Transcript
Speaker: This week is, do you know what this week is?
Speaker: APP week, maybe.
Speaker: That's right.
Speaker: National Advanced Practice Provider Week.
Speaker: So I've never stopped working.
Speaker: Exactly.
Speaker: I am technically on PTO, friends, but APPs are so important to us.
Speaker: And not just our sound APPs, but our APPs across the world.
Speaker: This is On Call.
Speaker: This would be really cool to just wear scrubs all the time.
Speaker: And you don't have to think about what you're going to wear to work.
Speaker: That is awesome.
Speaker: We're here to answer your questions.
Speaker: We can sit down and discuss them.
Speaker: Wait, I got to go.
Speaker: I'm on call.
Speaker: Wait, you're on call?
Speaker: I thought I was on call.
Speaker: Welcome back, everyone, to another episode of On Call with April and Alicia.
Speaker: I'm April.
Speaker: I'm Alicia, and we are back.
Speaker: Ladies and gentlemen, it's, guess what, April, it's not cold where I am.
Speaker: How is the weather where you are?
Speaker: You know, it's funny because we did our, you know, we did our fall episode and we're like, oh, fall's here.
Speaker: And I swear that like, I swear that since.
Speaker: Oh, fall's here.
Speaker: I was like, ugh.
Speaker: You said.
Speaker: Dread.
Speaker: It's fall, y'all.
Speaker: But I have been thinking about it because I think like the official day of the first day of fall is not yet.
Speaker: But also since we recorded that.
Speaker: It will be the Monday before this comes out will be the first day of fall.
Speaker: Yeah.
Speaker: 22nd.
Speaker: But since we recorded that episode, it has been sunny and 80 every day.
Speaker: I remember when we recorded it, I was like, oh, it's like, you know, 60s.
Speaker: It's this cool fall weather.
Speaker: I can wear warm clothes.
Speaker: No, we're back to shorts and tank tops.
Speaker: That's what you get.
Speaker: And that's what happens when you drink a pumpkin chai latte too fast.
Speaker: Just let it be summer, guys.
Speaker: I did go get one after we recorded.
Speaker: Let the good Lord bless us with sunshine or something, you know?
Speaker: I am in Cabo, and I was just really, really wanting to do this bad boy in video.
Speaker: I was telling you before we started, just this landscape, just really to make April jealous.
Speaker: That's all.
Speaker: But it wasn't working out so well.
Speaker: So I'm back indoors staring at the water while I do this.
Speaker: But boy, do I have the biggest smile on my face.
Speaker: Oh, that's good.
Speaker: And again, there's like, really?
Speaker: I am.
Speaker: Well, you know what?
Speaker: I think that everybody...
Speaker: should take time, well, we all should take time for ourselves, and we've done those mental health conversations before, but I do think that one thing I was always scared to do was travel by myself or go to a restaurant by yourself, things where I was always like, that's creepy.
Speaker: I was just going to go sit at a booth by myself.
Speaker: I still don't think I do it locally, but I'm kind of moving into this era mission mode of my life where I'm becoming, not a hermit crab necessarily, but
Speaker: I'm just kind of learning to soak it up for me.
Speaker: And it doesn't like I don't need to be entertained by people.
Speaker: It's very interesting.
Speaker: So it's been an interesting journey for me.
Speaker: Yeah, especially in the area that I'm at.
Speaker: So, yeah, it's been cool.
Speaker: Weather's been awesome.
Speaker: I got a little bit of remnants of some tropical storm that was moving out in the Pacific.
Speaker: That's about as close as I'm probably going to get.
Speaker: This season.
Speaker: But it's been awesome.
Speaker: The weather channel still lives on.
Speaker: Guess what?
Speaker: My YouTube TV app works in Mexico.
Speaker: So when I woke up this morning.
Speaker: I just turned on YouTube TV.
Speaker: And was like doing my morning walk down the beach.
Speaker: Listening to the weather channel.
Speaker: But I got to tell you.
Speaker: Quicksand.
Speaker: Middle of the night.
Speaker: I was watching a How to Survive Quicksand.
Speaker: Have you ever thought about Quicksand before?
Speaker: Well I mean I've seen it.
Speaker: You know like in movies and stuff.
Speaker: Well, the never ending story that you're a child of the 80s.
Speaker: Not that I don't want to be exposed to quicksand.
Speaker: Yeah, I was watching.
Speaker: It was fascinating.
Speaker: First of all, I want to know where quicksand is.
Speaker: So I do like I never go there.
Speaker: But they're like how it's like how to quicksand and riptides for some reason have been my new focus on like, how do you survive that?
Speaker: To ask me why?
Speaker: I don't know.
Speaker: But well, the riptide I do.
Speaker: But quicksand.
Speaker: For everybody that wants to know, I'm going to help you save your life.
Speaker: If you drink quicksand, if you start sinking, the more you pull away, apparently, that's what makes it tighten up.
Speaker: It's almost like there's Chinese finger toy things.
Speaker: Yeah, you're supposed to not move.
Speaker: You're supposed to do tiny circular movements with one leg and then you get one leg out, but you don't go to pull the other leg up.
Speaker: You've got to lay back on your back with the one leg out and then it'll create a pocket.
Speaker: All you do is just try and create pockets so that water comes in.
Speaker: You're welcome.
Speaker: I saved everyone's life.
Speaker: I'm going to just try to avoid it.
Speaker: Well, that's my point.
Speaker: Like, where is it even anyway?
Speaker: I know.
Speaker: I wonder if it even really exists.
Speaker: I don't know.
Speaker: I'm sure it does.
Speaker: It was on the NeverEnding story.
Speaker: He lost his horse to it.
Speaker: Do you remember?
Speaker: It was the saddest part of the story.
Speaker: It's also on that show that I just watched with Kirsten.
Speaker: There was an episode with quicksand.
Speaker: Ugh.
Speaker: That's a scary way to... I mean, can you imagine?
Speaker: Okay, let's not be morbid.
Speaker: I'm looking at the water right now.
Speaker: What are you doing, April?
Speaker: Jeez.
Speaker: You're the one that brought it up.
Speaker: Enough with the weather talk.
Speaker: You talk about the weather too much.
Speaker: let's talk about work.
Speaker: First of all, that was all you, but yeah, let's actually talk about work at this episode because this week is, do you know what this week is?
Speaker: APP week, maybe that's right.
Speaker: National advanced practice provider week.
Speaker: So, um, we thought we would do an episode in honor of that because, um, you know, we worked, I've never stopped working.
Speaker: Exactly.
Speaker: I am technically on PTO, friends, but the APPs are so important to us and not just our sound APPs, but our APPs across the world that we could not miss an opportunity to celebrate these fabulous people.
Speaker: So work never stops, you know.
Speaker: Well, that's true.
Speaker: And, um, you know, we have talked in different instances of when we, you know, as clinicians, we actually literally never stopped working because we're always on the lookout for something going awry around us.
Speaker: Um, and we didn't talk about this when we talked about my trip, but, um, when I was on my flight from, uh, Japan to Hawaii, uh, it was a late night flight.
Speaker: Like, you know, we boarded at 10, we ate dinner, um,
Speaker: you know, like 1230 in the morning, everybody's like settling in to go to sleep.
Speaker: The lights are off in the plane and they come over the announcement and say, you know, we have a medical emergency.
Speaker: If there's any healthcare professionals on the plane, if they could assist.
Speaker: And, um, yep.
Speaker: And so, you know, of course I got up and went to the back of the plane and, um,
Speaker: You know, long story short, I ended up spending the majority of the flight in the back of the plane with a physician that was from Japan.
Speaker: The two of us were tending to a Japanese passenger who was having a medical emergency, and we were able to stabilize her and get her safely off when we landed to paramedics.
Speaker: But, you know, and then it was just... When you were telling this story, Abe, and you're probably going to say this, sorry if I jump a gun here.
Speaker: You told me this story when we were talking...
Speaker: you know, shortly after he had returned.
Speaker: But it was something really cool about this interaction because he didn't speak English, right?
Speaker: This was right.
Speaker: Right.
Speaker: So it was a patient who didn't speak English, first of all.
Speaker: And then so then I was the first one to go back.
Speaker: And then probably 20 minutes later, the physician came back and he said to me, do you speak English or Japanese?
Speaker: And I said, no, do you speak English?
Speaker: And he said, no.
Speaker: And we found ourselves in a situation where we needed to work together to care for a patient with a language barrier there.
Speaker: And there was a flight attendant that did speak both English and Japanese and was able to translate a little bit.
Speaker: But when you're in the moment and you're...
Speaker: trying to actively do something for a patient, um, you know, it, it just slows you down, right.
Speaker: Having a translator.
Speaker: And so, um, he, he was putting an IV in the patient and, um, which by the way, super cool to see the kits that are on airplanes, if you've never seen one, but, um, but yeah, so we, we opened the kit and,
Speaker: we're looking for the, what he needs to put the IV in.
Speaker: And we were working in sync and I would like, I, as he was looking for something, I knew what he was looking for and would hand it to him and he would be like, uh-huh.
Speaker: And, and we just were working in sync together despite, you know, the language barrier, but it's just, it's just funny.
Speaker: Cause it's, I mean, the medicine is the same obviously.
Speaker: Right.
Speaker: But, um, but it was just, it was interesting.
Speaker: Um, it was a good experience and, you know, luckily she was, she's okay.
Speaker: Yeah, she, yeah, she did.
Speaker: So,
Speaker: You didn't have to stop.
Speaker: There was no diversion for the plane.
Speaker: So kudos to you guys.
Speaker: Did they give you a refund for your seat?
Speaker: We were over...
Speaker: We were over water, so there was no landing.
Speaker: I know a couple landings that have happened that way, but that's another story.
Speaker: The most important question is, did you get a refund or something?
Speaker: Did you get wings?
Speaker: Did you get wings put on your shirt when you left?
Speaker: I did not get wings, but they do have a voucher or whatever.
Speaker: They have a standard...
Speaker: you know, we'll give you this credit.
Speaker: So I did receive that, but it was...
Speaker: I was, I was, you know, we were getting off the plane and the head flight attendant, like, as I was getting off, gave me this humongous hug and was like, thank you so much.
Speaker: Like, I don't know what we would have done without you.
Speaker: And the pilot, like, I, you know, obviously he was flying the plane and he knew what was happening, but like, he's not in the back to see who is doing what.
Speaker: Right.
Speaker: So as we're walking up the, the jetway, he like literally ran up the jetway to stop me and like, you know, make sure he said, thank you.
Speaker: And so that was really,
Speaker: That was nice, too.
Speaker: I love that.
Speaker: My kids won't travel with me because they're like, you just never stop.
Speaker: Like, you never turn it off.
Speaker: And you never, and I'm like, you know.
Speaker: My kids thought it was amazing.
Speaker: Like, the girls were like, Mom, like, you helped somebody.
Speaker: And, like, they thought it was very inspiring, you know.
Speaker: I'm like drunk people at Bengals games, you know.
Speaker: Like, that's.
Speaker: the type of stuff where I'm like, somebody get them before they fall.
Speaker: And then Ramey's like, well, why are they drinking like that?
Speaker: In the middle of the day, it's irresponsible.
Speaker: I'm like, well, you gotta, you know, you gotta, I can't turn it off.
Speaker: So, but I, that's what I love.
Speaker: And I love that about us.
Speaker: I love that about us as clinicians.
Speaker: I love that.
Speaker: I always laugh.
Speaker: One of my really good friends is a pediatrician.
Speaker: And when we go together, she goes, well, I'm glad you're here because I want to raise my hand.
Speaker: Um, because she's like, when I'm off work, I'm off work.
Speaker: No, understandably, she doesn't do what we do, but it was just, um, it was just funny.
Speaker: Cause there was like another passenger that at the end of the flight was like, are you, you know, what are like, and I told her, I was like, oh, I'm a PA.
Speaker: And she's like,
Speaker: Oh, that was like really nice of you to, you know, stand up.
Speaker: And we were all like, in my family, we're like, I wonder if she also is healthcare and chose not to stand up.
Speaker: And that's why she was like, do you ever wonder how many healthcare people are that just turned and everybody, we are reading you for filth right now because.
Speaker: There are people listening right now who have done that.
Speaker: I have done that.
Speaker: I mean, you know, and honestly, you, you sort of got to get the right moment back.
Speaker: Yeah.
Speaker: Yep.
Speaker: Like, do I have it in me or not?
Speaker: But there's, or do I have the skillset to even manage this?
Speaker: Um, I've never been at that point, but I do know other people who are like, I don't do CPR.
Speaker: Like I wouldn't even know what to do.
Speaker: Um,
Speaker: We had a time to, we were at one dinner one time with friends and I was like watching this thing, like unfold, you know, like a couple booths over and my husband's like, you need to go.
Speaker: And I'm like, no, no, no.
Speaker: I think, well, then I said, I was like, I think they're all right.
Speaker: And then I kept watching and he was like, you need to go.
Speaker: Don't you?
Speaker: And I was like, yeah, get up.
Speaker: I have to get out of this booth, you know, but, um,
Speaker: That you need to go is like the famous spousal line for anybody who's married to a clinician.
Speaker: That's male or female.
Speaker: They're like, do you need to go?
Speaker: They just know.
Speaker: Like, I was telling April, like, I just dropped my phone yesterday to go help some lady that I thought was getting ready to fall off some steps while I was on FaceTime with my kids.
Speaker: Like, dropped it to the ground.
Speaker: And it was, like, just out.
Speaker: Like, it's just so – it's almost like you hear –
Speaker: the alarm in the hospital and it's like it just does something to your brain off and you're like right you're like time to go yeah there was one time in like disney world we were walking by a restaurant and the kid was like choking and i'm like watching as we're walking by and he's like you need to and i was like just hang on a second and they ended up being fine like i didn't need to but you know you just choking is one that freaks you said yeah it freaks me out a lot but so you just sort of watch from afar but um but yeah i mean i think that is the fun part i mean
Speaker: Probably not our spouses think it's fun, but the fun part about it is that it's ingrained in us.
Speaker: That's not specific to a specialty or a, you know, like what type of clinician.
Speaker: I think it's in all of us.
Speaker: We came all, everyone that comes into healthcare comes in because they want to care for people for the most part.
Speaker: I'm sure there's outliers, but for the most part, we've just got this fundamental core need to like want to take care of people.
Speaker: So I thought, yeah,
Speaker: vacation edition in honor of APP week that we should do.
Speaker: I know we did fact of fiction already, but let's do a factor fiction APP edition.
Speaker: do a few questions.
Speaker: Just a lot of appreciation is really what we want to put out there for our, all these people, our nurse practitioners, our PAs, our CNSs, our CRNAs, all of them that really do make a huge difference in patient care and deserve to have this honor.
Speaker: So yeah, let's do it.
Speaker: Let's go for it.
Speaker: How about you go first?
Speaker: All right.
Speaker: Do we keep score this week or is this a
Speaker: Let's not.
Speaker: It's a fun one this week.
Speaker: Let's look PTO score this week.
Speaker: And I feel like because I feel like we should probably know these answers.
Speaker: Yeah, I do kind of feel like this will be interesting.
Speaker: I did specifically try to go over questions that I didn't know.
Speaker: So that... Yeah, but we'll see.
Speaker: Mine are more ones that I thought you would know, but I thought we should cover.
Speaker: So, all right.
Speaker: Well, whatever.
Speaker: Knock it out the box.
Speaker: All right.
Speaker: First one is kind of gets that sort of just the...
Speaker: longevity of the professions um and so true or false the pa and np professions were created in the same year i guess you say founded i'm gonna tell you false immediately and the only reason i'm saying false i don't know what years they were respectfully respectfully but there's no way they are in the same year so which one was first i'm gonna say nps all right okay
Speaker: Well, you're right.
Speaker: So NPs, Loretta Ford and Henry Silver founded the first NP program at the University of Colorado in 1965.
Speaker: So that was the year the first ones graduated.
Speaker: And for PAs, Dr. Eugene Stead founded the first PA program at Duke.
Speaker: It started in 1965, but they graduated in October of 1967.
Speaker: So that is the date that is credited as founding the profession.
Speaker: Yeah.
Speaker: And they both were started, you know, because of the need for patients to have care.
Speaker: Yeah, the shortage of healthcare providers and the need for people to receive care.
Speaker: Yeah, I like that.
Speaker: And it was World War II, I believe.
Speaker: Yeah.
Speaker: And there was a fair amount of shortage there.
Speaker: And again, we're collaborating today.
Speaker: There was collaboration happening then.
Speaker: This has always been our destiny.
Speaker: I really believe that.
Speaker: So I think that's really, really cool.
Speaker: Okay, I got one for you.
Speaker: Ready?
Speaker: I'm ready.
Speaker: Dr. Fiction, physician assistants were originally called doctor's assistants.
Speaker: False.
Speaker: Oh, you're right, actually.
Speaker: Did I stump you?
Speaker: Because you paused.
Speaker: No, I was... Or did you really know the answer?
Speaker: Huh?
Speaker: I mean, I figured I knew the answer, but then I was like, is she trying to trick me?
Speaker: I was wondering if you were doing a little telenovela for us.
Speaker: Okay.
Speaker: But you're right.
Speaker: It is fiction.
Speaker: They were always physician assistants.
Speaker: They still use physician assistants, but did you know that some are moving to a title of physician associate?
Speaker: Have you heard that?
Speaker: Yes, I have.
Speaker: So that's...
Speaker: But it's, there's only, I think, three states right now that have officially adopted that title, like, clinically for PAs.
Speaker: Right.
Speaker: And so that's, you know, I'm actually keeping an eye on it for sound as the chief advanced practice officer.
Speaker: I'm keeping an eye on the states to see if there's any, anybody that we need to change, you know, for like contracts and things like that.
Speaker: Yeah.
Speaker: Well, but even though the name evolves, I think what's important to communicate is the mission is the same.
Speaker: Yep.
Speaker: And that is to provide excellent care.
Speaker: But you mentioned in your last question, like the PA role, the NP role, why they were created.
Speaker: But specifically to the PA role, from what I was looking up, it was created to make medical training more accessible.
Speaker: Yeah.
Speaker: and it grew into this profession after that.
Speaker: And I'm sure you probably know way more of that background, but they started around the same reason, same war, but to serve different, slightly different purposes at first, and then like, slowly blended.
Speaker: Yeah.
Speaker: Into their scope.
Speaker: So I think that's pretty cool.
Speaker: Look at us.
Speaker: No scorekeeping, no competition.
Speaker: We're united.
Speaker: I know.
Speaker: We're being so nice to each other.
Speaker: Why?
Speaker: Because there's sunshine in the sea that I'm looking at.
Speaker: So I should do my, guys, if I do my podcast here, we might not have a podcast because I won't be as cheeky.
Speaker: She won't be as mean to me.
Speaker: And as soon as I get back, I'll be like, it's terrible.
Speaker: I'm under my vitamin D lamp.
Speaker: Okay.
Speaker: All right.
Speaker: Your attorney, babes.
Speaker: Okay.
Speaker: So this one also, I think you'll know hands down, but I think it's important to point out because I do challenge me, Tito.
Speaker: I'm not going to challenge you today, I don't think.
Speaker: But one of the things that I think people don't realize is that there are some differences in the education that both PAs and NPs receive.
Speaker: So my question for you is, which education program teaches more generalized medicine, NPs or PAs?
Speaker: I'm going to say PAs.
Speaker: Okay.
Speaker: You are correct.
Speaker: So what do you mean by generalized medicine?
Speaker: So what I mean is our NP and nurse practitioners, when they go to school, they receive education kind of on a focused track, right?
Speaker: So like they will be maybe adult gerontology NPs or acute care NPs or a primary care nurse practitioner or a family nurse practitioner or pediatric or psychiatric or women's health.
Speaker: So they kind of
Speaker: Which, of course, you know, if it's adult gerontology or acute care, they're going to get generalized and for, you know, education in that field.
Speaker: But they're also kind of there's other tracks that are more focused, whereas P education is PA education.
Speaker: Everybody goes through the same program and it's not focused on one.
Speaker: specific track.
Speaker: Um, and so, uh, you know, when they do rotations, they do eight different rotations and eight different specialties.
Speaker: Um, and then of course there's, you know, post-graduation training that they can, you know, you can do in like a fellowship or, you know, things like that if you want to specialize, but, um, a PA degree is a PA degree, if that makes sense.
Speaker: So.
Speaker: Yes, I get it.
Speaker: And it's an easier licensing process.
Speaker: I would tell you that.
Speaker: I do know that much with all of our licensing barriers state to state.
Speaker: But yes, hey, speaking of APP week, I do think this is a good breaking news.
Speaker: You and I talked about compact for PAs.
Speaker: Yes.
Speaker: A couple of podcasts ago.
Speaker: Breaking news.
Speaker: There's only even though it is happening.
Speaker: The states don't have it up and running just yet.
Speaker: So there are, I think, one or two.
Speaker: So for those that took that information, then was like, April's a liar, just like I did.
Speaker: I actually had to look a little bit further.
Speaker: And it is real.
Speaker: It was passed in 24.
Speaker: You're absolutely right about that.
Speaker: Um, but this, I guess it takes like time to get it even then into legislation or something at the state level for them to adopt it.
Speaker: So they are projecting that as we roll into 26, we'll start going live with, I think it was, would you say 36?
Speaker: There's some, I don't think you said 36 states, but there was a fair amount that were beginning to come out.
Speaker: No, I think it was like 13 or something.
Speaker: Yeah.
Speaker: You lied by omission.
Speaker: That's all I was going to say.
Speaker: Um,
Speaker: April's a liar.
Speaker: I didn't lie.
Speaker: I've stopped looking at the sea.
Speaker: Could you tell I got mean?
Speaker: Okay, I'm back.
Speaker: Turn your chair back around to the water.
Speaker: I'm pacing because I can't.
Speaker: On my microphone, I told you so.
Speaker: I'm just chasing around and I quit looking at what was going on outside.
Speaker: I've quit having FOMO.
Speaker: All right, ready?
Speaker: Here's the next question.
Speaker: Factor fiction, April Burke.
Speaker: The APP workforce is projected to grow faster than the physician workforce over the next decade.
Speaker: True.
Speaker: I said factor fiction.
Speaker: Oh, so that's a fact.
Speaker: Right.
Speaker: I just wanted you to say the right word.
Speaker: It's actually fact, but this is not a competitive model.
Speaker: This is actually the demand of patients that's growing and the demand of availability, like the availability of nurses versus the physicians that are actually entering the workforce, which has been a challenge in some specialties in the physician lane.
Speaker: And I think we've experienced that and had those conversations within sound and
Speaker: You have your ebbs and flows.
Speaker: We have nursing shortages at times and you've got people like interested in VA that want to come in and then you've got shortages in that area and physicians are just kind of going through some shortages in some of the specialties.
Speaker: So yeah, there is a demand just to meet the demands of healthcare, meet the demands patients are living longer.
Speaker: And there's just not enough of us right now.
Speaker: So that growth just shows how central APPs have become, just not as a replacement.
Speaker: This is like the key part, not as a replacement, but just an essential part of making sure that these patients, all of these patients get timely care, period.
Speaker: So yes.
Speaker: Yeah.
Speaker: We're projected to grow quite a bit.
Speaker: I know we are.
Speaker: It'll be fun.
Speaker: I think so.
Speaker: I think so.
Speaker: We continue to grow our numbers here at Sound.
Speaker: More and more of our programs are using NPMPs.
Speaker: I am impressed to see, um, you know, I get even more impressed when I interview and I'll talk to an APP and there'll be somebody that was like 2002, 2003.
Speaker: And I'm often like, what was it like back in the old days?
Speaker: Like, that's kind of what I feel like, like 2002, um, we, they, we still weren't as prevalent.
Speaker: I feel like the big blow up happened or probably around 2010, 2011, where, um,
Speaker: medical groups really started leaning into that model so yeah when did you graduate NP school what year 2012 okay I was 20 I was 2008 um yeah I did now I did nursing school first so technically four years your elder not necessarily I had I made two degrees before you had your PA degree okay okay
Speaker: I mean, if we're going to keep it honest, because this is an honest podcast.
Speaker: I just think we should be honest.
Speaker: Just kidding.
Speaker: I did.
Speaker: You were practicing way before me.
Speaker: That is for sure.
Speaker: But yes, it just it's kind of a different world.
Speaker: It's even it's even different.
Speaker: I feel like we're going into narratives here, but.
Speaker: It's an exciting topic for us.
Speaker: I feel like it's even different post-COVID.
Speaker: It's just interesting to kind of live through, and I know we keep throwing the COVID world around, but it really is kind of like pre-COVID, post-COVID, and even post-COVID, the demand has gone up.
Speaker: That's all the resignation, all the people that got burned out, all the things that happened, all the exposure of all the fractures of the healthcare system that we're now getting to remediate.
Speaker: which is exciting to be a part of that.
Speaker: It's just interesting.
Speaker: So I couldn't even imagine O2, but then you take it back to the 60s.
Speaker: Oh, is it like, did they have to do all that licensing?
Speaker: Did they have to do compliance training?
Speaker: I'm sure they did licensing.
Speaker: I don't know about the compliance training, but you know, one of the funny things that I think about is... Do they do CMEs?
Speaker: I should have looked that question up.
Speaker: I think it's interesting because...
Speaker: You know, when, when I graduated PE school, like when I was in PE school, when I graduated PE school, there was no electronic medical records.
Speaker: Nope.
Speaker: They were all in, it was all on paper.
Speaker: So like as a student, I could like, you know, easily write notes and stuff like that, write out orders and that, you know, then they would, you know, we would sign them, whatever.
Speaker: And I, I do think, um, that education is different a little bit now because of the EMRs, because a lot of the students don't have access to that, to do the documentation, to do all of that.
Speaker: But I also thought it was interesting because, you know, some of our sites go through downtime at times, right?
Speaker: Whether they're doing, you know, updates to their system or sometimes, you know, there's data breaches and systems have to go down for whatever reason.
Speaker: Yeah, cyber attacks.
Speaker: Yeah, things like that.
Speaker: And it's interesting to see that because a lot of the newer clinicians have never documented on paper, they've never written out orders on paper, right?
Speaker: Which is so different than...
Speaker: Just, you know, typing in the name of the medication and the doses come up and you pick it right like you have to like know, like, you know, when you write it on paper, you have to know so.
Speaker: Yeah, there's no prompts.
Speaker: Like, you know, you just have to know what you want.
Speaker: You need to know and you need to know that almost just makes me it's very nostalgic for me when you talk about paper charting.
Speaker: Because it really was like very barbaric, but it was normal.
Speaker: And I think I came in at a point like we had converted to Epic within a year when I had started.
Speaker: Yeah, we had Meditech in the ER when I started in 06.
Speaker: So we had, I mean, I think it was Meditech.
Speaker: I mean, it was still clunky.
Speaker: But yeah, EMRs also do all your task-like thinking for you.
Speaker: And like, I think just kind of paves the way for the minutia.
Speaker: But it's always really good to be able to exercise it because like you said, you never know when you're going to get a cyber attack.
Speaker: You never know when you're just going to have to handwrite a prescription.
Speaker: And I would tell everybody, don't forget how we have to write those suckers because it's.
Speaker: the pharmacy still have an expectation and i had to write one two weekends ago that's kind of like wait a second do we still do we still put our dea up here number here on the rocks like i wasn't really sure i've gotten so used to like the click and the electronic stuff so yeah it's probably good to exercise the old muscle you know i know i mean it's you know like and we have
Speaker: It sounds started to develop like downtime protocols and things to use so that our teams are prepared for it.
Speaker: But I will say the one nice thing is that
Speaker: on paper, you know, you went home and your work was done because you had to do it on paper that day.
Speaker: You know what I mean?
Speaker: Like you had, you had to write your note and put that in the chart.
Speaker: Yeah.
Speaker: And then you're getting, um, delinquent messages and your, um, privileges are going to get sent.
Speaker: Not just me.
Speaker: Okay.
Speaker: Um, just kidding.
Speaker: Um, just kidding.
Speaker: But I do, if I take work on my delay, that's for sure.
Speaker: Especially anything clinical.
Speaker: I try to wrap it all up in the field.
Speaker: All right.
Speaker: What do you say?
Speaker: One more quick round.
Speaker: um or maybe you let's let end with you and then we'll close i know you started i'm in such a great mood i think i'm gonna let you finish this one one more yeah and that also gives me the advantage when i go back and listen about how how how well i won oh yeah yeah okay when i come back and tell hi and i'm mad
Speaker: I'll remind you.
Speaker: Yeah.
Speaker: I'll just remind you.
Speaker: Yeah.
Speaker: All right.
Speaker: All right.
Speaker: Sounds good.
Speaker: All right.
Speaker: Last one.
Speaker: And again, this is one that you'll know, but I think is important to just talk about.
Speaker: Yes.
Speaker: So true or false, the independence level for NPs and PAs is the same?
Speaker: No.
Speaker: That's false.
Speaker: And this was a great question to ask.
Speaker: Tell us why.
Speaker: And there's so many layers to this.
Speaker: There's so many layers and we will be brief, but.
Speaker: But tell the audience that wouldn't understand what you mean by independence.
Speaker: Yeah.
Speaker: What do you mean by independence?
Speaker: Right.
Speaker: Okay.
Speaker: So what I mean by independence is whether or not they can practice without a supervising physician who's like signing off on charts or, you know, reviewing cases, things like that.
Speaker: And there's so many layers to this because every state is
Speaker: has different, has a regulation around this, right?
Speaker: So every state sort of says, you know, what the requirements are of a physician working with an NP or PA.
Speaker: And it's oftentimes different between an NP and a PA at the state, even at the state level.
Speaker: And so this dictates things like, you know, for PAs, oftentimes they have to have like a supervising physician or delegating physician that they sign an agreement with.
Speaker: In general, more states do allow more independent practice for NPs than they do PAs.
Speaker: And that is at the state level.
Speaker: But then the next layer is that...
Speaker: For us, it's at hospital levels, right?
Speaker: Because we work in the acute care setting.
Speaker: So there's documents at the hospital level, like called rules and regulations, bylaws, and actually your list of privileges of what you're allowed to do that also dictate.
Speaker: Yeah, we just don't walk into a hospital and like grab a stethoscope and a blood pressure cup and say, hey, what's up?
Speaker: In a computer, you've got to go through really rigorous processing for a hospital to trust you.
Speaker: And that's every hospital for those listeners that are not in the medical field.
Speaker: Any hospital you walk into.
Speaker: So you're safe.
Speaker: We're not just walking in.
Speaker: Right.
Speaker: And I mean, that's the same for all clinicians.
Speaker: But for APPs in specific, a lot of those documents will indicate what supervision level is required by the physicians that we're working with.
Speaker: And it can range from
Speaker: you know, both providers seeing the patient every day to the physician's co-signing notes, you know, things like that, reviewing things for quality checks and things like that.
Speaker: So I brought this question up because I think it's important for people to understand.
Speaker: But I also think as an APP, it is important for you to know...
Speaker: what your state and what your hospitals say, right?
Speaker: So my plea, you know, to all of any APPs that are listening is if you don't know what those documents say, then take the time to find out and really understand what the requirements are for your practice.
Speaker: So,
Speaker: Absolutely.
Speaker: And we've gotten into this when we were co-directing.
Speaker: This was a conversation that came up a lot.
Speaker: Sometimes it could be in reverse, right?
Speaker: It's what the hospital allows, maybe at the state level or at the board level, what is not...
Speaker: like what not recognized, we'll say it that way.
Speaker: So it can get really dicey because the two systems aren't, they're not expected to talk and, you know, and make it all make sense.
Speaker: And then if you start talking about going state to state and working between a bunch of states, again, every state has their own flavor.
Speaker: So I love that you brought that up because it's not even just between
Speaker: how a PA practices, how an NP practices, but also how a PA practices state to state and how an NP practices state to state.
Speaker: That varies.
Speaker: Yeah.
Speaker: All of it is, it's, it can be incredibly confusing, but you're right.
Speaker: Like advocating for yourself is the best thing you can do.
Speaker: Cause at the end of the day, it's on you to know what you can and can't do.
Speaker: Right.
Speaker: And like, I didn't even realize a lot of that as a, you know, as a practicing clinician until we came in a leadership position, we were directors together and we were sort of unfolding all these layers together to be like, oh my goodness, there's all these things to read and understand.
Speaker: Well, it's ultimately protecting.
Speaker: I think there's a ton of stuff that we all think we could do.
Speaker: I certainly don't think I could go do open heart surgery.
Speaker: I love procedures, but I'm not a surgeon.
Speaker: Right.
Speaker: But I need to know.
Speaker: in the worst case scenario, did I do what I was allowed to do?
Speaker: Not what I could do, but what I was allowed to do.
Speaker: And that's probably the best way to take a look at it.
Speaker: So yeah, that was a great question to end this one on.
Speaker: Yeah, I think so.
Speaker: It's all over, April.
Speaker: I think I'm just going to stay.
Speaker: I'll just stay down here.
Speaker: I'm going to stay seaside for the summer.
Speaker: How about that?
Speaker: And then we'll have really good podcasts.
Speaker: Sounds good.
Speaker: We'll have very positive.
Speaker: We said through the summer.
Speaker: Good God, you see?
Speaker: It's already Freudian.
Speaker: I know.
Speaker: Through the winter is what I mean.
Speaker: I did hear that, but I wasn't going to call you out.
Speaker: Yeah.
Speaker: Well, you should have called me out.
Speaker: That's fine.
Speaker: I am living in my sunshine glory.
Speaker: And if you guys want to live in your glory, come join me.
Speaker: But if you can't, you can always DM April and I on Instagram.
Speaker: You can follow us at On Call with April and Alicia.
Speaker: Excuse me.
Speaker: That's on Instagram.
Speaker: You can also find us on LinkedIn.
Speaker: And you can find us in our email inbox.
Speaker: It has been so sad and lonely because, you know, does anybody email anymore unless it's about work, work, such...
Speaker: I don't know.
Speaker: But if you want to, it's on podcast.
Speaker: Sound physicians.com.
Speaker: And if you've got some ideas, you tell us what your APP thoughts are.
Speaker: What are some things that you're celebrating this week?
Speaker: What are you celebrating about yourselves?
Speaker: What are you guys celebrating your accomplishments?
Speaker: We'd love to hear that.
Speaker: We'd love to celebrate you.
Speaker: Send us some posts and let us repost you.
Speaker: We'd love to see that.
Speaker: So we certainly love to engage with you guys and really celebrate.
Speaker: And we're so grateful for every APP.
Speaker: I know we talked a lot about hospital medicine.
Speaker: That is our focus.
Speaker: Again, we have CNSs, we have EG, we have NP, we have CRNAs.
Speaker: All of these people deserve to be celebrated.
Speaker: All of these people help make our health care functional.
Speaker: So we are so grateful for all of you guys.
Speaker: I hope that you have the best week ever and that everyone celebrates you and recognizes you for what you've done for all these patients.
Speaker: Absolutely.
Speaker: Everybody have a happy APP week.
Speaker: And until next time, we'll stay on call and you guys stay well.
Speaker: You said it backwards, but we'll take it that way.
Speaker: That's all right.
Speaker: But you stay well and we'll stay on call.
Speaker: That's all right.
Speaker: It's APP week.
Speaker: We're going to give you forgiveness.
Speaker: Bye, everybody.
Speaker: Bye, guys.
