Current News and Personal Opinion is produced
by
John Hardman RPA-C as a volunteer service for Minnesota PA's.
(April 2, 2000) The only way to get over a writer's block or to develop a creative spirit as I call it, is not to sit in front of the keyboard and hope for a miracle, but to set a goal. I have to thank Clover Schultz, our President-Elect for the inspiration. Having to submit time-lines to the Board of Directors, Committee Chairs, and others responsible to the Board, are set with having to look at the next year with either a blank page, or a glowing, overly ambitious agenda, or more preferably, something in between. I choose something in between, and committed to two articles a month. So here's to keeping with the plan.
I recently was in touch with Bev Kimball, our Legislative Chair, via email, and she was looking for some collaboration from the Board, in regards to work force issues for PA's in Minnesota. I had at the same time received an email from a PA journal club that I monitor, JMEDCLUB@LIST.SERVE.BROWN.EDU . The email mentioned an article on PA's, NP's, and CNM's that was worth checking out. Turns out the article was recently published in March 2000 in the journal Medical Economics Magazine, and was available online at : http://www.pdr.net/memag/public.htm?path=docs/032000/article1.html. So I let Bev know about the article, and I thought that perhaps this would be of interest to those that follow this column.
The article starts right off with a premise in it's title, The New Generation of Providers, What do PA, NP, and CNM spell? A revolution in health care. As a PA reading this article, I'm wondering how is this going to set with physicians in a magazine of their own? I must say that the author Robert Lowes, Midwest Editor, was fair to each of the disciplines mentioned including the physicians. But some of the subtitles, especially, "Job snatching: Not a realistic concern-for now," has got to get even the most steadfastly assured physicians a little uncomfortable. The article did provide yet another opportunity to define the relationship with PA's and MD's as a dependent one with the physician supervising the PA. Yet NP's and CNM's were categorized as independent practitioners with collaborative relationships with physicians, except that, "NP's can work free of physician supervision or collaboration in 22 states and the District of Columbia," as quoted from the Nurse Practitioner Magazine. Nurse midwives could work independently as well, in nine states and Washington DC according to the American College of Nurse Midwives, and another 1998 study that was quoted listed the number of states as 18, depends on the definition of independence. The article goes on to describe the expanding market for physicians as well as for mid level providers and details some of the differences in pay and productivity.
I think that the article is a good one for all PA's to read, so as to be more aware of the content of some of the editorial comments on the shape of medicine over the next five years. As quoted in the article, Richard Cooper, Director of the Health Policy Institute, Medical College of Wisconsin, projects the number of PA's in the year 2005, will be 62,109. Together with 116,153 NP's and 9,766 CNM's, the number of mid level providers will have doubled since 1995. Physicians will still outnumber mid level providers, but the ratio will have shifted from 5:1 to about 3:1.
On a personal note, I work in Family Practice at the St. Cloud Medical Group, in St. Cloud Minnesota, as part of a muti-specialty clinic with 20 physicians in Family practice and 41 physicians total. Including myself, there are 6 PA's and 1 NP employed. As the practice grows we are actively recruiting physicians but not PA's or NP's. The prevailing sentiment is that PA's assist the physicians in their practice and do not necessarily replace them. Many of the patients that I see were unable to book appointments with their physician on a same day basis, or their physician is off that day. They are happy to see me, knowing that I will confer with their physician, or resolve their problem myself. As new physicians develop panels of patients in their practice, eventually more PA's will be needed.
My belief, is that PA's offer physicians a way to compliment their practice, and should not be seen as competing for patients, but as enhancing patient care.
I am interested in your comments about this article. Click on the email link at the bottom, and let me know what you think. I will include your comments in a future column.
You can also send your comments about the article to the editor of Medical
Economics Magazine, at meletters@medec.com
.