PAs and Nurse Practicioners as medical control?

[Ridryder 911]

Spock, in my area the P.A.'s are more catered since the P.A. program here is under the medical school and is their .."baby".. the NP is considered a "step-child". The P.A.'s here are almost guaranteed at least up to $ 100K starting, if one applied themselves.

I just finished a study on NP salary, profession, etc.. and the average salary was about $78,000-$94,000 and this considering ER and acute speciality areas. I do agree, it is definitely regional. NP have not caught on as much here in this region, but I am seeing a large trend to them because of liability, insurance and autonomy reasons. Many CNS, & NP have recently replaced a lot of the P.A.'s because of the speciality instead of "broad medical model" education, as well linking to a specific physician for license. CNS, has not caught on or recognized for their speciality, one of my choices not pursuing that level.

Yes, we have a long to way go, but I believe within a few years, things will be changing drastically. As you know when they can save money and still re-coup the costs their hearts and loyalty will follow. More and more states are allowing NP's to be medicaid reimbursed.

Now, it will be interesting when the debate hits the fan.. when NP's will be required to have a doctorate level... and physicians calling them Dr.'s... it is already getting steamed...LOL

R/r 911

[Dustdevil]

Spock, in my area the P.A.'s are more catered since the P.A. program here is under the medical school and is their .."baby".. the NP is considered a "step-child". The P.A.'s here are almost guaranteed at least up to $ 100K starting, if one applied themselves.

That is my observation in North Texas too. Those who find jobs seem to easily pull in six figures early on. Although, it seems that there is a disparity between the grad rate and the opportunities available to them. I think a good many of them end up having to move to find a good position.

I too have lost a lot of the admiration I once had for PAs. I once thought that PA was the way to go, and thought they were awesome. But over time I have seen far too many of them working over their pay grade and making boneheaded mistakes. I recently took a dyspnea patient into the ER with acutely exacerbated COPD bronchitis and an infiltrate. The PA for some reason got all focused on the patient's tachycardia and BP of 150/91 and started calling for beta blockers. Every nurse in the room -- including the lowly 22 year old Ensign -- quickly got this look on their face -----> :shock:

On the other hand, I have never had anything but great experiences with NPs of any specialty. I find them a lot more wholistic (not to be confused with holistic) in their approach to the patient, while, as Rid said, more focused in their understanding. It seems clear that while a PA receives a broad foundation, it is not built upon until well into his career, through personal focus. NPs come out of school more ready to apply what they have learned in independent practise.

[Asysin2leads]

I too have lost a lot of the admiration I once had for PAs. I once thought that PA was the way to go, and thought they were awesome. But over time I have seen far too many of them working over their pay grade and making boneheaded mistakes. I recently took a dyspnea patient into the ER with acutely exacerbated COPD bronchitis and an infiltrate. The PA for some reason got all focused on the patient's tachycardia and BP of 150/91 and started calling for beta blockers. Every nurse in the room -- including the lowly 22 year old Ensign -- quickly got this look on their face -----> :shock:

Heh, that reminds me of the time we brought a refractory SVT patient into the ER. The pretty yet very inexperienced resident decided that he needed cardioversion. Praise Jesus she was thinking aloud while setting up the defibrillator, as when she said the words "Okay, so lets charge to 200 joules" the entire room which included 5 nurses, two PA's, 2 paramedics and 2 paramedic students all said in unison "NO!!!" , as if on cue. Eh, guess you had to be there.

[zippyRN]

like most things it depends on how it;s done

there is No way a Medical Director should be anyone other than an approrpaitely qualified and fully trained as a Specialist Medical practitioner ( i.e. board certified Attending, CCST holding Consultant/ Qualified UK General Practitioner ) in an appropriate field and have a a pre hospital care award as well ( e.g. DipIMC/FIMC for the Brits)

in terms of a 'medical control' bod / Clinical Advisor there is not reason why an advanced practice Nurse or Paramedic ( where paramedics are Higher Education prepared health professionals) or a PA cannot fulfill that role as a sounding board to request advice or authorisation especially it's to go outside the Standing order/ protocol/ clinical guideline.

[Spock]

My experience with NP's and PA's is similar to what both Rid and Dust describe. Salaries are not the same here in Western PA. I may tell some of the PA's they need to move when I hear them complaining about their salaries again. Of course I don't think they are worth six figures but what do I know. Things may change in PA because most of the doctors finishing their residencies leave the state because we have horrible malpractice laws which won't change because our governor is a lawyer as is most of the over paid and under worked state legislature. I'm thinking of moving to North Carolina. I guess we are getting off topic.

Live long and prosper.

Spock

[bassnmedic]

My personal belief is that only a M.D./D.O. should be Medical control. PAs and NPs are physician extenders and should not be allowed to handle Med Control duties. I think that the different experiences have with PAs may depend on where they might have gotten their degree from, for instance some Universities have other PAs teaching the PA curriculum where as others such as the University of Florida utilize MDs to teach the students, that could be a difference. I can't speak on NPs as I have not much experience with them, but where I'm at PAs generally are making upwards of 125k to start.

Take care,

Todd

[Ridryder 911]

I have talked to many NP's and P.A.'s on their idea of this question and as of yet, they all felt only a physician should be medical control. Likewise, (approx 15 or so) felt that they probably were qualified to do so for education level, but agreed there is not much to medical control anymore. Most medical control is pretty much standard protocols and standard of care. Again, none of them showed in any interest in ever being such, if it was even offered to them. They too felt it would be much more a headache, than its rewards...

R/r 911

[Doczilla]

NPs and PAs do not generally have the critical care experience that I would want for medical control. Even PAs who have completed an EM fellowship have very limited ICU experience. Physician extenders exist in the ED setting largely to handle more minor cases, freeing the MD/DO for more critical patients, and the training of the physician extender generally reflects that. And unlike the EM residency-trained doc, none have done fellowships or had much of any training in administration of civilian EMS or legal aspects of that realm of care.

There are exceptions, of course, but I have only seen them in the military setting, and their ability to oversee prehospital care usually comes from a background as a medic (91W/68W/18D) rather than from their PA training. There are some PAs and APNs who are well-trained in trauma care and are part of the trauma service here who do a good job of taking care of trauma patients. I have not seen any physician extenders in the medical critical care area.

I see the only genuine need for online medical control as being for critically ill patients, questionable refusals, or the need for advice on complicated ethical issues that arise in the field. For these patients, physicians are the only ones formally trained to give out the orders and advice needed.

'zilla

[buckeyedoc]

I think that we can all agree that we've come across physicians who don't know their arse from a whole in the ground. Three or four come to mind as we speak. I know 2 PA's who are also paramedics and I trust their judgement long before that of some physicians. I can see where in some very rural areas with a lack of medical staff would benefit from PA medical direction. I don't necessarily agree with NP's being medical control. I know a few NP's. While they are good practicioners, I'd be leary of having them give medical direction over an EMS situation. I work in an area where you can't swing a dead cat and not hit at least 3 hospitals. I have 3 level I trauma centers within less than 30 min drive and several level II centers. We are served by 2 HEMS agencies and both of them have a bird in the county I work in.

[AZCEP]

This kind of bird,

Or some other kind?

Honestly, the issue of medical direction should not be this complicated. If you are working in an area that allows physician extenders (PA,NP's) give you an order then, perhaps you should make sure there isn't legislation against it.

There is a very simple reason the title is "Medical Control Physician". We work under a physician's license, not a PA or NP's. Someday this may change, but for now don't go looking too far into it.