As a practicing PA I agree mostly with your response about the use APP’s in the face of physician shortages. Physicians are the most highly trained, and it is improper for a PA or NP to obtain a Doctorate and present themselves as a doctor to their patients. With that being said there is a place for increased (not complete) autonomy especially at the acute or primary care level. Every good advance practice provider and primary physician should know their limitations and have a low threshold for referral when needed. The physicians, PA’s, and NP’s and other advance practice clinicians need to work harder to put medical politics aside bring together a cohesive plan of team health care.
As a physician assistant in emergency medicine, I agree with Dr. Stack’s comments and statements. Since PA’s are trained in the medical model, and where physicians take a significant role in our training and supervision, PA’s want to continue with the “physician-PA” team model.
The physician is the captain of the ship. We as PA’s enjoy an excellent working relationship with out physician supervisors and colleagues.
As far as nursing providers declaring independent practice, they do have a license to practice NURSING. Where my confusion begins is why nursing personell use medical diagnosis for charting, as well as for billing purposes.
As a former nurse, I was taught that a nursing diagnosis must NOT be written as a medical diagnosis (this would be practicing medicine without a license). An example of a nursing diagnosis for a skin laceration would be: Actual impaired tissue integrity related to disruption of tissue.
I hope that patients will not become confused when a health care provider with a PhD or a DNP, introduces themselves as ‘doctor”.
I both agree and disagree with Dr. Stacks’ comments concerning advanced practice providers. If he is going to make statements concerning the AMA’s stance on this subject, then he should be knowledgeable about the difference in PA’s vs NP’s (which I think he is, but rather he choose the “easy” response of just grouping several different professions together). The PA profession has never attempted to depart from the Physician/PA relationship and the PAEA has stated the terminal degree for the PA profession as a masters degree. Dr. Stack should not have taken the easy road in making a blanket statement about all advanced practice providers and called a spade a spade and stated the AMA’s true stance on the NP/DNP movement. As a PA I am tired of being lumped in with the NP community, not because I don’t respect them as providers, but because we come from entirely different aspects of medical training, practice style, future professional goals, etc.
Choosing to lump the PA community in with the NP community either shows Dr. Stack’s laziness in accurately researching the topic at hand; OR shows his ignorance in the subject matter. Either option is not a desirable trait in someone who holds a leadership position. I am not a physician, Doctor, MD or DO nor do I wish to be. What I do want is for physicians to stop comparing PAs to NPs, stop calling me a mid-level provider, and at a minimum respect the role the PA plays in the current healthcare system.
This letter is in response to the article featured in the September 14, 2015 issue of ACEP Now with Kevin Klauer, DO, EJD, FACEP and Steven J. Stack, MD, FACEP, AMA President.
On behalf of the Society of Emergency Medicine Physician Assistants (SEMPA), the national organization that represents all physician assistants who practice in the emergency setting, we would like to offer supportive comments and some essential clarification of the PA role in a physician-led health care team.
As PAs, we wholeheartedly agree that physicians, by virtue of educational process, training and specialty certification, are the most highly educated and trained clinicians in the health care system. We also absolutely agree with the Truth in Advertising campaign that the AMA has spearheaded. As clinicians, who also have the patient’s greatest interests at heart, PAs by law, statute, and professional ethics, attempt to avoid any confusion or misrepresentation of our role, our title, and the profession. We feel that despite any advanced degree at the doctorate level, it is imperative that only a MD or DO be referred to as doctor in the clinical setting.
SEMPA, as the organization that represents emergency medicine PAs, would like to clarify that while we support the term of Advanced Practice Provider (APP) when referring to PAs and NPs collectively, PAs and NPs are two professionally independent groups, each with their own individual unique philosophy, educational/training model, and goals. PAs value being members of a team that provides excellent care for patients, and believe that the team approach serves the patient more completely. For nearly 50 years, we, as physician assistants, have practiced medicine, with physician supervision, as members of a physician led healthcare team. PAs have never sought independent practice, nor do we foresee a change in the philosophy of our profession.
In emergency departments across the country, PAs practice in a variety of roles to evaluate and manage patients and are proud of the work we do in emergency medicine. As highly skilled clinicians, we competently evaluate and treat a variety of emergency and acute care conditions with the clinical support and guidance of our supervising physicians and do not aspire to be perceived as physicians.
Our professional policies endorse our roles as members of the health care team, which recognizes the physician as the leader of that team, and we will continue to make clear and consistent efforts to communicate our stance, which does not include independent practice.
Respectfully submitted,
The SEMPA Board of Directors
Physicians are the most highly trained healthcare professional, I agree. There are not the only healthcare profession with access to excellent universities and clinical training. Medicine is not an all or nothing field and your interview reflects a dismissive view of the skills and abilities of physician assistants. I also believe in the 10,000 hour rule to achieve mastery but going to medical school and residency are not the exclusive path to achieving mastery in a given field.That is not to say that it is the same for a PA as it is for a physician. When I reached my 10,000 hours it did not make me a physician but it made me a solid clinician with excellent skills. The AMA would be better served by embracing the PA profession as we have embraced the medical profession. PAs have always promoted the physician/PA team but an increasing number of physicians prefer to work with NPs because they don’t want to supervise PAs. This stance has been a boon to the NP profession
6 Responses to “AMA President Dr. Steven Stack Talks Physician Shortages and APPs”
September 20, 2015
Robert MonzingoAs a practicing PA I agree mostly with your response about the use APP’s in the face of physician shortages. Physicians are the most highly trained, and it is improper for a PA or NP to obtain a Doctorate and present themselves as a doctor to their patients. With that being said there is a place for increased (not complete) autonomy especially at the acute or primary care level. Every good advance practice provider and primary physician should know their limitations and have a low threshold for referral when needed. The physicians, PA’s, and NP’s and other advance practice clinicians need to work harder to put medical politics aside bring together a cohesive plan of team health care.
September 21, 2015
David Pecora, PAAs a physician assistant in emergency medicine, I agree with Dr. Stack’s comments and statements. Since PA’s are trained in the medical model, and where physicians take a significant role in our training and supervision, PA’s want to continue with the “physician-PA” team model.
The physician is the captain of the ship. We as PA’s enjoy an excellent working relationship with out physician supervisors and colleagues.
As far as nursing providers declaring independent practice, they do have a license to practice NURSING. Where my confusion begins is why nursing personell use medical diagnosis for charting, as well as for billing purposes.
As a former nurse, I was taught that a nursing diagnosis must NOT be written as a medical diagnosis (this would be practicing medicine without a license). An example of a nursing diagnosis for a skin laceration would be: Actual impaired tissue integrity related to disruption of tissue.
I hope that patients will not become confused when a health care provider with a PhD or a DNP, introduces themselves as ‘doctor”.
September 25, 2015
Dayna JaynstrinI both agree and disagree with Dr. Stacks’ comments concerning advanced practice providers. If he is going to make statements concerning the AMA’s stance on this subject, then he should be knowledgeable about the difference in PA’s vs NP’s (which I think he is, but rather he choose the “easy” response of just grouping several different professions together). The PA profession has never attempted to depart from the Physician/PA relationship and the PAEA has stated the terminal degree for the PA profession as a masters degree. Dr. Stack should not have taken the easy road in making a blanket statement about all advanced practice providers and called a spade a spade and stated the AMA’s true stance on the NP/DNP movement. As a PA I am tired of being lumped in with the NP community, not because I don’t respect them as providers, but because we come from entirely different aspects of medical training, practice style, future professional goals, etc.
September 28, 2015
Russell Wilson, PA-CChoosing to lump the PA community in with the NP community either shows Dr. Stack’s laziness in accurately researching the topic at hand; OR shows his ignorance in the subject matter. Either option is not a desirable trait in someone who holds a leadership position. I am not a physician, Doctor, MD or DO nor do I wish to be. What I do want is for physicians to stop comparing PAs to NPs, stop calling me a mid-level provider, and at a minimum respect the role the PA plays in the current healthcare system.
October 1, 2015
SEMPA Board of DirectorsDear Editor,
This letter is in response to the article featured in the September 14, 2015 issue of ACEP Now with Kevin Klauer, DO, EJD, FACEP and Steven J. Stack, MD, FACEP, AMA President.
On behalf of the Society of Emergency Medicine Physician Assistants (SEMPA), the national organization that represents all physician assistants who practice in the emergency setting, we would like to offer supportive comments and some essential clarification of the PA role in a physician-led health care team.
As PAs, we wholeheartedly agree that physicians, by virtue of educational process, training and specialty certification, are the most highly educated and trained clinicians in the health care system. We also absolutely agree with the Truth in Advertising campaign that the AMA has spearheaded. As clinicians, who also have the patient’s greatest interests at heart, PAs by law, statute, and professional ethics, attempt to avoid any confusion or misrepresentation of our role, our title, and the profession. We feel that despite any advanced degree at the doctorate level, it is imperative that only a MD or DO be referred to as doctor in the clinical setting.
SEMPA, as the organization that represents emergency medicine PAs, would like to clarify that while we support the term of Advanced Practice Provider (APP) when referring to PAs and NPs collectively, PAs and NPs are two professionally independent groups, each with their own individual unique philosophy, educational/training model, and goals. PAs value being members of a team that provides excellent care for patients, and believe that the team approach serves the patient more completely. For nearly 50 years, we, as physician assistants, have practiced medicine, with physician supervision, as members of a physician led healthcare team. PAs have never sought independent practice, nor do we foresee a change in the philosophy of our profession.
In emergency departments across the country, PAs practice in a variety of roles to evaluate and manage patients and are proud of the work we do in emergency medicine. As highly skilled clinicians, we competently evaluate and treat a variety of emergency and acute care conditions with the clinical support and guidance of our supervising physicians and do not aspire to be perceived as physicians.
Our professional policies endorse our roles as members of the health care team, which recognizes the physician as the leader of that team, and we will continue to make clear and consistent efforts to communicate our stance, which does not include independent practice.
Respectfully submitted,
The SEMPA Board of Directors
October 2, 2015
Tim Bewley, PAPhysicians are the most highly trained healthcare professional, I agree. There are not the only healthcare profession with access to excellent universities and clinical training. Medicine is not an all or nothing field and your interview reflects a dismissive view of the skills and abilities of physician assistants. I also believe in the 10,000 hour rule to achieve mastery but going to medical school and residency are not the exclusive path to achieving mastery in a given field.That is not to say that it is the same for a PA as it is for a physician. When I reached my 10,000 hours it did not make me a physician but it made me a solid clinician with excellent skills. The AMA would be better served by embracing the PA profession as we have embraced the medical profession. PAs have always promoted the physician/PA team but an increasing number of physicians prefer to work with NPs because they don’t want to supervise PAs. This stance has been a boon to the NP profession