FullPracticeAuthorityandResponsibility
What PAs are Saying
December 2016
ThroughDecember20,2016
“Appreciateallcommentsre:FPAR.Inconsiderationtotitle(namechange),Isubmitthatitis
simplyamatterofNOMENCLATURE.Wearecertainlynottrainedintoday’shealthcareerfield
atthelevelof“assistants”.Examplesofassistantsintoday’shealthcareerfieldaredental
assistant,medicalassistant,andnurseassistant.Wearerecognizedaspractitioners,inthe
samegeneralrealmwithtrainingofnursepractitioners.Sincewepracticemedicine,not
nursing,tobestdistinguishOURskillsetandtraining,IsubmittheONLYlogicalansweris
MedicalPractitioner.Ihaveinitiatedandvettedlocallywithahugeresponseinbuyinginto
MedicalPractitioner.Withthisexplanation,andchangedirectedtowards50yearsofchangein
healthcarewithnomenclature,thissolutionshouldnotmeetwithargumentfromanywhere.”
PA(Alaska)
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“IfullysupportFPARandampleasedtoseethedevelopmentofthetaskforceandtheefforts
yourteamhasdonetopropelthePAprofessionforward.
AsPresidentofmystateacademy(Wisconsin)weareinsupportandarealreadyworking
towardsFPARandModelStateLegislation.IwillbeworkingwithmyChiefDelegateandtheWI
delegatestofullysupportthisattheAAPAmeetinginMay.Ourchapterisworkingwithour
newlyhiredlobbyingteamtoputaplantogetherforFPARforWisconsin.
Ihaveonerecommendation:Thestatementthatsays:"collaborationshallbecontinuous"is
problematicasitstillinfersthatPAsaredependentpractitionersandwillbealegalissueasthis
allbecomesdownstreaminstatestatutesinthefuturewhenimplemented.Icanguarantee
thattherewillbepracticelawyers,corporatelawyers,medicalexamininglawyerswhowilluse
theterm"shall"anduseittohamperPApractice.Irecommendtoremovethe"shallbe
continuous"andeitherleaveoutthatsentencealltogether,ordescribecollaborationasan
equalprofessionalresponsibilityofallpartnersinthecareofthepatient.
Let'sgetthisrightthefirsttimeandavoidanylanguagethatcouldtripupthePAprofessionin
thefuture.”PA(Wisconsin)
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“IamstronglyinfavorofaroutetoPAfullpracticeresponsibility.Ibelieveitiscrucialtothe
futureofourprofession.Withfullpracticeresponsibility,PAscanmoveaheadtobecome
primarycareprovidersalongsideNPsandphysicians.Withoutit,theprofessionwilleventually
shrivelandbecomemerelyahelpinghandtoourNPandMDcolleagues.Wewillloseourbest
andbrightesttoNPprogramsandmedicalschools.
IhavebeenaPAfor29yearsandhavealwayspracticedatthetopofmylicensewithagreat
dealoffunctionalautonomy.AtthispointIdonotbelieveanyoneelseshouldbelegally
responsibleformymedicaldecisionsandjudgement.Thereisnocontradictionbetween
workingasateamandfullpracticeauthority-physiciansworkwitheachotherallthetime,and
Iwouldarguethatonlyafoolpracticesmedicinewithoutinputfromcolleaguesandcoworkers.
Intermsofmyjobsatisfaction,theonlybarriertomycompletesatisfactionwithmyprofession
istherequirementfordependentpractice.IamenrolledinanRNprogramcurrentlyandam
planningtoapplytoNPprogramsassoonasIcan-Iwouldmuchprefertofulfillrequirements
forPAfullpracticeresponsibility,butcannotassumethatmyprofessionandmyprofessional
associationswillpushhardenoughformetoseefullpracticeresponsibilityinmyworking
lifetime.”PA(Washington)
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“SeemsperplexingtomethatasaPA,IcantrainMD’s&NP’s,butdonothavefullpractice
authority.Icanunderstandfornewgraduatesrequiringaperiodofprovingoneselfbutshould
alsoincludeMD’s&NP’s.Thisantiquatedrestrictiononlyfurtherconjuresdivisiveattitudes
amongprofessionals.Andcertainlycreatesmorerestrictionsforpatientsseekinghealthcare.I
doubtpatientswouldbeamendabletoreceivingmedicalcareofthe1970’swhenmedicinehas
advancedtotoday’sstandards.SowhyshouldPA’scontinuetopracticewithoutfullpractice
authorityintoday’sclimateashasbeenrequiredformanydecades?Ourknowledgeand
expertisehasadvancedbeyondtheearlystagesofPApractice.AsPA’s,wearetrulycompetent
andcapableforfullpracticeauthorityandthus,shouldberecognizedassuch.Onapersonable
note,asaPA,theNP’s&MDatmypracticeconsidermeasanequalforfullauthorityforall
areasofbusiness&patientcare.Otherpracticesinmylocalealsorecognizetheprofessionalism
&capabilitiesoftheiremployedPA’s.Seemstherestrictionoffullpracticeauthorityisjusta
technicality,somethingsomeone,somewherefeelsaneedtocontrol.PA’sarebetterthan
that!”PA(Indiana)
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“AsaP.A.Cthat'sbeenpracticingfor31yearsIsawthiscomingdownthepikeaverylongtime
ago.Itseemsthatnursepractitionerswhoarebasicallynurseswhogetamaster'sdegreein
oneparticularfieldhavecontinuouslybeatenoutPhysicianAssistantswhogotomedicalschool
andhaveintensemedicaltraining.Iseethisbeinganongoingongoingissueforthefutureand
theseneedstobecorrected.”PA(California)
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“IamaPAattheNashville,VA.IappreciatetheadvocacytheAAPAisprovidingforthis
concern.Ipersonallyinteractedwiththisissuethisweek.IwasattemptingtostafftwoPAjobs,
inwhichmychiefofstaffsaid"ohIshouldjuststaffthesepositionswithNPs,theyareeasierto
get,anddomoreofthisworkthanaPA".Heactuallysaid"theyarecheapertoo"despitethe
factthatthePAsmaystartoffhighersalarybutcapoutattheVAquicklybecauseoftheGS
position;whereasanNPisonanursingscaleandcontinuestohaveraisesandendsupat
retirementmaking$10-15KmorethanaPA.”PA(Tennessee)
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“IwantedtogivealittlebitofmyfeedbackasaPAstudent.Ihavefoundmyselfalittlejealous
attheadvancesAPRNsandthenursinglobbyareabletoattainfortheirsideoftheprofession.I
hatetosayit,butasfuturePA,Ifeelaswearebeingleftbehind.FromwhatIseeonlineand
fromPAsinthefield,therearemanythatfeelthisway.NPsaregainingintheVA,gainingin
whattheyareauthorizedtodoinindividualstatesandIbelievetheywillcontinuetomake
gainsbecausetheballisalreadyrollingfortheminthatdirection.Ithinkmoraleandthebelief
thatAAPAislisteningislow,thereforedecreasingmembershipandenthusiasmthatchangecan
bemade.FPARsoundslikestepsintherightdirectionarenowbeingconsidered,Ihopethe
suggestionscanbeseriouslyconsideredcomeMay.
Itisalsomybeliefassillyasitmaysound,thatthename"Assistant"inPAisdetrimentalforus
intheeyesofuninformedpatients,intheeyesofcolleaguesandneedstobeupdated.
Unfortunately,IthinkadoctorateforthePAprofessionissomethingthatneedstobeseriously
consideredandevaluated.Intheeyesofthepublic,governmentofficialsandevenintheoffice,
havingthetitleof"Doctorofxxx"isautomaticallyassociatedwithahigherdegreeoflearning,
careandexperience.Somethingthenursingprofessionrecognizedandisusingtoadvancetheir
cause.”PAStudent(Texas)
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“IthinkwhatyouaredoingisgreatandwillmakeadifferencebutIcantellyou(havingworked
inmanystatesoverthepast15years)thatmanystatemedicalboardswillresistthisasthey
continuetotryandimplementevermorerestrictionsonourpractice“bigbrothering”theexact
definitionofphysicianoversightwhenitisleftbroadinthestatute,restrictingthemedications
wecanprescribe,etc.
Ithinkwhenthisnationalmovementhitstheairways,therecouldbesomestateretaliationand
itwouldbegreatiftheAAPAhasaplaninplacetocometotheaidofanystateswhomay
experiencethisblowbackastheburdenofthisfightwillfallontheshouldersontheStatePA
societiesiftheAAPAisn’tgoingtocomealongsideandfightthegoodfightwiththem.”PA
(Nevada)
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“IcurrentlyworkasaPAinaFederallyQualifiedHealthCareCenter,inBurlington,Vermont.
WehaveterrificsupportfromourleadershipwithregardtobalancingthenumberofPAsand
NPsinourorganization.WeworkcollaborativelywithMDsandmanageourownpanelof
patients.However,inapplyingtootherpositionsoutsideCHCB(CommunityHealthCareof
Burlington),nursepractitionersaremoreandmoreobtainingthesepositions,especiallyin
primarycare.Iknowspecificallyofjobsaroundthestateinaddictionmedicinethatarebeing
awardedtoNPs;tothelocalVAoutreachclinicandtoalocalstudenthealthcarecenter.While
Idonothavespecificdatatosupporttheseobservations,Iknowatleastinthestudenthealth
caresituationthatlackoffullofautonomywasthereasonfornotbeingabletohireaPA.Ifeel
thattherearesomanyopportunitiesforoutreachgiventheruralnatureofmybelovedhome
stateifthereweremoreautonomy.IhavecometobelievethatifwelltrainedPAsaregoingto
haveopportunitiesopentothem,especiallyinPrimaryCare,itisnecessarytoseekfullpractice
authorityandresponsibility.”PA(Vermont)
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“ThisyearIwasdeniedconsiderationforatleasttwojobsbecauseofArkansas'shighly
preferentialtreatmentofnursepractitionersoverPAs.Asamatteroffact,IhadaDNPtellme
afterreviewofmyresumethatwith16yearsofpracticeundermybelt,Iammorethan
qualifiedbut"weonlywantnursesanddoctors."AlthoughnotintheVAsystem,Iwouldreally
appreciatesomehelp&guidancehereinArkansas.”PA(Arkansas)
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“Again,theAAPAisbehindthe”8”Ball!Weneedafullpressonthisissue.Ihavebeenaretired
militaryPAforalmost25years,andIhavealwaysbeensupportiveoftheAAPA
inspiteofitsfailurestomeetanddealwithreality.TheNPorganizationismuchmore
supportiveoftheirmembershipissues!WeneedtobeProactivevs.Reactive.Weneedtobein
thesamepositionastheNP’sareinFederal,State,Militaryarenas.”PA(Tennessee)
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“IwanttothanktheleadershipforkeepingontopofthisissuewiththeVA.Parodywiththe
NPsisveryimportanttoallofusworkinginourcommunities.”PA(Texas)
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“ItisdisappointingtoseehowslowtheAAPAhasbeentorealizethis.Nowwemustbereactive
insteadofproactive.Whathaveourlobbyistsbeendoingforus?TheNPsarecrushingour
profession,loweringourpayandtakingourjobs!!”PA(Illinois)
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“IamacertifiedPAandhavemydoctorateinClinicalPsychology.RecentlyIwasturneddown
foranin-patientpsychiatryjobatalocalhospitaleventhoughIhaveyearsofexperiencein
Psychiatry.Iwastoldbytheemployer,thatIhaveaveryimpressiveresume’howeverIwould
requireacollaborativeagreement.TheystatedtheywerehiringaPsychiatricNPwithyearsless
experiencebecauseofthisissue.IhavenoticedinthestateofCaliforniaandPennsylvaniathe
majorityofbehavioralhealthpositionsareseekingNPsandhavenointerestinPA's.Ihave
beentoldnumeroustimesthishastodowiththe"supervision"requirementsofPAs.Ithinkthis
isaverydisturbingtrendandonethathasmademequestionhowlongthePAprofessioncan
lastifdoesn'tgainaccesstoindependence.IcanhonestlysayIwouldofgonetoNPschoolhad
Iknownthiswouldlowermycompetitivenessasamentalhealthpractitioner.Iwouldloveto
seePAsgainlegislativegroundonthisrestrictionthathasthepotentialtohurttheprofession
succeed.”PA(Pennsylvania)
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“Withallduerespect,Ithinktheadvancementofnursingpracticeisaturfwarinthesensethat
itcostsemploymentopportunitiesforPA’s.Thishasbeenhappeningforyearswithout
noticeableeffortsonthepartofAAPAtochangethesituation.Howdidthisnewruledevelop
tothepointthatPA’swerenotincludedintheproposedrulebeforeitwasputoutfor
comment?Cominglatetothetablesuggestsalackofawarenessaboutwhatwashappeningat
theVAandinthevariousstateswhereAPN’shavemoreauthorityundertheregulationsthan
PA’sdo.WedoourselvesandourpatientsadisservicewhenwenormalizewhattheAPN’sare
doinginsteadofrecognizingitfortheturfbattlethatitis.”PA/Faculty(Maine)
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“IhavebeenaworkingPAinfamilypracticefor37years.Ipracticeinaruralareawithoutdirect
supervision,servingacommunitywithoutadequateprimarycare,yetmy1800patientsmay
losemyverygoodcaresimplybecause,whenmysupervisoryMDretires,Iwon'tbeabletofind
anotherphysiciantobemysupervisor.Iwillbeforcedto"retire",losingajobIloveandthe
incomeitprovides,andmycommunitywilllosemyservicesasanexperiencedandvery
knowledgeableprovider!Atthesametime,NursePractitionersinmystateneedonly2yearsof
experiencetoworkindependently,withfullpracticeauthority!Howcanthispossiblybeeither
rightorgoodforourcommunity'shealthcare?PleasepushforwardonFullPracticeAuthority
forPAs,assoonaspossible!!”PA(Maine)
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“Pleasemoveforwardwithindependentpractice.Wehavelostyears,letusnotwasteany
moretime.Weareable,willingandready.Wecannotlagbehindournursepractitioner
colleagues,weareaspreparedtocareforourpatients.”PA(Texas)
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“IamaPApracticinginHawaiiwith2yearsofexperienceinaprimarycaresetting.Iamalso
theactingtreasurerofourstateAPAchapter.
Myinitialreactionofhesitationtofullpracticeauthorityandresponsibilityadmittedlystems
frommyrelativeinexperienceasapracticingPA.Simplyput,Iwouldnotfeelcomfortable
servingasasoleprovideratthispointinmycareer.However,asIlooktothenext5yearsand
considerpastpreceptorsandcolleagueswithdecadesofclinicalexperience,Icanseehow
consideringaninitiativelikeFPARmakessense-especiallyinanenvironmentofincreasing
competitionfromournursingcolleagues.ThisisofparticularrelevanceinHawaiiwherenonphysicianproviderpracticeislargelyAPRNdominated.
IhavealwaysconsideredthemostsignificantdifferencebetweenMDandPAtrainingtobethe
lackofacompulsoryresidency.Withenoughclinicalexperience,however,thisgapintraining
oftenbecomeslessevident/relevant.Perhapsthefactthat"fullpractice"isrelativeto
experienceneedstobeaddressedbytheFPARcommittee.Thismayinformthecreationofa
uniformmethodologytocertifypractitionercompetencesuchasanadditionalexam,optional
residency,physiciancertification,etc.Regardlessofhowclinicalexperienceismeasuredto
definefullpractice,itwillbeimportanttoaddressthedifferencesintrainingandexperienceto
gainthesupportandbuyinfromphysicianorganizations.
Thankyoufortakingonthisimportanttaskonbehalfofourprofession.Iamveryinterestedto
seethedirectionthistakes.”PA(Hawaii)
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“IapplaudtheFullPracticeAuthorityandResponsibility(FPAR)initiativeandthinkitisneeded
forbothpatientcareandourprofession.Iamsuretherewillbemanycommentsforand
againsttheinitiative,butfeelthisisaneededchangetopositionthePAprofessionforthe
futureandforthecontinueddeliveryofhigh-quality,cost-effectivehealthcare.
Iwouldliketoprovideapersonalexampleofhowbeinga‘supervised’healthcareprofessional
iscounterproductive.Irecentlyacquirednewhealthcareinsuranceandwouldliketogotomy
primarycarePAforcompletionofmywellnessevaluationtoqualifyforaninsuranceincentive.
Iwasveryupset(asapatientandaPA)tofindoutthatonlyphysiciansandNPsareeligibleto
performthewellnessevaluationandcompletetherequireddocumentation.WhenIquestioned
thispolicy,Iwastoldbytheinsurerthat‘althoughPAsaretrainedtoperformmanyofthe
servicesprovidedbyyourprimarycareprovider,theymustworkandbillunderthesupervision
ofalicenseddoctor’andare,therefore,ineligible.Policiesandbeliefslikethis,inpartcausedby
our‘dependent’status,arenothelpfultoanyone,otherthanperhapsphysiciansandNPs.
MyconcernwithFPARisthattheprofessionbepreparedforpossibleunintended
consequencesandmaintainthebenefitsofteam-basedcare.Onepossibleunintended
consequencemightbeanincreaseddemandfordemonstrationofcompetencyintheabsence
ofphysician‘supervision’.Employers,hospitals,andotherstakeholdersmaylookformorethan
ageneralist’strainingtodemonstratecompetencyinspecialtypractice,andwemayneedtobe
abletomeetthatdemandeitherthroughresidency/fellowship,certification,CME,orother
methods.Ibelieveourprofessionshouldbeproactiveindetermininghowtodemonstrate
competencyratherthanhavingotherstellushowthatshouldbedone.Wealsoneedtoassure
maintenanceofacollaborativerelationshipwithphysicianssowehavetheirassistancein
managingclinicalsituationsoutsideourtraining,experience,and/orscopeofpractice.Ibelieve
thisisimportantforpatientsafety,PAliability,andmaintainingthehighqualityofcare
providedbyPAswithinthescopeoftheirpersonalabilities.”PA(Pennsylvania)
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“IhavebeenpracticingasaPA-Cfor18yearsandwasanICURNfor12yearspriortothat.I
haveworkedinbothruralfacilitiesandurbanfacilities.I’veworkedinastatewhereImayuse
thetitle“doctor”becauseIhaveearnedabonafidedoctoratefromastateuniversity.Iamnow
workinginastatewhereIamnotallowedtousethatterminology(becausealthoughthereis
noevidence,theAMAthinksitconfusespatients).IamlongoverthefactthatI’mcalledan
“assistant”andI’mlongoverthefactthatinMinnesotaIcannotcallmyself“doctor.”Ido;
however,wanttoshareastorywithyou,afterworkingwithforeignphysiciansfor30years.
IhavefamilyfriendswholiveinPakistan.Twooftheirsonsattendedmedicalschool.Oneof
themdecidedtocomeovertotheUStotaketheUSMLECS-2exam.Hegotcaughtupinascam
inChicagoby“educators”fromPakistanwhopromised“studygroups,room,board,etc.”for
$4500permonth.Hewasstuckina1-roomapartmentwith8otherstudentslearningabsolute
garbagefrompeoplewhohadneversatfortheexam.IwasSHOCKEDtofindouthehad
finishedmedicalschool(withaboveaveragemarks)andhadtakenandpassedboththeUSMLE
1and2tests(withflyingcolorsImightadd)buthadNEVERlaidhandsonapatient.
Isubsequentlyworkedonmultiplecaseswithhimeverynightforatleast5weekstohelphim
prepareforhistest.Thankfullyhepassed.But,Iwasastoundedathowmuchbookknowledge
hehadandhowhehadnevermissedadayofclass….yetwassodangerous.Hecouldlegallyuse
theterm“physician”and“doctor”yetIpersonallywouldn’tlethimtouchevenmyworst
enemy.Heknewabsolutelynothing.Completelyclueless.Igavehimacasestudyofapatient
withdarktarrystools-hisfirstdiagnosiswascancer.Igavehimacasestudyofa16yearold
withasimpleviralsorethroatwhowasattheclinicwithhermother-hedidafullreviewof
systemsandexamincludingsexualexamandaskedherwhyshewasnotsexuallyactive
(remember,thisisinfrontofhermother).Igavehimacaseofanemergencystrokevictim,and
hedidnotdoaneurologicalexam.Doyousee?Completelyclueless.
Morethan50%ofthephysiciansintheU.S.areforeign,andthemajorityofthemarecoming
fromIndiaandPakistan(over80%combined).Iunderstandtheymustgothroughafull
residency,butinmyopinion,thatisafarce.I’venowworkedwithatleast4Minnesotafully
licensedphysicianswhowentthroughfullinternalmedicineresidencywhohavesuchpoor
clinicaldecision-makingskillsIwouldn’tletthemtouchmypatients,ANDtheyweresoarrogant
theyrefusedtocollaborateordiscussalternativetreatmentoptions.Oneofthemevengaveme
the“wellI’msureyouwenttoPAschoolbecauseyoucouldn’tgetintomedicalschool.”Alsoa
farce,asIwasacceptedinto2differentmedicalschoolsontwodifferentoccasions,onewas
MayoClinic.ICHOSEtobeaPA.
HereisarecentarticlethatisimportantaboutphysiciansparticularlycomingfromIndia:
http://www.reuters.com/article/us-india-medicine-education-specialreporidUSKBN0OW1NM20150617
IthinktheAMAhasbeenelitistandoutrightstubborntoallowPA’stopracticewithany
independentauthority.Theywouldfranklyratherembrace“physicians”withsubstandard
training(withonly5-6yearsoftrainingoutofhighschool-nodifferentthanaPA)thanallow
PA’stochangethenametosomethingrespectableandpracticewithanyauthority.Casein
point:therewasonestatethatruledthestate’smandateon“notusingtheterminology
doctor”unconstitutional,statingthatphysicianshavethemonopolyontheword“physician”
butnottheword“doctor.”Despitethis,therearestill17stateswheretheAMAhasinfluenced
law-makerstomandatethisterminologyprohibition.Ithinkifyouwantanythingtohappen
withregardtoPA’spracticeand/ortheirname,youhavetogetthebuy-infromtheAMA.I’m
notsurethat’sgoingtohappen.”PA(Iowa)
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“IamaMMS,PACinmy11thyearofpractice.Inotonlyfullysupportquicklyanddefinitive
movingtoward"FullPracticeAuthority",buthonestlyfeelitisnecessaryforthesurvivalofthe
professionoutsideofsurgicalspecialties.
MovingtowardsFPAatthispointisessentiallychasingwhathasalreadyhappenedtomostPAs
intherealworld.I'msuretherearesomePAsstillworkingcloselywithaphysicianinan'old
school'model,butforthevastmajorityofus(myselfincluded)thisideadiedyearsago.
Inmy4thyearofpractice(inUrgentCare),themedicaldirectorandadministratorcametome
toinquireifIwouldbeginfillingthe"physician"slotsontheschedule.Classically,wealways
hadonedoctorandonePAworkingatalltimes.Theywerehavingtroublefillingoutthe
physicianschedule.Isaidnothatthiswasnotappropriateforthepracticesettingwewerein.
Overthenextseveralweeks-IwastoldifIdidnotagreetothisIwasoutofajob,becausethey
couldhireNP'swhowouldworkwithoutphysicians.IrelentedasIhadstudentdebtanda
housepayment.
ForthenextfiveyearsIwasthe"physician"ontheschedulewhenIworkedandneverspoketo
anMDonceaboutapatient.Ieventuallymovedtoanotherstatelookingforwardtoworking
withMDsonceagain,buttheonlyUrgentCareworkIcouldfindwasmeworkingasthesole
providerinthebuildingwhenworking.ThegoodsideofthissituationisthatIamsupremely
confidentinmyabilitynow,thedownfallforallofusisthatmanyofusaredoingthejobofa
physicianwithoutthelegalabilityoranythingevenclosetoequalpay.
EveryPA'Iknow'isinessentiallythesamesituationandmanyhavebeenreplacedbyNPs.NPs
nowhave2hugeadvantagesoverusinmodernhealthcare.Itisimportanttorecognizethat
modernhealthcareisnotownedordirectedbyphysicians.Thus,1.NPshavefullpractice
authorityandarenotheldbackbyarbitrarysupervisionrulesand2.NPsaremoreattractiveto
physiciansnow.Letmeexplain:thereisnolongeradirectmonetaryincentivetophysiciansnot
owningpracticestoemployPAsvs.NPs.AllofthesavingsfromemployingaPAgotoa
healthcareorganization,whileallofthesupervisionliabilitystillrestswiththephysician.Thus,
physiciansattheseorganizations(whicharenowtheoverwhelmingmajority)wouldmuch
rathernotbebotheredbyPAsandtheirrequired'supervision'.
Inconclusion,theAAPAandPAsindependentlyMUSTquicklyanddefinitivelyacquireFPAor
thePAprofessionwillbegintodisappear.”PA(California)
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“WhataFANTASTICstepfortheprofession!Thiswilldecreasetheburdenonthehealthcare
situationandraisethestandingofthePAandprofession.
AfteralltheseyearsasdoctorsputmorepressureonthePAandnurseshavetheirautonomyas
NPs,it'sacredittotheexecutivesthatwillraisethestandardsofthePAandourautonomy.I've
beenaPAfor17yearsandpts(patients)ratherwantedtoseemeinsteadoftheMD.Weneed
tohavetherespectofalltheprofessionsasautonomywillallowasweworkalongsidetheMD
thewayitshouldbeinsteadofworkingforthem!
Thiswillenhancetheprofessionandimprovethewellneededrespectaswell!”PA(NewYork)