The Medical Model vs. The Nursing Model

The Medical Model vs. The Nursing Model

It was none other than Florence Nightingale (1859) who thought medicine and nursing should be differentiated from one another. Even in the 1970's, physicians were still lecturing nurses about nursing. Strikingly, BSAVA Congress reported veterinary surgeons lecturing nurses about nursing in 2005! In 1985, Stockwell defined a "model" as a "simplified way of organising a complex phenomenon." The medical and nursing models are some of the most widely talked about topics in PA, NP, and medical interviews. However, it is up to the student to do much of the research about these topics and truly understand their profession and the basis behind the practice they are about to commence. Although difficult to understand and convoluted, the medical and nursing models are strikingly unalike in the most basic ways. I hope this article brings light to just that for you and that you may begin to see the true differences.

The Medical Model (PA and MD/DO)

Physician Assistants, Doctors, and Nurse Practitioners

Physician Assistants, Doctors, and Nurse Practitioners

Updated: 03/15/2016

Over the last 200 years, several million public books and publications were archived into a database where a word search counted the number of times “physician assistant” or “nurse practitioner” was used. You can see the preliminary results here. Not so surprisingly, "physician assistant" began to pop up around the same time as "nurse practitioner," however, more folks seem to quote nurse practitioners in their novels than physician assistants. Could it be because your average American is less educated about all mid-level providers? Is AAPA doing a poor job of promoting physician assistants in the United States? Are nurse practitioner lobbyist groups stronger than we anticipated? Or is it because there are simply less well-known physician assistants in the scientific community? These are questions I do not have answers for, but if you're curious about the difference between the three different types of advanced providers, please keep reading and enjoy!

Health Care Experience and PA School

Health Care Experience and PA School

Updated: 06/08/2016

Whether you’re new to learning about physician assistants, you’re still not sure if PA is right for you, or you know that you want to go into the medical field, health care experience can be a tricky business. Many application systems out there require you to fill in your experience in a very technical, monotonous way. The CASPA (Central Application Service for Physician Assistants), AMCAS (American Medical College Application Service) and TMDSAS (Texas Medical and Dental Schools Application Service) are the most well-known. So you’re probably wondering what type of health care experience (HCE) you’ll need? Yes, the abbreviation “HCE” stands for health care experience, and you’ll see many students and PAs using it a lot when they talk about admissions requirements. I’ll talk about the different types of experience below and then list a few types under each. Just as a tip, always ensure that your “training” for any profession you list below is not counted in your hours of experience, as schools will not accept any training hours as HCE.

Patient Care Experience

This is experience in which you are directly involved in the patient’s care. 

CASPA Personal Narrative Tips

CASPA Personal Narrative Tips

Last Updated: 08/07/2015

Personal Statement vs. Personal Narrative

Blatantly, they’re the same thing. CASPA gave the personal statement a new, more fitting name. If you’re new to the application process, you’ll soon figure this out. The prompt: “In the space provided write a brief statement expressing your motivation or desire to become a physician assistant. Keep your statement general as the same essay will be sent to all schools you will apply to. Your statement must be written in your own words and may not exceed 5,000 characters (not words).”

First Time Applicants

It is such a daunting task to write about yourself. You worry that you might expose too much of yourself, or too little. You could focus on the wrong things, or be too trite in your word choices. You might try a draft writing in the third person, as if you were writing about a friend. This all gets you thinking about what someone who knows you well and is in your corner might say about you. Some of the fluff might fade away and you focus on what you think would make you an outstanding PA. Subtly highlight your achievements, but don’t harp on them. Explain any transitions in your life. Try to spin negatives into positives without dwelling on them too much. Write in an active voice, e.g. “completed reports” instead of “reports were completed”. Stay focused on one thing at a time. Either way, start early, outline, and brainstorm. My personal narrative came from thoughts and memories of my entire childhood and life experiences - a culmination of everything up to the very day I started writing my narrative.

Sustainable Growth Rate Legislation AKA "The Doc Fix"

Sustainable Growth Rate Legislation AKA "The Doc Fix"

As a preface, the SGR has been an ongoing problem for providers serving Medicare patients and their beneficiaries. In the past, a "doc fix" has been applied to prevent massive Medicare reimbursement rate cuts, which ultimately would end up in fewer physicians available to treat Medicare patients. Congress is attempting to pass a comprehensive bill that will "fix" the problem (one that rewards quantity of services rather than quality of care) rather than doing an annual patch, which has been the practice for the last ten years.

This is a huge deal for our profession, but also the future of healthcare. Many professional PAs believe that this bill could make or break the profession, which is why it is so important that you are active in pursuing its passage. The SGR bills were both recently passed out of the House and Senate committees and will move to the floor of both chambers sometime in the first few months of 2014. AAPA has been HEAVILY engaged in the development of the bills, as well as some of the amendments which were included in the bills. PAs in the states of the relevant senators have been interviewed and have conveyed personal stories to their senators to help garner support.

Once AAPA finds out early this year what the next steps are for the SGR legislation, they will put out a call to action to AAPA members asking for their support and for them to contact members of Congress to ask them to support these PA provisions. PAFT (PAs for Tomorrow) and their many members are the best advocates they have for the profession. Additionally, other healthcare organizations with aligned interests and Congress are working with them directly on this matter.

What You Need to Know:

Physician Assistants and Medical Scribes

Physician Assistants and Medical Scribes

The word scribe is Latin for scribere, which means "to write." A scribe has been known historically for recording events, making written copies of documents, and more recently, "transcribing" word for word. Medical scribes have emerged most recently in response to the extensive use of EMR into clinical practice from widely used handwritten and dictation methods. 

What Role do Medical Scribes Have in Healthcare?

Medical practices, hospitals, and typically lots of emergency departments hire medical scribes to relieve the providers unequipped with rapid typing skills or who cannot simply find their way around on EMR software. A medical scribe serves to record the actions and words spoken as they occur. Scribes cannot implement their own observations into the medical record. The scribe documents the activities of the provider as they occur and must include the name and signature of the provider who performed the encounter. The provider is required to attest of his/her presence during the encounter, verifying they have reviewed the scribe's documentation and the accuracy. The provider must also sign and date the encounter. 

What are the Benefits of Medical Scribes? 

E-Prescribing and Physician Assistants

E-Prescribing and Physician Assistants

Legal in 48 states, e-prescribing is a herald that medicine is continually evolving. Your state approval is one of many milestones required to achieve electronic prescribing of controlled substances (EPCS). Pharmacies and EHR (electronic heath record) software companies are fully aware of the challenges they must overcome to meet the requirements of the Drug Enforcement Administration's Interim Final Rule (IFR). When each of these aforementioned systems receives a DEA audit, a company named Surescripts certifies and connects the pharmacy with the prescriber application through a national health information network. This allows a provider to review prescription history, to send off non-controlled medications electronically to a patient's pharmacy, and many other quick and easy functions all through their very own EHR!

Fig 1. Surescripts logo. 

From Ethics and Professionalism: A Guide for the Physician Assistant, authors Blessing and Cassidy describe prescribing and dispensing capabilities of a Texas PA: A PA is allowed to prescribe or sign a prescription drug order if given the order to do so under a licensed physician. A PA in Texas has authority to prescribe Schedules III-V and non-controlled medications (sometimes referred to as legend drugs). If a PA wishes to prescribe controlled medications, they must register with the DEA (Drug Enforcement Administration) and DPS (Department of Public Safety). Unfortunately, organizations like TAPA (Texas Academy of Physician Assistants) must continue fighting for our rights to prescribe medications of all classes, including Schedule II.

2013 AAPA Salary Report Review

The 2013 American Academy of Physician Assistants Salary Report, A Review

It's important to stay updated on the salary of a PA, specifically PAs in the field you plan to go into. This can have positive or negative effects on your future and could eventually enable you to single out the speciality, subspecialty, or practice setting you choose for yourself. This salary report also helps PAs ready to go into practice negotiate the best compensation package, hourly rates, salary rate, bonus packages, productivity measures, and benefits packages available. But this salary report isn't all about salary, it also talks about schools, coursework, and other information about becoming a PA you might find useful along your journey. Remember, this is just a review, so I'll just highlight a few that I think are cool and important, but if you want to see more, you'll need to purchase a membership. Lets get started!

The first part of the Salary Report is on PA Facts - this is basic information not regarding salary you might find useful.

Table 1. Table featured in AAPA Annual Survey 2013. This
particular table features the area of medicine and surgery
PAs work in by percentage. 

1. The average PA program takes 26 months to complete; nearly all award master's degrees
2. 93,000 certified PAs work in every medical and surgical setting across the country
1. 37.5% practice in a hospital setting
2. 38.1% work in a  group practice or solo physician office
3. 24.4% work in community health centers, freestanding surgical facilities, nursing homes, school or college based facilities, industrial settings, or correctional institutions
3. Each year, a PA treats around 3,500 patients
4. A PA writes approximately 2,600-5,200 prescriptions each year. [That's about 50-100/week!]

Salary Report

This report was collected by a voluntary survey released online to AAPA members and non-members between March-July 2013. An astonishing 18,000 PAs responded, reporting valuable information about those working more than 32 hours/week for their primary clinical employer. The information is also presented in such a way that divides PAs into two categories: PAs with a base salary only and PAs with bonuses in addition to their base salary.