I am still not a damn doctor.

HB 2029 SB 915 

I am still not a damn doctor.

For as long as I can remember, PAs (Physician Assistants) have been arguing for more respect, more autonomy, fewer ties that bind. But as a new PA in Texas in 2000, I felt pretty great about the level of independence we had. I felt like I had agreed to be, more or less, a medical resident for life. Like a PGY1, a first-year intern, white coat pockets bulging with pocket guides and notes when I first graduated. As I became more experienced, a Resident with more practical knowledge each day, then up and up, until now I have been doing the same specialty for 20 years, and I am like a PGY21 if that were a thing… but I am still not a damn doctor.

Do I know a lot? Yes, yes I do.

Can I manage 99.9% of what I encounter? Yes- but that’s by design. I stay in my lane. I know my lane REALLY well. Trust. You want to have me as your Provider if you ever need help in my lane.

I also know what I don’t know. I also have zero ego about it. I have no problem curb-siding my docs or any doc that I happen to think is the best brain on any particular matter. I love that about modern medicine. I love that about living in a big city with rich resources and some of the best-trained physicians in the world.

Don’t people still ask what a PA is? When will you be a Doctor?”

Yes- rarely now, but it still happens. IT IS OK!

I am also proud that there are quite a few docs that come to me with questions about my area of expertise. But at the end of the day, the buck stops with my SPs (Supervising Physicians). I am ok with that. When I signed up to be a PA, I signed up for fewer student loans, but I also signed up for not being “the doc.”

Even though I did sit through (and aced) the medical school classes with the medical students, plus rocked clinical rotations with the medical students #gunner (in addition to our PA classes), and have never taken one minute of online coursework instead of real didactic medical education, I recognize that the formal training MDs and DOs receive in Residency and Fellowships after we part ways at the White Coat Ceremony makes all the difference.

SO – Can someone please tell me what in the world Nurse Practitioners (the NP Lobby) think they are trying to do here in HB 2029 / SB 915?? They have written themselves out from under the supervision of physicians and placed themselves at the top of the medical provider food chain. This is insane. To be clear, I am not an advocate of this policy change for PAs either, who are arguably more qualified to work like our physicians, given our education and training mirrors physicians.

Although some of the rules and regulations placed on SPs (Supervising Physicians) and PAs are tedious, overly regulatory, unnecessary, a burden on our SPs and anti-business, legislation like HB2029/SB915 is NOT the answer.

As a PA of over 20 years, I get frustrated by red tape that has nothing to do with public health and safety and everything to do with politics and lobbying power. However, I do not think that we are entitled to simply “find and replace” our relationship to MDs and DOs throughout the TMB Occupations Code. And NPs have done just that in this bill!

NPs that are trained in the NURSING model (PAs are trained in the MEDICAL model, like our MD and DO counterparts), NPs, whose programs contain largely online components and much smaller clinical components so they can continue to work as RNs while going to school, and narrowly focused predetermined fields of study, NPs that fellow nurses later monitor on the NURSING BOARD, not the MEDICAL BOARD, should most certainly NOT get to “find and replace” themselves out from under MD/DO supervision and definitely not place themselves as providers over PAs! That is absurd. It would be laughable if it were not so dangerous.

Please understand me. I know and work with many wonderful, smart, and talented NPs. I love and respect my NP colleagues. I have gone to see NPs myself and have sent my family to see NPs. This is not what this is about. This is about the fact that in Texas, I have known that all of those NPs have had the same phone a friend option in their back pocket, if & when needed that PAs have. They have all had an SP, Supervising Physician, that I also vetted and respected that I knew was part of their pool of knowledge and resources.

The answer for fixing Texas’s broken healthcare system is to STRENGTHEN the relationship between SPs (MDs and DOs) and their Non-physician Providers (PAs and NPs) by getting rid of all of the burdensome restrictions and regulations placed on SPs that either hire or go into business with a Non-physician provider; NOT TO SEVER IT. And NOT let one-half of Texas’s Non-physician providers get wished into a different career.
If NPs wanted completely independent practice, then they should have gone to medical school. They still can.

READ this BILL

HB 2029 SB 915 

HB 2029 SB 915 

SUPPORT HISD TEACHERS

December 22, 2020

Support #HISD TEACHERS

Talking points against the proposed new sick leave policy

  • Forcing quarantined teachers to use their sick leave when they are well enough to do their jobs is a bad policy for teachers, a bad policy for taxpayers, and a bad policy for our students.
  1. Compelling quarantined educators to use their sick leave legally obligates them not to work. 
    1. It restricts them from logging on and continuing to teach online classes, even if they are perfectly able to do so.
    2. This Policy is an unnecessary financial burden on teachers at a time when we cannot afford to give our educators any more reasons to take their talents elsewhere. 
  2. This Policy severely disrupts the continuity of instruction for students. 
    1. When teachers are absent, students have a substitute or an Associate teacher for the time the teacher is out. For a COVID quarantine, this could be 5-10 class days or longer.
    2. However talented or well-meaning, a substitute is not equivalent to a teacher that has been carefully chosen by a school administrator for a particular class or department and has been an integral part of the school community from before our children step onto campus. 
    3. Furthermore, there are not enough substitutes to go around, generally. This problem is particularly critical in AP classes or where certification is needed in GT and Special Education. When there is no appropriate substitute available, our students may get shuffled to another online class in a similar subject, or, in smaller schools, students may even miss two weeks of vital instruction.
  3. Many teachers have children of their own, and contrary to popular wishful thinking, children can indeed contract COVID. 
    1. How would the proposed changes apply if a teacher has to stay home because one of their children has COVID or was exposed to COVID?
  4. Contact tracing is flawed as it is. 
    1. Only covering leave for teachers who can prove they contracted the virus at work sounds like a convenient way for the district to deny COVID coverage to anyone. That is not the sort of relationship between teachers and administration that HISD claims to want to foster.
    2. As parents and taxpayers, we do not want our tax dollars spent on substitutes and HISD central administration investigations of COVID cases. That money is best spent on our full-time teachers and students and efforts to prevent COVID transmission.
  5. This proposed policy change provides an incentive for teachers to not report that they have or have been exposed to COVID-19. Unreported illness could have a severe negative impact on everyone involved.
  6. These circumstances have already disrupted the lives of our students significantly. In order to serve our students well, we need to focus on continuity and consistency. 
  • We ask that no changes in Policy occur on January 4th. 
  • We ask that the current COVID-19 Policy for Teachers remain in place and only be revisited after all HISD Teachers and staff are offered the COVID Vaccine in 2021.

Read More about it here.

December 20, 2020

Letter #HISD TRUSTEES

Dear Trustees Judith Cruz & Patricia K. Allen,

I am writing about the changes to the #Covid-19 sick leave policy recently proposed by the #HISD #Houston Independent School District.

I have become aware that, effective the first day of school in 2021, teachers will be obligated to use up their sick leave should they need to quarantine because of a possible infection or exposure to #COVID. Therefore, made to utilize their sick leave, teachers will not be left to do as they have been all these months and teach from home.

The proposed Covid-19 sick leave policy does NOT allow teachers to utilize all of the tools available to them, their students, and the parents to keep our children moving forward despite these challenging circumstances.  

The proposed Covid-19 sick leave policy does NOT give our professional educators the benefit of the doubt that they deserve nor the flexibility that they have unquestionably earned over the last ten months to determine for themselves if they are well enough to teach online or indeed need to use their sick leave. Meanwhile, schools are forced to find substitutes to fill in for needlessly absent teachers. At specialized schools such as #Carnegie Vanguard, I assure you that our teachers cannot be replaced easily, and even one day of missed instruction can be the equivalent of one week at another school. 

The proposed Covid-19 sick leave policy does penalize honesty in reporting exposure, encourages silence, and turns a blind eye in the face of potential sources of contagion to avoid the negative repercussions HISD has proposed. Teachers lose pay and benefits accrued. The proposed Covid-19 sick leave policy pits a teacher’s desire to support their household against their desire to support their students. 

Furthermore, teachers who do contract COVID will only be granted paid leave if they can prove to the district’s satisfaction that they contracted COVID at work. As has been shown repeatedly, contact tracing has not been done consistently or with any degree of accuracy in Houston or Harris County. A method of reporting and tracking that relies so heavily on the accurate, honest, and frequent testing and monitoring of non-employees, particularly underage persons, by definition, means that there can be no certainty of how or when a teacher may have been exposed. Penalizing teachers for their inability to do the job that our own @Houston Health Department and CDC have been unable to do seems ridiculous on its face.

In conclusion, I sincerely feel that all proposed changes to the Covid-19 sick leave policy should be postponed until the Covid Vaccine (initial dose & booster) are made available to all HISD teachers and support staff. After that time, it seems reasonable to revisit this policy, which has been sufficiently flexible, given the extenuating circumstances our teachers find themselves in for the better part of the last year.

Please reconsider changing HISD’s current sick leave policy.

Sincerely,

Maria Castro Calzada, PA-C, CHT – Infectious Disease Specialist and concerned Parent

Carnegie Vanguard High School, Parent & PTO VP Communications & Membership

Lanier Middle School, Parent & PTO Member