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Minutes of Y's Men Meeting of March 23, 2017

Susanne Atkins & Dean Meredith Kazer

Ms. Atkins informed us that PAs learn the same material as doctors, but do it in a condensed period of time much in the way that medics were instructed during WWII.  They came about because of the shortage of primary care physicians that manifested itself in the 1960s.  This shortage has continued and become more acute during the subsequent years, which have contributed to the growth in the number of PAs.  Now there are about 100,000 in the U.S and about 2000 in Connecticut. PAs now practice in every medical specialty including surgery, but unlike physicians they have to keep current in every aspect of medicine to retain their certification.  Certification is obtained after their training through the passage of a rigorous examination that is required every few years. 

Like doctors, PAs can prescribe medications, including narcotics, and will treat patients with the same degree of proficiency as a doctor.  It is interesting to note that PAs carry medical malpractice insurance like a doctor.  However, they get sued far less frequently.

An advantage of PAs is their lower cost to their practices, insurance and Medicare although typically the patients don’t see these savings.

Nurse practitioners are registered nurses that have received a prescribed training program beyond that provided to regular nurses.  They are required to have a master’s degree at the end of this additional training and are encouraged to take it further and obtain a doctorate so they end up with six plus years of academic and clinical preparation.  NPs practice in six areas although none specialize.  Like PAs, PNs can prescribe medication although they generally use a more holistic approach before resorting to medication. 

As in the case with PAs, they came about because of the shortage of primary care physicians especially during times of war.  Two-thirds of NPs are still in primary care settings and frequently are involved in follow-up work.

Q&A

Q.  Can anything be done about caregivers devoting so much time to record keeping rather than interacting with a patient?

A.  Some PAs don’t bring a computer into an examination room.  They take notes and enter the notes and their recommendations into a computer later.  Also electronic record keeping is relatively new.  It will get better as more caregivers get more familiar with it.  It does make information much more available and is better for health care.

Q.  Do NPs work in hospitals?

A.  Yes and their badges identify them as such.

Q.  What are the problems with government health care medicine?

A.  Medicare reimbursements are low and Medicaid reimbursements are even lower.  Caregivers have to make up for this with high volume so patients can be rushed in and out.

Q.  Are there PAs or NPs in dentistry?

A.  No.

Q.  What is the difference between health and wellness?

A.  Wellness is often associated with preventative care.

Q.  Do PAs perform complete physicals?

A. PAs do physicals, but you have to realize that Medicare doesn’t cover complete physicals just wellness exams so if you want a complete physical, you have to pay for it out of your own pocket.

Q.  When does the transfer of care take place between a physician and a PA?

A.  PAs and physicians are interchangeable.  They both provide the same level of care.

Q.  What about apple cider vinegar?

A. There is no evidence that it works?

Q.  Are you covered by malpractice insurance?

A.  Yes, but we have a lower incidence of litigation.

Q.  Can you sign off on clinic work?

A.  An NP can sign off on everything except home care.

Q.  Do you anticipate that PAs and NPs will bring about the demise of primary care physicians?

A.  It looks like it’s going that way.

Q.  What role does a PA play in the surgical theater?

A.  They are usually the first surgical assistant, but they will perform some surgery themselves.

Q.  Are these good future fields for young people?

A.  Yes.  The prospects are very good.