[NPInfo] A PA on feedback on what other PAs feel about the
DNP/Independence
David Mittman
dmittman at comcast.net
Sat Dec 1 16:26:11 PST 2007
Michael:
I'll tackle that one as I am in officer and co-founder of an NP/PA group
which you know. I am sure you also expected me to bite on this one.
I personally believe, feel and think that everything NPs do impacts PAs and
vice versa. So do many more of us and that is why we decided to work
together in the ACC. I think that you may disagree with this concept (us
working together in an association). If I am wrong about that please let me
know.
My Answer:
If NPs are unable to persuade the state of NY that they need a doctorate and
all that goes with that to practice, PAs may actually become the preferred
provider as they will have less "baggage" (will not have been to war with
the medical society, etc) and will continue to be clinically sound
practitioners. It's possible but not what you asked.
If the Doctorate becomes the only way to be an NP in NY, PAs I suppose
generally PAs will do the same thing for less salary, and that will also
impact NPs. Today, that is not the case. They may also be able to train less
expensively and faster (again with already proven good clinical results)
which will mean they will gain more of an advantage with more clinicians in
the system. If the things I pointed out in my last note are still important;
a 2 year postgraduate education, staying with the "pilot" concept, ability
to provide good clinical care without becoming a research or policy expert,
it might actually HELP grow the PA profession. It really depends how
seriously NPs take the title "Dr" and what they do with it. If they want to
compete educationally (not clinically) at the level of an MD (as has been
indicated), they will run into the same if not more problems MDs are facing.
The low reimbursement, the long hours, the barriers to practicing quality
medicine, the huge patient load to break even, -these are all being faced
today by physicians. Why are few opting for primary care? They have
doctorates, full independence and significant stature in the community and
still don't want the job. Many say they would not go into the profession if
they were young. Why would NPs not face the same reality? Like I said the
Minute Clinics may not seem attractive to NPs anymore. Who knows what will
happen? In this case, the differences between NP and PA philosophy will
become greater.
Because PAs were a competency based profession and not degree based, degrees
did not hold the same importance that they did in general for nursing. Even
though 80% or more of PA Programs now offer a Masters, PAs have been slow
to mandate them 100% as part of becoming a PA because of tradition and
people knowing it would threaten/hurt colleagues and dissuade students from
coming into the profession. Of course, the Masters has happened anyway. But
this history is why PAs have not understood the push towards a doctorate.
Regarding independent practice, again it means two DIFFERENT things to both
groups. Did you ask the PA her definition of "independent"? To PAs (and
physicians and possibly other healthcare professions) independent practice
means practicing by yourself (something I have written here many times). It
means hanging out your own shingle. PAs generally like practicing as part of
a team and most do not want to practice alone (their definition of
independence). With that being said, we generally practice very autonomously
and all through the PA world we have PAs practicing in their own clinics,
today the military has us pretty close to practicing independently and so do
the more rural states. In NY, there are hundreds of PAs practicing alone
without a physician, owning their own clinics, etc. I still believe most PAs
like being around other practitioners including docs. They don't want to
practice alone, as evidence also shows us, few NPs do. So when you speak to
PAs about "independent practice" please define it first for them. I think
you will see you are NOT using the same definition. From the majority of NPs
I know independence means the FACT (and something I love) that physicians
can have NO control over your legislation and profession. I think many PAs
would opt for the same thing and still retain their philosophy of team
practice. (As physical therapy used to be).
Michael, honestly and truthfully, PAs don't understand the need for DNP as
they feel they are trained well for what they do. Don't forget there are
about 35 (maybe more) residency programs all in specialties so PAs can go
back for what they view as advanced clinical training of 1-2 years as a
physician level resident. Montefiore has been using PAs as surgical
residents for over 30 years. I think you would agree, the fact that they do
not get a doctorate for that is a true CRIME and I think you will see that
happen if the DNP becomes the norm for NPs(Dr.PAS)
Also and very importantly, I do not think the average PA thinks what NPs do
educationally or about independent practice effects them "significantly".
They don't often see the big picture. As is much the same as NPs many don't
join their state orgs (I bet in NY both professions have very close % of
state membership), many are content as long as they are paid well and there
is no CRISIS hanging over their head. When a crisis hits, they will step up
to the plate and defend their profession. Look at the states where NPs are
independent, PAs do very well there also. They don't see it as a threat.
Also look at the FACT that NPs mandated Masters degrees way before PAs and
there was no rush to hire NPs over PAs -why would the doctorate change that?
They know their clinical training carries the profession.
All of this being said, when you look at what we all do and where we will
wind up I feel we are more in bed together than many of us realize. We have
the same problems, the same barriers, do the same things, have the same
educational needs, we are both invisible and misunderstood, the same people
hate us and much, much more.
Hope I shed some light on the subject. Time to take my wife out for dinner.
Yours for 2 stronger professions,
Dave
> I would like to pose two questions to the group.
>
>
>
> Hypothetically, if the NP profession DOES move to DNP as mandatory entry to
> practice AND DOES move to fully autonomous legally independent practice in
> all states, how does this affect the PA profession or other "non-physician"
> providers? I know many people on this list serve think it is a waste of
> time or useless to make the DNP mandatory or obtain independent practice.
> Regardless of that opinion, has anyone heard PAs speaking against NPs moving
> to the DNP and/or independent practice because they feel it adversely
> affects the PA profession?
>
>
>
> The reason I ask this question spurs from comments from a PA I met this week
> while giving a lecture in NC. He was against NP independence and mandatory
> doctorate degree because he believed it would adversely affect the PA
> profession and the way PAs are perceived by society as well as by other
> health care providers.
>
>
>
> Thank you for your responses.
>
>
>
> Michael E. Zychowicz, DNP, RNFA, NP-C, FAANP
>
> Associate Professor of Nursing
>
> Nurse Practitioner
>
> Mount Saint Mary College
>
> 330 Powell Avenue
>
> Newburgh, NY 12550
>
> (845) 569-3144 (Office)
>
> (845) 569-3360 (Fax)
>
> www.msmc.edu
>
>
>
>
>
> -----Original Message-----
> From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
> Of mfnp at cox.net
> Sent: Saturday, December 01, 2007 3:44 PM
> To: NP Info
> Subject: Re: [NPInfo] DNP and R*E*S*P*E*C*T
>
>
>
> My 1 Cent in this, to gain "RESPECT", is not to incorporate the word
>
> "nurse" into the title and go more general, like almost all the other
>
> health care professions
>
> , and first get known as /*PROVIDERS*/, and then work on the initials.
>
> That has been one of our problems, our only identity is "Nurse", and
>
> that terms means anything from a front desk clerk without any health
>
> care credentials, to include LPNs, LVNs, RNs, NPs at any degree level. I
>
> am not ashamed of being an RN, but that is all the public understands,
>
> i.e., a nurse is a nurse, and it does not make a difference what degrees
>
> or experience level you have.
>
>
>
> We are providers, just like a physician, psychologist, optometrist,
>
> podiatrist, etc., and until we break through this perception, that is
>
> what we will constantly be fighting first and foremost. In the publics
>
> eye we are either "Dr.", meaning a physician, or a "Nurse", and that is
>
> how we are all viewed in a general sense. We need to change a very
>
> general perception and the more initials we add, the less likely we are
>
> to reach what we truly do. Marty
>
> _______________________________________________
>
> NPInfo mailing list
>
> NPInfo at nurse.net
>
> http://lists.nurse.net/mailman/listinfo/npinfo
>
> *****************************
>
> _______________________________________________
> On 12/1/07 4:22 PM, "Michael Zychowicz" <mzychowicz at hvc.rr.com> wrote:
> I would like to pose two questions to the group.
>
>
>
> Hypothetically, if the NP profession DOES move to DNP as mandatory entry to
> practice AND DOES move to fully autonomous legally independent practice in
> all states, how does this affect the PA profession or other "non-physician"
> providers? I know many people on this list serve think it is a waste of
> time or useless to make the DNP mandatory or obtain independent practice.
> Regardless of that opinion, has anyone heard PAs speaking against NPs moving
> to the DNP and/or independent practice because they feel it adversely
> affects the PA profession?
>
>
>
> The reason I ask this question spurs from comments from a PA I met this week
> while giving a lecture in NC. He was against NP independence and mandatory
> doctorate degree because he believed it would adversely affect the PA
> profession and the way PAs are perceived by society as well as by other
> health care providers.
>
>
>
> Thank you for your responses.
>
>
>
> Michael E. Zychowicz, DNP, RNFA, NP-C, FAANP
>
> Associate Professor of Nursing
>
> Nurse Practitioner
>
> Mount Saint Mary College
>
> 330 Powell Avenue
>
> Newburgh, NY 12550
>
> (845) 569-3144 (Office)
>
> (845) 569-3360 (Fax)
>
> www.msmc.edu
>
>
>
>
>
> -----Original Message-----
> From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
> Of mfnp at cox.net
> Sent: Saturday, December 01, 2007 3:44 PM
> To: NP Info
> Subject: Re: [NPInfo] DNP and R*E*S*P*E*C*T
>
>
>
> My 1 Cent in this, to gain "RESPECT", is not to incorporate the word
>
> "nurse" into the title and go more general, like almost all the other
>
> health care professions
>
> , and first get known as /*PROVIDERS*/, and then work on the initials.
>
> That has been one of our problems, our only identity is "Nurse", and
>
> that terms means anything from a front desk clerk without any health
>
> care credentials, to include LPNs, LVNs, RNs, NPs at any degree level. I
>
> am not ashamed of being an RN, but that is all the public understands,
>
> i.e., a nurse is a nurse, and it does not make a difference what degrees
>
> or experience level you have.
>
>
>
> We are providers, just like a physician, psychologist, optometrist,
>
> podiatrist, etc., and until we break through this perception, that is
>
> what we will constantly be fighting first and foremost. In the publics
>
> eye we are either "Dr.", meaning a physician, or a "Nurse", and that is
>
> how we are all viewed in a general sense. We need to change a very
>
> general perception and the more initials we add, the less likely we are
>
> to reach what we truly do. Marty
>
> _______________________________________________
>
> NPInfo mailing list
>
> NPInfo at nurse.net
>
> http://lists.nurse.net/mailman/listinfo/npinfo
>
> *****************************
>
> _______________________________________________
> NPInfo mailing list
> NPInfo at nurse.net
> http://lists.nurse.net/mailman/listinfo/npinfo
> *****************************
>
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