Standards: it seems as if everyone is talking about them today. We are either creating standards, improving standards, setting new standards or raising standards. Ultimately, as decades pass, standards grow, and this seems appropriate considering the health care needs in the United States and our world standing in that sphere. Like most Americans, I had always assumed that we were naturally – Number One – but was disheartened to discover that my assumptions were grounded in my patriotism and not in evidence-based studies. Depending upon the source and the year, the US typically ranks in the top 20 or 30% and shockingly behind all other nation members of the G-10 (including many smaller countries). This surprising revelation gave me pause to reflect on our “standard of care.”
What does the word “standard” connote to the average PA, NP, or patient in terms of academic achievement? It might be interpreted as an entry-level bachelor’s or master’s degree – or perhaps even a doctoral degree. Many of these advanced levels could never have been imagined in the past but are now very much a part of the 2021 working world for PAs and NPs. How quickly times change with more and more clinicians earning doctorate degrees – spurring insurance companies and administrators to establish yet even newer benchmarks based on this academic proliferation. If we as a profession do not set our own standards, someone else or another profession will surely try to do it for us. If ever we needed cohesive leadership, it is now! Maybe you are the person who can lead us into the future?
What do I personally think of standards? I believe that standards are a very positive modifier of our practice protocols and approaches to medicine. I see the patient as the ultimate winner when a profession has high standards. Standards lead to increased study and competence. Standards are set and maintained by academia, education secured at conferences, and CME provided by associations. They are enhanced by experience and certified by procedural attestation such as those through residency rotations. There will, in the near future, be a mandated procedural attestation required within all institutions of medical care. When looking at medical specialties, we note that either a residency or a specialized track of education and experience defines what an institution requires for an NP or a PA to be hired.
Most of the specialty areas need highly experienced, highly motivated, and extremely well-educated PAs and NPs and are willing to provide a mini residency. Some of these specialties require additional education, CME, preceptorship, and a specialized curriculum in addition to an advanced degree. I will repeat a sentence that I wrote ten years ago: “The time is quickly coming upon us that will no longer place on a resume ‘PA seeking a hospitalist role, —- willing to learn, seeking physician willing to teach.’” That time became a reality more than five years ago. Physicians are engaged in their own fight for survival, focused on issues which affect their profession, leaving little time for the altruism of the past when they sought to be the “teacher” to a nonphysician. The economy, new health care laws, insurance mandated reimbursements, malpractice issues, and the huge financial debt incurred while becoming doctors have caused them to protect their own turf and areas of responsibility.
What will possibly be the standard for the PA in the next few decades? PAs will be a graduate of a doctoral program, be highly intelligent, and have the interest to further their education by means of residencies of various lengths to best prepare for the arduous task of caring for an additional 31 million patients in a decade with decreasing numbers of physicians. The PA will be a team member that possesses a team attitude and team spirit as the care of patients will be delivered by highly trained team members. Personally, I see this as a positive move and will be comforted as a patient to realize that all of the medical personnel with whom I have a relationship share a unified approach and attitude that will enhance my treatment, wellness and outcome. I think that the nursing profession will continue to grow in this same direction as they are recognized experts in so many specialties today.
This shared approach to patient care will require many signatures and notes on the EMR which can become tricky for many clinicians. With a team approach, opportunities for medical error will require heightened vigilance. And when errors occur – who is responsible – the institution, or the clinician? It is and has always been the clinician, and these errors are often due to the exhaustion felt by providers: reading every note, reviewing every test, and reconciling every new medication order. Prior to my own retirement, I began to feel the exhaustion of doing the detective work and realized that I was becoming a relic. As malpractice exposures rise, so too the need for a personal malpractice policy. Younger clinicians are much better suited to the demands of this ever-increasing administrative multi-tasking than those of us from an earlier vintage. This new era makes a malpractice instrument essential, now more than ever. Be careful and refrain from choosing based on cost alone, without fully understanding the policy terms and the provider’s history in the healthcare market. “New” companies with new perks come and go and may not exist in a few years, when you might need them. Make your own educated decision to prevent hardships in the future. Quality PA Professional Insurance is important to understand, easy to get, and provides the stable and individualized protection your career demands.
By Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
PA Advisor to CM&F