you know your colleagues, try discussing politics, religion, sex, money (what it should be spent on), some topic that you don’t usually discuss with them and you will soon find out that you don’t agree on some very key issues. Knowing a few facts about an individual does not mean that you know them. Most of us assume that our friends think and feel the same way about things and issues as we think and feel about them. That is why it is usually very surprising and disturbing when we learn that we disagree with our friends on some “important” point. Most of us find it hard to disagree without being or becoming disagreeable.
There is usually some level of affection, favored status or esteem for a person we call a “friend” and the relationship develops over a period of time. The statement “I know you” can be positive and endearing or negative and accusatory depending upon who is saying it and the tone with which it is said. We spend a lot of time with people that we really do not know. Your “friends” really do not know you very well either. If a recording of all of your actions, spoken words, and thoughts for a week could be made available to your friends, it would probably provide some shocking new information about you to your friends. After such an enlightening experience, some of your “friends” may no longer want to associate with you.
Your co-workers, colleagues, associates and acquaintances are not really your friends. Friends are the people that you contact when there is no activity forcing you to be together. People you call or visit when you do not want anything from them. Friends are people who know some of your faults and still like you. Friends are people who you enjoy conversing with and enjoy their company even when the activity that you are engaged in is insignificant. Friends are people that you can disagree with and not have the disagreement impact on the relationship. Friends can tell you when you are wrong and still be there to support you when you are being punished for your wrong without saying “I told you so.” Friends can offer you constructive criticism and not be upset with you for ignoring their advice. Unfortunately, most of us use the term “friend” very loosely, we apply it to individuals inappropriately and that is why we are so frequently disappointed by our “friends”.
Shortage of MDs...Replace Them With PAs? Article
Title: Shortage of MDs…Replace Them With PAs?
Author: Wendell S. Wharton, Jr., P.A.
One of the nice things about being an old man is having lived long enough to identify a cyclic pattern to things and events. In ladies’ fashion designs the hem lines go up, then come down, and then go up again. In men’s fashion designs the lapels on the coats go from wide, to narrow, to wide again. In finance interest rates go up, then come down, and then go up again. In health manpower estimates there is a shortage of physicians, then there is a surplus of physicians, then there is a shortage of physicians again.
Is it for real this time? Is there really a shortage in the number of physicians currently practicing medicine within the United States or did the experts at the Association of American Medical Colleges, AAMC, miscount or poorly project the numbers again. If I’m not mistaken during the period from 1950 to 1979 the AAMC projected that there was supposed to be a shortage of physicians. Then for the period from 1980 to 2000 they projected that there was supposed to be a surplus of physicians. Now they are projection that during the period from 2000 to 2020 that there will be a physician shortage. Did the medical education system over correct for the projected shortage and end up with a surplus or did the AAMC simply miss the mark on both counts?
Was this truly a cyclic manpower scenario? If there is a true cyclic nature in operation here, was there a surplus of physicians from 1930 to 1950 and, if mankind is still alive, will there be a surplus of physicians from 2030 to 2050? If the AAMC is correct and we are in or headed for a ten to twenty year period with a shortage of physicians, what are the implications for Physician Assistants, PAs? Will a decrease in the number of physicians result in an increase in the demand for PAs? It appears that some of the leaders of the profession think that it will, or at least those in PA education feel that will be the case. According to the Physician Assistant Education Association, PAEA, a number of PA programs have already increased the size of their entering classes or plan to do so within the next three to five years.
The plan appears to be to prepare for the upcoming shortage of physicians by providing an increase in the number of PAs. This sounds like we are touting that the health care system should “replace MDs with PAs”. Will a shortage of physicians result in an increased demand for PAs, maybe yes or maybe no. A few years ago when the demand to decrease the number of hours worked by residents was thought to be the beginning of an increased demand for PAs, there was no significant increase in the number of PAs employed by hospitals.
Unfortunately, the AAMC assessment of health care manpower needs counted all patient care encounters as physician encounters and the projected MD shortages did not take PAs into account. I would like to think that the past omission of PAs from their equations for the predicted physician shortages was the reason that we did not have the disastrous effect on patient care that was predicted.
Unfortunately, the total number of physician assistants nationally is not significant when compared to the total number of physicians nationally and therefore we did not account for the averted disaster. There are not enough of us to be the solution to the predicted physician shortage and the small percentage of increases in PA program class sizes will not make a significant difference in our numbers anytime in the foreseeable future.
If we want to seriously be a part of the solution then we ought to recognize that this predicted physician shortage is already a real problem in most of the countries around the world. Let’s start addressing the issue of the global physician shortage. The new push for military and civilian PA use internationally was in response to existing physician shortages.
We have issues with the FMGs/IMGs who desire to practice in our country and leave the country where they were educated and trained. Granted some of these individuals are US citizens who were not able to gain admission in an American medical school and only went to a foreign medical school to become a physician. However, we talk about increasing the number of slots for US medical schools, and maybe others are talking about increasing the number of slots for foreign medical schools, but when are we going to talk about the ideal number of providers per a certain number of patients or population size globally? Let’s get involved in the discussions at the World Health Organization, WHO, or its successor organization and begin to talk about global health with even more gusto than we now discuss global warming.
"...What We Think...We Are." Article
Title: “… What We Think … We Are.”
Author: Wendell S. Wharton, Jr., P.A.
Engage if you will, in a moment of positive reflection and introspection and ponder the following question, “Who are you?” The answer to that question is not your profession or your job. Can you answer that question without saying what you do, what you have, what you like, what you want to accomplishment, or who you are related to? Just for a moment, think about who you are and attempt to describe yourself in ten words or less using only descriptive adjectives.
This may not be a very easy mental exercise and most will only focus on their positive attributes. I think that we are basically good people but, outside of work, I believe that most of us focus on the wrong things. There was a popular old saying which stated “you are what you eat”. Well, I would like to modify that saying to have it reflect “that you are what you think.” Your thoughts about the world, people, things and the events around you say a lot about you and reveal who you really are.
What do you think about, outside of family, friends and work? Are your thoughts usually positive or negative reflections regarding people, events or things that you encounter or are exposed to daily? How would you feel if all of your thoughts for a day or a week were recorded and somehow displayed for your family, friends, colleagues, associates and acquaintances to see and hear? What would people learn about you that they did not previously know? Most of us would be embarrassed if all of the people that we encounter on a daily basis could hear all of our thoughts about them in addition to all of our other thoughts.
In order to give proper credit where credit is due, this concept is not mine originally. Sometime we can find very profound statements in some very unusual places. For example, I like the quote which I read years ago, “We may not be all that we think we are, but what we think, we are.” I read this in an “Archie” comic book during the early 1960s. I actually remember something that I read more than forty years ago which was printed in a comic book of all places. Yes, I also read the required literary classics as part of a college prep curriculum but this quote embarrassed me as I reflected on my thoughts.
This quote taught me an important lesson in life, that as a man thinks, so is he. This helped me to alter my perspective on myself and the people around me. My purpose for writing this article was to cause you to pause and reflect on your thoughts and attitudes. It is probably a good thing that all of our thoughts are not verbalized. Hopefully this little reflective mental exercise will help you obtain a proper perspective of yourself and those around you.
PA Specialty Recognition Article #2
Title: PA Specialty Recognition # 2
Author: Wendell S. Wharton, Jr., P.A.
The National Commission on Certification of Physician Assistants, NCCPA, has finally approved their much publicized “Principals on Specialty Recognition” and they are not worth the paper that they are printed on. They state that PA “Participation in specialty recognition will be voluntary.” Let’s get serious, who are they kidding? The NCCPA may not make “specialty recognition” mandatory but once it gets out in the market place and some PAs have it and some don’t, it will soon become a requirement for employment.
But the saddest part of this scenario and the real kicker to this document is their last point, “Specialty recognition will define competencies for specialty practice and create a pathway for the development and assessment of those competencies.” The tip of their previously hidden agenda is now part of their printed public policy. And like any good iceberg, there is much more to this issue than is immediately apparent.
The NCCPA is an organization which supposedly has some expertise in examination development but after being in existence for more than thirty years cannot develop an examination to assess one specialty outside of primary care medicine now wants us to believe that they can define the competencies needed for all specialties. And all of a sudden they now have the capacity to create a pathway for the development and assessment of all competencies for all specialties. If you believe them, then as the old saying goes “I have some swamp land under a bridge that I want to sell you.” Your name must be Gulliver and you must be as naïve as the day is long.
In years long since passed, the NCCPA claimed to be gathering data for the development of specialty recertification examinations. Those of us who took those recertification examinations were actually given what amounted to old initial certification examinations with some experimental questions included, and that our scores would be compared to others within the same specialty. After years of taking our money, they admitted that all they could claim to assess was that core knowledge of Primary Care Medicine which should be basic to every certified practicing PA.
This is a power play on the part of the NCCPA which will insure that they continue to monopolize the certification/recertification playing field by adding specialty recognition to their game plan as they see this as the future direction of the profession. It also insures that they will make even more money from PAs in the future by charging for the specialty examination in addition to the certification examination. They are creating the demand for this “specialty recognition” and they are pushing the agenda for it because it serves their best interest.
Before too long they will be traveling all over the country promoting (I mean explaining) this concept to state licensing and regulatory agencies just as they did when they lobbied (I mean explained to the legislature) to get initial certification into state laws and regulations as a prerequisite to PA practice across this country.
Changing clinical practice specialties may soon become a thing of the past. PAs will be locked into one specialty just like our physician colleagues or we will have to be double/triple boarded (recognized?) in order to practice in multiple medical specialties? Once you enter a specialty, with or without specialty recognition, will you be allowed to change to another one? Are new PA graduates doomed if they elect not to attend a postgraduate PA residency program? For those specialties for which postgraduate PA residency education does not exist, will specialty recognition be based solely upon years of clinical practice in a particular specialty? Who will develop the assessment tool/specialty examination for those multi-disciplinary specialties in which there are only a small number of PAs currently practicing? Will additional education/training be required for specialty recognition? Will the NCCPA develop a “grandfather recognition clause” for those of us that already have ten or more years of clinical experience in a medical or surgical specialty?
The NCCPA’s approved principals and points of consensus on specialty recognition raise more questions than they answer. Supposedly they have not worked all of the qualification and implementation details out yet. At least the public document does not include the mechanisms for education and assessment for specialty recognition.
Personally and professionally, I believe that this is a very bad idea and I believe that in the future, as a profession, we will regret going down this path towards specialty recognition. That’s my opinion, what’s yours? Please send your thoughts, comments, suggestions or questions to: article-comments@medexenterprises.com.
"If You Can't Say Anything Nice..." Article
Title: “If You Can’t Say Anything Nice …”
Author: Wendell S. Wharton, Jr., P.A.
Once again it is election time for the American Academy of Physician Assistants, AAPA, and the Nominating Committee has published their recommended candidates for each available office. Soon the platform statements for each candidate will be available for our review.
Politics, to some people it may as well be a four letter word. Politics, politicians, political parties, campaigns and the political process leave a lot to be desired. Nationally and in most state and local elections, negative comments by a candidate regarding their opponent are a common occurrence during a campaign. At least during our professional election campaigns negative comments are not uttered by the candidates. The negative comments that we are confronted with come from the voting and not-voting PA population, and they are only verbal, never written.
If you want to encourage someone to vote for your favorite candidate, then say something positive about him or her regarding their position on some professional issue or past experience. Build up your favorite candidate without tearing down or saying anything negative about their opponent. We do not have to resort to “mud slinging” to help our favorite candidate win the election. In fact it might be better for all of us if we kept our negative comments about another individual to ourselves.
When making a comment, any comment, regarding another human being, the best advice is to say something positive, “If you can’t say anything nice, then don’t say anything at all.” This powerful bit of good advice is a quote from a Walt Disney movie many years ago. (The movie was entitled “Bambi” and the statement was made by Thumper, the rabbit, after making a negative comment about Bambi, the deer, and being chastised by his mother who reminded of his home training.)
A New Name For PAs
In the Letters to the Editor section of the October 2006 issue of The Clinical Advisor under the title "PAs are Disrespected", PA Collin Ross, MD, PhD, MPH, PA-C, of California presented a brief argument for changing the name of the PA profession from "Physician Assistant" to "Physician Scientist". He states that "the minute the word 'assistant' is added to any title, it psychologically implies something substandard or clerical."
The primary focus of the letter appears to be his dissatisfaction with the fact that in the state of Maryland, PAs can be supervised by Podiatrists.
I do not think that The Clinical Advisor is available as an on-line magazine, but I am sure that if you contact the editor he will be glad to sent you a copy of the letter or the magazine. His e-mail address is: Larry.Frederick@cortgroup.com. Their website states that they welcome comments on their editorials.
"... Just Like Me?" Article
Title: “… Just Like Me?”
Author: Wendell S. Wharton, Jr., P.A.
When we consider ourselves as human beings, most of us like ourselves. We know that we are not perfect. When we assess ourselves, we gloss over our shortcomings and exaggerate our positive attributes. We present our “best face” when meeting others and we are “politically correct” with our responses to others, most of the time. We like ourselves and in spite of our occasional bad behavior, we think that we are pretty good people.
Well, consider this quote which I remember from my childhood:
“What kind of world would this be, if all of the people in it were just like me?”
(Author unknown)
Because most of us think that we are pretty good people, we believe that the world would be a better place if all of the people were just like us, thought like us and acted like us. However, if you really think about this question for a moment or two you might come to a different conclusion. What if everyone did exactly what you did and, more importantly, did not do anything that you did not do? (Please pardon the double negatives.)
Your first response would probably be that the world would be a better place because there would not be any killing, robbery, hate crimes, child abuse or etc. because you have never done any of those things. Accepting that as the truth, consider what the world would be like if everyone had all of your bad habits. Do you still think that the world would be a better place? Do you disregard the speed limit, tell lies, spread negative gossip and steal time or office supplies from work?
Well, let’s get right to the real ugly part of this scenario, how many good things that currently exist would the world be missing because you don’t believe in, contribute to or participate in them? Would we still have the Red Cross, United Way or Salvation Army? How about aid to disaster victims and Doctors Without Borders, would they still exist? Do you give to those less fortunate than yourself?
According to data from the 2000 U. S. Census Bureau, Physician and Surgeons, Physician Assistants and Registered Nurses are in the top ten percent of earnings for individuals employed full-time. However, according to the U.S. Internal Revenue Service data we are in the bottom ten percent when it comes to charitable deductions. As a group, health care professionals make more money than most of the people in this country and we give away the least. In the richest country in the world, a large percentage of the most financially well-off individuals don’t give to the less fortunate.
I believe that as health care professionals with the financial means to do so that we should lead by example and give of our time, our talents and our treasure to those who are less fortunate than we are. Don’t tell me that you gave at the office or that you help people every day at work. I’m not talking about your job. You get paid, and quite nicely I might add, to provide the care to your patients. I’m talking about giving to someone outside of your circle of family and friends, and not looking for something in return. Volunteer your time, donate your skills, give some of your money to help the less fortunate and give for the sake and joy of giving.
“A man never stands as tall as when he stoops to help a child.” (Author unknown)
If you have a problem helping some adult who “squandered their opportunity to make it in life” then help a child to have a better life. Volunteer your time, help a child learn to read and develop an appreciation for reading and the written word. Donate your skills, perform school physicals or be the health care provider for their soccer games or whatever. Give some of your money to help feed, clothe and provide health care to the needy children in this world.
If all of the people in the world did exactly what you did, would this world really be a better place?
I believe that we are all blessed with the things and abilities that we have in order to be a blessing to someone else. There are a number of organizations, causes, programs and individuals that could use your assistance, whether it is your time, your talent or your treasure that you give. Let us help make the world a better place. No matter how much or how little we have done in the past we can all do more.
I know that individually we cannot help them all of those in need but each of us can do more than we have done in the past. Do you know how much money you gave away last year? What percentage of your annual salary did that amount equate to? How much time did you spend volunteering or donating your professional skills? Did you give away an hour of your time per month or less? If you don’t know the answers to these questions then you probably did not volunteer, donate or give away very much. Calculate what one percent of your salary would be and plan to give that amount to a charitable organization or split it among several of them.
Again I will ask you to ask yourself the following question:
“What kind of world would this be, if all of the people in it were just like me?”
AAPA and Professional Diversity Article
Title: AAPA and Professional Diversity
Author: Wendell S. Wharton, Jr., P.A.
In an attempt to provide leadership for the Physician Assistant, PA, profession the American Academy of Physician Assistants, AAPA, has again included “Diversity” as one of its cross-cutting concerns in it 2006-2007 Strategic Management Directions.
The AAPA Strategic Management Direction regarding diversity is:
“Promote an inclusive environment that maximizes and encourages diversity. Promote cultural competency in patient care and educate PAs in the precepts of these competencies.”
The AAPA first included “Diversity” as one of its Strategic Goals & Objectives, the precursor to its Strategic Management Directions, in the early 1990s.
To its credit the AAPA has come a long way in its efforts to address the diversity related issues that face our profession since it days of benign neglect of the old Minority Affairs Committee. The Academy has become sensitive to ethnic and cultural issues and now recognizes that diversity encompasses this and much more. They made some mistakes and quickly corrected them once the error was called to their attention.
How then can AAPA be silent on a membership diversity issue that is exclusive rather than inclusive, decreases rather than maximizes, and inhibits rather than encourages diversity. By not speaking out against the Accreditation Review Commission on the Education of Physician Assistants, ARC-PA, position to stop accrediting PA programs affiliated with two-year, community college, associate degree granting educational institutions, the AAPA is in effect agreeing by silent consent with the ARC-PA.
The AAPA has maintained that it represents and speaks for the PA profession. This ARC-PA action will disenfranchise ten PA programs and their students. Since the majority of the students and faculty of these ten PA programs are members of an ethnic minority, this could have a significant impact on the future ethnic composition of the profession.
Just in case you think that 10 programs out of 136 is not significant. I would like to remind you that in the past one PA program with a large number of minority students did not submit a report to the Association of Physician Assistant Programs (then APAP now PAEA the Physician Assistant Education Association). The missing information from that one program skewed the APAP data so much that an asterisk was placed next to that year in their reports.
Because there are so few ethnic minorities in the PA profession, relatively speaking, the loss of several programs with a significant number of matriculating minority PA students is a cause for concern. Because of the impact that this loss could have of the future diversity of the PA profession, I cannot believe that the AAPA would be silent on this issue.
I refuse to believe that the AAPA is all talk and no action when it comes to diversity. It must be that all of their closed door, behind the scenes activity just has not been made public yet. I know that the AAPA did not just sit by quietly and let this happen. Please, somebody please tell me what the AAPA did and is doing to stop this insult to PA professional diversity.
AAPA Hurts State Chapters Article
Title: AAPA Hurts State Chapters
Author: Wendell S. Wharton, Jr., P.A.
I just attended the California Academy of Physician Assistants (CAPA)Annual CME(continuing medical education) Conference in Palm Springs, September 28 to October 1, 2006. The conference was great.
There were approximately 800 attendees. It was well organized, well run, beautifully laid out and decorated, and the lectures were enjoyable and educational for the most part.
However, the exhibit hall was large, pretty, and by comparison to previous years, pretty empty. The number of exhibitors was noticeably less than in recent years. In fact, it was so obvious to me that I questioned the CAPA staff about it and was told that a number of the corporate exhibitors said that they only send their representatives to a state once a year for PAs (Physician Assistants) and they had sent them to the San Francisco conference in May with the AAPA, American Academy of Physician Assistants.
Given that this event is the major source of non-dues revenue for CAPA, this is going to seriously effect their budget. I do not mean to make it sound like CAPA sill fold because of this. CAPA will survive as it has in previous years when AAPA held their annual conference in California.
This is not a new issue. AAPA does the same thing to some state chapter every year. They claim that there is no emperical data which demonstrates that the presence of the AAPA converence in a state has a negative impact on the host chapter's finances. Therefore, AAPA does not offer any financial assistance to the host state chapter to off set their loss of non-dues, CME, revenue.
I was told by some of the previous CAPA leaders that this happens ever time AAPA comes to the state and that other states have had the same problem. There have even been attempts to present resolutions to the AAPA House of Delegates to change their policy so that they could financially help the states that they hurt. But the resoultions have failed each time basically because the AAPA leaders agrue, quite convincingly that the Board of Directors has the fiduciary responsibility for AAPA and not the House of Delegates.
Next year it will be Philadelphia's turn to suffer in silence and deal with the decreased non-dues revenue as AAPA invades their state.
This financial abuse may be legal but it just is not fair. AAPA can give away money to worthy outside organizations but refuses to help its own unless it is for a political issue.
I can remember when California had their members withhold their AAPA dues years ago and threatened to pull out of the AAPA altogether years ago because of AAPA's lack of sensitivity to CAPA's concerns. In fact, they thought that they were being "screwed" by AAPA and published a copy of the AAPA logo in the CAPA newsletter with a "screw" going through the AAPA logo to express their dissatisfaction with AAPA.
I hope that AAPA does not force CAPA to once again take some type of drastic action in order for AAPA to take it seriously.
It seems shameful that some people ignore peaceful attemps by others to voice a serious concern. And these same people seemed so shocked when the others resort to radical behavior to get their point across.
My simple solution to this issue would be to look at the average non-dues revenue related to CME for the last three to five years before AAPA's presence. Then compare that figure with the amount of non-dues revenue related to CME for the year that AAPA was in a particular state. If there was a decrease in amount for the year that AAPA was there, then let AAPA make up the difference.
This would create another negative expense item for AAPA budget, but the amount would be insignificant with respect the the total AAPA budget and very significant for the host state chapter. This would build up some serious good will and might even help cooperation and participation.
AAPA should realize that charity begins at home.
Specialty PA Certification Article
Title: Specialty PA Certification
Author: Wendell S. Wharton, Jr., P.A.
Physician Assistant ( PA) certification and recertification have been "hot topics" within the profession for almost as long as PAs have been in existance. These topics generate a lot of discussion and debate in official meetings and private conversations. For most of us they are very emotionally charged subjects. It is hard to have quite polite dialogue about either topic, especially in a large group, without things getting heated up.
Well it seems that we have added another "hot topic" the this list, "specialty PA certification". It does not matter which side of the fence you are on with respect to this issue, it is very easy to find someone with different views and opinions. I have seen colleagues strain to maintain some degree of political correctness when arguing their points on this divisive issue.
For the record, I think that specialty PA certification is a very bad idea. I do not buy the argument that it will help the PAs within a specialty gain recognition for their expertice. I think that it will creat a barrier for PA
enrty into a specialty and for movement between specialties.
Like the "add on surgery exam" that used to exist, this will just be another revenue generating item for the NCCPA which has not proven that it has the ability to adequately test the level of medical knowledge of PAs in each of the different specialties in which we practice. For years they claimed that the recertification examination compared a PAs knowledge of primary care medicine with other PAs practicing in the same specialty. They eventuially gave up on their claim to know exactly how much primary care medicine a PA should know for each of the various medical specialties and began to insist that there is a basic core of knowledge of primary care medicine that all PAs should know regardless of specialty. By their establishment of a minimum passing score on the recertification examination they have declared that they know just how much primary care medicine you need to know and remember in order to be a PA.
In my opinion all the NCCPA did in the early years was just take our money in the name of recertification and gave us versions of the initial certification exam. They had no idea how much I knew about Obstetrics or Orthopedics and I don't think that they really cared because there was no end-point to the exam and there was not enough data on scores of PAs in the specialties to be statistically significant.
Let's assume, for the sake of discussion that the NCCPA now has enough data to determine the minimum level of knowledge of primary care medicine necessary to practice as a PA even in a non-primary care specialty. What make them think that they have the expertise to develop recertification/special recognition/or whatever examinations for each of the specialties?
Like it or not, this issue is already past the talking stage, the NCCPA is currently developing "potential specialty modules" to be included as part of their recertification exam, PANRE. In fact PA Dan McNeill, on of the AAPA representatives to the NCCPA was quoted as saying "Specialty recognition is going to happen, but the details haven't been worked out yet."
This is all being done to "ensure that PAs who move into specialty areas, safely practice in those areas". Please, give me a break! While I respect my colleagues on the NCCAP Board, once again I disagree with them. There is no way that they can ensure that I practice safely. Passing their exam will not ensure that I practice safely. All it does ensure is that I paid them a fee and obtained a passing score on their special exam. I doubt that they will even claim to have established that they know how much I know about the specialty which I practice.
Dan McNeill may be right, this may already be a done deal. However, that does not make it a good deal. What is it that they are trying to fix?
What's broken, what's the problem? Has there been an increase in patient care negative outcomes caused by PAs in specialty practice? No, that is not the case. Claiming that this is patient safety issue is truly misleading. This is all about stroking someone's ego by providing them some type of special status recognition for their "knowledge", or "expertise", or just "years of experience" in a certain specialty.
What this will do is set up additional requirements for those PAs who want to practice within a specialty outside of Family Medicine. It will also add more money to the NCCPA bank accounts that the do not deserve because it would have been earned under a false claim.
Please send your comments, thoughts and opinions regarding this article to: article-comments@medexenterprises.com.
Which PA Degree? Article
Title: Which PA Degree?
Author: Wendell S. Wharton, Jr., P.A.
Did you know that there are some PAs "out there" practicing clinically with doctorate degrees, masters' degrees, baccalaureate degrees, associate degrees and some with a certificate only and no degree?
Did you know that our national professional organization, AAPA, has more than one policy on their books regarding the issue of academic degrees for PAs?
AAPA "...recognizes that many currently practicing PAs graduated from non-baccalaureate programs..."
AAPA "...endorses the baccalaureate degree as the current minimal degree for physician assistants..."
AAPA "...recognizes that PA education is conducted at the graduate level..." and encourages programs to offer graduate level degrees.
The current AAPA Education Council is deliberating this "degree issue" and will attempt to offer a policy that clearly states the Academy's position. Talk about walking on egg shells, this policy will have some serious ramifications for all of us. I'm sure that tihs will be discussed in Quebec at the PAEA meeting next month and in Philadelphia at the AAPA annual conference next year.
ARC-PA has already decided not to accredit associate level degree PA .programs. They didn't wait for AAPA to figure out where they stand on this issue. What will this mean with respect to access to the PA profession in the future?
Will our patients benefit from our masters or doctorate degree? What effect will any new degree requirements have on our colleagues that do not possess the degree? If we will need an advanced degree in the future, which one wil be the best one to have (and please don't tell me M.D.)?
We now concern ourselves with patient "health desparities" and I think that we are about to create some future "profession desparities" for ourselves by changing from a fairly open, inclusive profession, academically speaking, to a fairly elite, exclusive profession.
Please send your comments, thoughts and opinions regarding this article to: article-comments@medexenterprises.com.
"Dr PA" Article
Title: "Dr. P.A."
Author: Wendell S. Wharton, Jr., P.A.
Most Physician Assistants, PAs, are aware of the fact that some patients refer to their non-physician health care provider as "Doctor". This occurs even though the patients have been told and admit that they know that their health care provider is a Physician Assistant, PA, or a Nurse Practitioner, NP. Some patients have gone as far as to say "You are a Doctor to me" or "You are my Doctor". You can introduce yourself as a PA and correct them when they call you "Doctor" but some patients will continue to refer to you as "Doctor".
As problematic as the above situation may be, that is not the focus of this article. My concern is the growing number of clinically practicing PAs with non-medical doctorate degrees who refer to themselves as "Doctor" and have their patients call them "Doctor".
Let me first state for the record that I am not to PAs seeking and obtaining advanced degrees, including doctorate level degrees. In fact I think that those individuals should be commended for their efforts. All of us should continue a life long learning process both formally and informally. I am also aware of the fact that in the academic arena, faculty rank and compensation are linked to advanced degrees. Non-clinically practicing PAs are not the issue issue being addressed here.
Physician Assistants who have earned a doctorate degree have earned the right to be called "Doctor" I respect that and I agree with it in academic and nonclinical arenas. My concern is addressing a PA as "Doctor" in a patient care setting and having patients refer to them as "Doctor".
It is difficult enough to explain to patients that we are not "Medical Doctors" but Physician Assistants who are trained, educated and licensed to practice medicine, within some well defined limits. Are we now going to take even longer with our introductions to explain the fact that we are licensed to practice medicine but our doctorate degree is not in medicine?
In most states it is illegal to hold oneself out to be a "Medical Doctor" if in fact you are not one. Is it enough that we are called "Doctor" and have the letters "Ph.D." or D.P.H." or "D.P.A." or Ed.D." or whatever badge engraved on our name or sewn on our white coats? Do we just modify the consent form that patients sign agreeing to be seen by a PA to explain our unique situation? What should we do ethically and legally to avoid confusion and malpractice litigation?
In an effort to avoid even to appearance of any professional misrepresentation, in the clinical setting, how should we address PAs
who have earned a doctorate degree? While I am sure that we don't have a professional policy addressing this issue at the state or national level, maybe we should begin to discuss this before a problem occurs instead of reacting to a negative situation after the fact.
Please sent your thoughts, comments, suggestions or questions to: article-comments@medexenterprises.com.
Current PA Issues Articles
Beginning with the first Monday in September, 09/04/06, as part of the News and Events section of the MEDEX Enterprises home page, we will present a brief "mini" article which reflects an opinion on a professionally related current event or topic. The first "mini article" will address the issue of clinical PAs with doctorate degrees, "Dr PA". Subsequent future topics will include "Requiring Master's Degrees for PAs"; "Specialty PA Certification"; and "Will the Associate Degree PA Be Like the Associate Degree RN"?
MEDEX Press Release
A press release was published on PR Web Press Release Newswire on July 10, 2006, entittled "MEDEX Enterprises Announces the Grand Opening of Their Virtual Classroom to Prepare Physician Assistants for the National Board Examination". The press release included a Podcast as an additional feature. The press release may be viewed at: http://www.prweb.com/releases/2006/7/prweb405501.htm
To hear the Podcast go the the press release above, under Options on the right hand side of the page, click on "Listen t Podcast MP3".
PA Board Review to Test Only
In response to numerous requests, MEDEX Enterprises will now allow individuals who signed up and paid for the PA Board Review Course to change their registration to the "Test Only" option.
To effect this transfer of status the individual must submit a brief e-mail message to us requesting that the change be implemented. Send the request to: boardprep@medexenterprises.com. The e-mail must end with the word "Signed" and the full name of the registered individual typed below it as their signature authorizing the request.
Making this transfer will void the course tuition refund guarantee and the granting of CME credit for completing the course if the required number of expanded SOAP notes are not submitted.
This modification of existing policy will allow some individuals the opportunity to matriculate through the course "backwards", testing first and then completing the study assignments. This will also relieve the pressure that some individuals felt to "fly through" the expanded SOAP notes and quizzes just to get to the multiple choice exams.
Ideal PA Board Review
There are many different ways to prepare for the national PA board exam and many types of board review courses.
What would be the IDEAL PA board review course for you?
Send us an e-mail at boardprep@medexenterprises.com and give us your description of the ideal board prep course.
New Practice Test Only Course
In responce to popular demand, MEDEX Enterprises will offer a way for induviduals to just take practice board type exams without going thorugh the entire MEDEX Review Course.
This new "Test Only" course will a series of multiple choice exams and will still offer feedback and study recommendations but it will not offer any CME and it will not offer a money back guarantee. The cost for this "Test Only" option will be $125.
The "Test Only" portion of the MEDEX program is now up and running.
PA Course Costs $250
The cost for the MEDEX Enterprises Physician Assistant National Board Examination Prepartion and Review Course is $250. The cost of the course includes a non-refundable administration fee of $50 and the course tuition of $200 for a total cost of $250.
MEDEX PA Board Review
MEDEX Enterpreses, Inc. is happy to announce the launching of its interactive on line national board examination cretification and recertification preparation and review course. The MEDEX website was activated on Thursday, March 9, 2006, the board review course began beta testing on Monday, April 17, 2006, and innovative approach to medical education via the advanced learning tool began live, on line, registration and matriculation at 8:00 am, Monday, April 24, 2006.
2006 National PA Conference
The American Academy of Physician Assistants (AAPA) held their 34th Annual Physician Assistant Conference, May 27 through June 1, 2006, in San Francisco, California.
There were 7,100 PAs and a total attendance of over 9,500 making it one of their "strongest conferences". Planning is under way for their 2007 conference in Philadelphia.
For more information regarding the Academy, membership benefits and the Conference contact AAPA at their website: www.aapa.org
New PA Competencies
In an effort to define the Physician Assistant competencies, a collaborative effort involving four organizations, the American Academy of Physician Assistants (AAPA), the Physician Assistant Education Association (PAEA), the Accreditation Review Commission for Physician Assistant (ARC-PA), and the National Commission on the Certification of Physician Assistants (NCCPA), has resulted in a new document entitled "Competencies for the Physician Assistant Profession". This document delineates what graduate physician assistants should know and be able to perform and accomplish in their role as health care professionals. It addresses competencies in medical knowledge, interpersonal & communication skills, patient care, professionalism, practice-based learning and improvement, and systems-based practice. The entire document can be accessed from the website of each of the four participating organizations. It can also be accessed directly at: www.nccpa.net/PAC/Competencies_home.aspx
There is a Bill in Congress to Make PA Practice Illegal
Did you know that there is a bill before congress that would make the practice of medicine by PAs and NPs illegal?
H.R. Bill # 5688, entitled "Healthcare Truth and Transparency Act of 2006", submitted by Mr. Sullivan, would in effect allow only MDs, DOs and DDs to practice medicine in the USA. All others that are not physicians, osteopaths and dentists would be "prohibited" from the practice of medicine.
To view this 4 page bill for yourself go to: http://www.magnetmail.net/images/clients/AOA_/attach/BillText.pdf
After you read the bill, you may want to send your representative an e-mail message requesting that they oppose this bill. To find out who your representative is and to send them an e-mail go to:
www.house.gov/writerep
Your message does not have to be a long one, just make sure that your vioce is heard. I would suggest that you refer them to AAPA at www.aapa.org for any detailed factual information that they need.
I have been that this bill was aimed at all of the non-phisician "doctors" in the health care arena, specifically the RNs that have doctorate degrees. This seems to make the "Dr. P.A." article even more relevant and timely.
PA & NP Outpatient Visits Increasing
According to a CDC's MMWR report, the US Center for Disease Control and Prevention's Morbidity and Mortality Weekly Report, the ratio of patients seen in an outpatient setting only by a non-physician provider nearly doubled in 2004 from six percent to eleven percent, while the number of patients seen only by a physician dropped from 81percent to 78 percent.
There were approximately ninety million patients seen in out-patients settings in 2004, and the number of visits seen by PAs and NPs increased and the percentage of patients seen became even more prominent.
This is even more significant when one considers the number of physicians practicing in this country versus the number of PAs and NPs.
For more information contact the CDC at : www.cdc.gov/nchs/about/major/ahcd/nhamcsds.htm
PA NPI Numbers
Do you have your National Provider Identifier (NPI) number? HIPAA, the Health Insurance Portability and Accountability Act of 1996 requires that the NPI replace all provider numbers in Medicare and Medicaid transactions by May of 2007.
You can apply on line at: https://nppes.cms.hhs.gov or you can call them at: 800-465-3203.
AAPA Blasts ARC-PA
The American Academy of Physician Assistants, AAPA, blasts the proposed Postgraduate Accreditation Standards from Accreditation Review Commission on Education for the Physician Assistant, ARC-PA, as both “unnecessary and undesirable”. To view the full response see the bulleted item under the “What’s New” section on the AAPA website home page at: www.aapa.org . The ARC-PA’s proposed standards can be viewed at: www.arc-pa.org/Post_Grad/post_gad.html
New Role For Canadian PAs
In an expansion of their use of PAs in the military, Canada is now ready to begin using PAs to treat civilians in the civilian Emergency Rooms in Ontario. To read the entire article, go to AAPA News button on the page under the News Room tab on the top of the AAPA website home page at: www.aapa.org
2007 AAPA Conference
The AAPA‘s 35th Annual PA Conference will be held in Philadelphia, PA May 26-31, 2007.
Need CME?
PA Things to Know
- The N.C.C.P.A. certification exam schedule is:
Summer PANCE July 5 - Oct 6, 2006
Fall PANCE Sept 1 - Dec 21, 2006
and the N.C.C.P.A. recertification exam schedule is:
Fall PANRE Aug 1 - Oct 31, 2006
Winter PANRE Jan 15 - Apr 13, 2007
Fall PANRE Aug 1 - Oct 31, 2007
- In 2006, 70% of the applicants to PA programs were female;
- There are currently 136 fully accredited PA programs in the US;
- You can be sued for selling or buying old NCCPA exam questions;
- You can only take the Board Exam once every 90 days;
- 10 to 25 percent of testers fail the Board Exam;
- 1/3 to 1/2 of repeat test takers fail the Board Exam;
- Approximately 5,000 PA students graduate each year.
PA Historical Society
The history of the Physician Assistant profession is now being pulled together and stored at Duke University by the newly formed Society for the Preservation of Physician Assistant History. The Society is collecting artifacts and documents from the early days of the profession. They have also developed an historical time-line which chronically depicts the development, growth, progress, and accomplishments of the PA profession. For more information on PA history visit their website at: http://pahx.org
2006 California PA Conference
The California Academy of Physician Assistants (CAPA) held its 30th Anniversary celebration at their 2006 Annual CME Conference in Palm Springs, California at the Wyndham Hotel September 29 to October 1. For more information visit their website at: www.capanet.org
PA Educators Name Change
In January, 2006, the Association of Physician Assistant Programs (APAP), at their annual meeting in Puerto Rico, voted to change their name to the Physician Assistant Education Association (PAEA). The change was to incorporate education into their name and to remove the reference to programs. Given the fact that some PA programs are actually departments or divisions at their respective institutions, the name change was deemed appropriate. For more information contact PAEA at their website: www.apap.org
PA Educators to Meet
The Physician Assistant Education Association, PAEA, is planning to hold their 2006 Annual Education Forum October 25-29 in Quebec City, Canada. They expect more than 300 educators to attend, topping their successful, well attended Education Forum in Puerto Rico last year.
The meeting will include workshops on Basic Faculty Development Skills, Designing and Writing a Successful Reasearch Grant Proposal and an Advanced Clinical Coordinator Workshop. There will be sessions for discussion of hot topics in PA education including PA students and International PAs.
For more information visit their website at: www.PAEAonline.com
International PA Jobs and Programs
Not only are individual PAs working in a number of countries around the world, a number of countries have begun an active effort to recruit PAs from America to help sovle their health manpower problems. Additionally, several countries have begun their own PA programs and some of them now have more one.
There are 5 PA programs in the Netherlands and 2 in Canada. Did you know that England, Scotland and Canada were actively recruiting American PAs?
For information international PAs, volunteering internationally as a PA, international PA employment and PA programs, visit the AAPA website: www.aapa.org/international/index.html or contact AAPA staff member Marie-Michele Leger, P.A.-C., Director, Clinical and International Affairs at: mleger@aapa.org.
PA Sued By N.C.C.P.A.
A graduate Physician Assistant and several Physician Assistant students were sued by the National Commission of the Certification of Physician Assistants (N.C.C.P.A.) for collecting, copying, distributing, and selling questions from their certification examination. For more information please read their newsletters (Summer 2004 Vol. 5 #2 and updated Summer 2005) published on their website at: www.nccpa.net
Specialty PA Exam Coming
The National Commission on Certification of Physician Assistants, NCCPA, is planning to convene a task force to "look for solutions to meet the needs of specialty PAs". Any exam venture developed in this area "will in no way replace the generalist recertification exam" but be an additional exam according to current NCCPA President Bill Kohlhepp.
For more information on the issue of coming specialty PA certification visit the NCCPA website at: www.nccpa.net
Forum on Specialty PA Practice
On June 24, 2006, thirty (30) PA organizations were represented at a meeting in Atlanta to discuss issues regarding the recognition of PAs in a growing number of medical and surgical specialties. The focus of the meeting was "not to debate whether the NCCPA should offer specialty examinations".
Since the NCCPA hosted the meeting and invited all of the participating organizations, it is safe to assume that they controlled the agenda. However, it is hard to believe that the topic of specialty exams did not come up.
For a summary of the meeting prepared by the NCCPA, go to their website: www.nccpa.net/News_A_TheForum.
To view the slides of the data presented by the AAPA reps go to: www.aapa.org/grandp/specialty-slides.pdf.
Pathway II is Dead
For those PAs who did not want to recertify by sitting for the NCCPA exam again, the old alternative referred to as "Pathway Two" will no longer be an option. It will be discontinued. According to the N.C.C.P.A. the last scheduled administration of the "Pathway Two" option for recertification will end September 28, 2007.
MEDEX 2008 Holiday Schedule
MEDEX Enterprises, Inc. 2008 Holiday Schedule
The virtual classroom of the MEDEX Enterprises National PA Board Examination Preparation and Review Course will continue to be available during the holidays, 24 hours each day for seven days each week. However, the MEDEX Enterprises offices will be closed for the observance of the following national and religious holidays and the administrative, instructional and technical support staff of MEDEX Enterprises will not be available on the following dates:
Jan 1 New Year’s Day
Jan 21 Dr. Martin Luther King, Jr. Day
Feb 18 President’s Day
Mar 21 Good Friday
May 26 Memorial Day
Jul 4 Independence Day
Sep 1 Labor Day
Nov 11 Veteran’s Day
Nov 27/28 Thanksgiving Day
Dec 25/26 Christmas Day
MEDEX Disclaimer
The byline articles presented in the News & Events Section express the opinion of the author and do not necessarily reflect the views or policies of MEDEX Enterprises, Inc., the Board of Directors or the stockholders. The publisher and the Corporation do not assume any responsibility for unsolicited material. Letters to the editor are encouraged and the publisher reserves the right to publish or not, in whole or in part, all letters received. Letters to the editor should be addressed to:
Editor
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or e-mailed to: editor@medexenterprises.com.
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