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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, and 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 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.
I am also proud that quite a few docs 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 we are entitled to simply “find and replace” our relationship with 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 to 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.