At the third annual PharmEHR Summit April 17, leaders in the electronic health record (EHR) and pharmaceutical industries gathered to discuss the status of EHR adoption and potential collaboration between EHR and pharmaceutical companies.

The summit, hosted by PDR Network and held in Philadelphia's Wanamaker Building, kicked off with opening remarks by Richard Altus, president of PDR Network. Altus gave a roundup of how EHR adoption has evolved over the last three years. Among his points, he noted:

• Sixty-eight% of physician practices have completed some type of EHR implementation, according to Black Book Research.
• Over 350,000 eligible professionals have registered for Meaningful Use (MU) attestation, according to a December 2012 CMS report.
• The EHR market is expected to grow 21% in 2013, per a survey published in the Feb. 22 Black Book Rankings.
• Development of interoperable EHR solutions has become a priority, as evidenced by the CommonWell Health Alliance - an independent, not-for-profit trade organization open to all HIT vendors and committed to the idea that a patient's data should be available to patients and providers, regardless of where care occurs.
• Remote patient monitoring and communications will become a focus, as healthcare organizations transition to ACO models.

During a discussion on EHR adoption, MU and patient engagement requirements, Douglas Gentile, MD, MBA, CMO, Allscripts, said several factors were contributing to EHR and e-Prescribing adoption rates, but one primary factor was fueling growth: "This is being driven by money, particularly Meaningful Use money."

New Workflow

When physicians implement EHRs, it completely changes their workflow - from documentation to looking up patient information to billing and discharge. "We literally live in the EHR," Gentile said.

One of the biggest problems for the physician becomes filtering the wealth of information offered up by the EHR. In many cases, the physician has become the bottleneck for handling and managing many tasks that used to be overseen by other staff members, Gentile explained. To be successful, EHR solutions must find a way to move these administrative processes back to the appropriate staff.

Patient Portals

The growth of patient portals was another area Gentile touched on. The Office of the National Coordinator for Health Information Technology has made patient engagement a priority, with the belief that greater engagement will lead to decreased healthcare costs and better outcomes. Providers have developed a variety of portal environments, using EHRs to deliver information to patients and communicate with them, in an effort toward meeting MU patient education and engagement requirements.

"Patients want and expect to interact with providers online, including Baby Boomers," Gentile said.

The ROI for patient portals is now being realized, as providers are able to push time-consuming paperwork, patient registration procedures and questionnaires to the portals, Gentile said.

Pharmaceutical Partner Opportunities

With the growing need to manage chronic diseases, physicians will have to do more than prescribe drugs; they will need to make sure the patient understands his disease and is taking medications correctly, to affect behavior change. Providing patient education through the patient portal is one way to do this, said Edward Fotsch, MD, executive chairman, PDR Network.

Since pharmaceutical companies are experts in their products, the companies, through partnerships with EHR companies, could offer new communication on a given drug, beyond the usual monograph, as well as educational programs and financial packages/rewards for using their products. Interactivity could avail the companies with feedback from patients on how they are responding to their medications.

The key to such solutions: customization. "Patients want information tailed to them," Fotsch said.

EHR Interoperability

A panel of EHR and pharmaceutical company representatives discussed why the EHR "flavor-of-the -month" mentality is problematic, the need to communicate across multiple platforms and obstacles with delivering granular information to the right place with today's fractionated technologies. Talk also revolved around how pharmaceutical companies can help with drug efficacy questions in the hope of treating patients more effectively and less expensively.

The Future

In a session titled "EHRs: The View from Wall Street," Sean Wieland, senior research analyst, Piper Jaffrey, made bear and bull cases for EHRs (he is bullish on EHRs) and painted a future in which a doctor is standing in line at Starbucks and pounding through his EHR. However, he said changes will need to happen to make that vision a reality, as EHR vendors are challenged by outdated technology platforms (e.g., client servers running Citrix), and said cloud technology is where things are heading. The Common Well interoperability effort/Google approach "has to happen," Wieland added.

Michael Golub, MD, FACP, CMO, Digitas Health, a former ER physician, noted in "EHRs: The Clinician's Perspective" that time is the currency of this century. EHRs can help physicians gain time through clinical decision support tools offering evidenced-based medicine recommendations. They "help doctors make fast, smart, accurate decisions at the point of care," he said. By the same token, EHRs add time-consuming tasks to the physician workflow. The take-home lesson: EHR use depends on usability, Dr. Golub said, pointing out that many physicians are moving on to the second generation of EHRs.

The National Association of Pediatric Nurse Practitioners conference in Orlando is in full swing. Day two of the event opened with the associaton's business meeting, offering insight into the achievements of the group over the last year, introducing candidates for the upcoming presidential election and sharing the latest association news.

Starting the morning's events, members met both candidates running for the office of president: Mary Chesney, PhD, RN, CPNP, and Nan Gaylord, PhD, RN, CPNP. Both women shared their visions for the future of the organization, highlighting the importance of the pediatric nurse practitioner role in coming years.

NAPNAP president Susan Van Cleve, DNP, RN, CPNP-PC, then shared her report on the association's most pertinent business. Van Cleve described NAPNAP's new set of strategic initiatives, including advancing the PNP role, advocating to improve children's health and developing a greater association presence. "You [the members] go out and represent us in over 80 different groups," Van Cleve said. "It's pretty amazing."

She also described the association's achievements over the last year, including developing a health policy committee, partnering with the National Center for Learning Disabilities to create an educational website, and leading the revision of the Pediatric Nursing Scope and Standards of Practice. Van Cleve also noted that NAPNAP continuing education credits are now accepted by the boards of nursing in all 50 states.

Regarding NAPNAP's future, Van Cleve said the group will work to expand education programs while increasing public education outreach, focus on health policy at the state level while providing greater support to its chapters and revise its website.

"As you know, the state issues are great," Van Cleve said. "We are looking at shifting our energy to the state level." She added, "Even though we have had a lot of transitions, NAPNAP is in great shape." The transitions Van Cleve referred to include recently moving headquarters to New York City from Cherry Hill, N.J., and a change in the chief executive officer position.

Felicia Taylor, MBA, acting NAPNAP CEO, said that despite the recent changes within the organization, membership has grown 9% over the last 4 years, to 7,538 members. She also shared new member benefits, such as an OTC medication safety website, mental health/violence outreach, and a revised identification, prevention and treatment clinical practice guideline for adolescent obesity.

Health policy chair and presidential candidate Chesney, treasurer Margaret Hannan and NAPNAP Foundation president Jo Ann Serota also addressed the audience, rounding out the morning's business meeting.

NAPNAP elections run through April 30. For more information on the candidates or any of the business mentioned in this blog, visit www.napnap.org. 

Here at the National Association of Pediatric Nurse Practitioners (NAPNAP) 2013 conference in Orlando, leagues of NPs are gathered for 3 days of educational sessions, CE credits and networking. 

At today's opening session, hundreds of NPs were welcomed to the Hilton Orlando's Orange Ballroom to launch the week's events. NAPNAP president Susan Van Cleve, DNP, RN, CPNP-PC, greeted attendees and mentioned some of the week's highlight events, including the association's business meeting, taking place on Thursday, April 18, which will discuss news and legislation and give members an opportunity to meet candidates running for office in the next NAPNAP election. 

The first president of NAPNAP, Janet McCleary, shared a history of the organization from its origins 40 years ago. "When we began in 1973, our registration fee was just $10," McCleary said, to laughs. "To attend our meeting, it was only $25." Now, the organization has grown from 400 members to nearly 7,600. "It's truly amazing," McCleary said of the growing membership. "It goes above and beyond all expectations we had in 1973."

Following McCleary's address was keynote speaker Todd Whitthorne, president/CEO of Cooper Concepts, Inc. Whitthorne discussed the nation's growing obesity problem, including the increased number of patients, both adults and children, with type 2 Diabetes. His overall message, "What About Me?", addressed what contributes to overall health: genetics, diet and exercise. "There is a huge difference between living and being alive," Whitthorne said. "No one has a bigger impact on your health than you." 

During his presentation, Whitthorne shared some startling statistics: Nearly 18.4% of 4-year-olds in America are now obese. These children face many potential health problems, including heart disease, asthma, social and psychological problems, and bone and joint issues.

He urged all pediatric nurse practitioners in attendance to use every tool available to get children more physically active and achieve overall health. "We must promote, embrace and model exercise as medicine," Whitthorne said. He stressed the importance of variety in exercise, promoting use of the FIT (frequency, intensity, time) program.

"One year from today, you will either be more healthy or less healthy. The choice is yours," he said. As final encouragement to the pediatric nurse practitioners in attendance, Whitthorne left the room with an important message: "It's easier to build a healthy kid than to fix a sick adult." 

Reader Michael spoke out for the "silent majority." "Unless the individual wants a DNP and wants to be employed at the University level and/or wants to do research; thinking of making it a mandatory requirement in the future is wrought with problems and a monumental mistake," Michael said. "The greatest majority of the supporters of making the DNP a mandatory requirement are those who already obtained their DNP and need to justify their decision to obtain it, spend the money for it and expended the rigorous energy needed to obtain it. You want a DNP, that's fine, but don't make it a requirement. It should be an optional choice."

Several readers weighed in with support for Michael's sentiments. "Hear, hear. I have felt no need to obtain a DNP. I evaluated the coursework of multiple programs. If it was truly ‘clinically based' I would have wanted this degree. I love my work as a practitioner. I have no interest whatsoever in becoming a healthcare administrator, researcher or educator," reader Dana said at www.advanceweb.com/NPPA.

What are your thoughts on the DNP degree? Let us know in the comments below.

For more information on the DNP, check out some of our recent articles:

• DNP Subspecialties
• A Community of Doctors of Nursing Practice
• BSN-to-DNP Education
• The DNP and the Healthcare Home

Return to the ADVANCE for NPs & PAs homepage.

Below are three of our latest Comments & Feedback columns. If you didn't get a chance to weigh in on these topics yet, there's still time! Use the comments section below to let us know what you think.

• While You Wait: The results of the 2012 National Salary Survey of NPs & PAs will be revealed in February's issue. While you wait for the results, see what some of your fellow clinicians had to say about the 2011 survey findings. We can promise you one thing: You will be pleasantly surprised when you open to the salary article in the February issue of ADVANCE for NPs & PAs.
• Fast-Track Students vs. The Nurse Veteran: We shared your comments on our NP & PA Student Blog post "Students vs. the Nurse Veteran" by fast-track NP student Terrance Clark. Clark wrote, "New nurses can intuit that a 20-year veteran of nursing has an education that is 20 years out of date. The experience and hands-on knowledge earned does not a current knowledge base make. A new nurse's education is current, therefore they have value to add."
• PA Week: Night & Day: We highlighted reader submissions from PA Week 2012. Click on the link on the left to see how some PAs celebrated, and how others could use your help in spreading the word and making PA Week 2013 even better.

Have something to say that doesn't fit into our Comments & Feedback column? We accept submissions on all topics. Check out our Writer's Guidelines to find out how you can lend your expertise on the topic of your choice.

Last week, Newsweek published its final print issue. As a magazine enthusiast (I subscribe to many, I've studied them, and I work for one), I was saddened to hear the news. I remember a time when finding one of my favorite magazines in the mail meant I would be sitting on the couch for the rest of the night to read it from cover to cover.

But times change, and the reality is that more and more publications are moving away from print formats and going online only. There are various reasons for this, including readers' preferences. Many don't want to carry around stacks of paper, and enjoy being able to read all of their favorite articles right from their very own laptop, tablet or smartphone.

I have to admit that I no longer subscribe our local paper, The Philadelphia Inquirer, because it's more convenient and less expensive to read it online. Luckily, your subscription to ADVANCE has always been and always will be free. And you still have your choice of reading the traditional paper version or our digital edition.

So, which do you prefer? To make sure it keeps coming (either to your mailbox or inbox), please update your contact information on an annual basis here: http://www.advanceweb.com/General/Subscriptions.aspx

 Editor's note: This post was written by Elizabeth Rosto Sitko, managing editor for ADVANCE.

Last week, the Facebook post below caught a lot of attention. What's your opinion?

"Both the American Nurses Association and the American College of Emergency Physicians have issued calls for a ban on the sale of assault weapons. Do you think it is the responsibility of healthcare provider organizations to urge this type of action?"

Some said yes and some said no. Here's just a few of the comments we received.

• "We can all do our part. As nurses, as humans." - Teanne
• "Just stand in a trauma unit for one night and come back and give me your answer." - Melissa
• "Yes! Absolutely! It's everyone's responsibility to speak up for what they believe!" - Kelli
• "Absolutely not. I have stood in the trauma unit for 15 years and taking away my legal guns, which I carry conceal because I am licensed to do so, and taking away my rifles, which I enjoy shooting responsibly, will do nothing to stop the common street thug with an illegal weapon, other than allow me no protection for myself and my property when I'm leaving the trauma unit at midnight, sitting at a red light, and getting jacked by said thug." - Dana
• "Most of our ER staff is armed; we see what's out there. As the Boy Scouts say, be prepared. The bad guys will always find guns; we need to be able to defend ourselves." - Diana
• "Absolutely. Prior trauma nurse here at Miami Dade County. Some individuals have no business having weapons. Period." - Teresa
• "This is definitely not the responsibility of healthcare provider organizations. This is a civil liberty. I'm sure many members of the groups do not support a ban. These groups should focus on healthcare issues." - Rita
• "Supporting mental illness awareness and research would be a wiser choice! Let's be honest, what health professional has not taken some form of weapon to work with them?" - Susan

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

Last week, NP & PA Student blogger Terry Clarke shared his concerns over the status of nursing. "I am currently in a class called ‘Societal Forces' as a precursor to my first semester of advanced assessment in the Adult/Gero Primary Care Nurse Practitioner track. The teachers are passionate and well informed. The speakers are excellent, but the subject matter...The subject matter is frankly depressing. The class theme seems to be: ‘Here is how messed up the system you are entering is. Good luck,'" Terry wrote.

He continued, "We have heard about unions pricing themselves out of competitiveness and the changes that may or may not come with the inception of the Affordable Care Act. Cultural resistance to evidence-based practice. Medicare's new community health pay guidelines. Rural primary care clinics struggling to stay solvent. Sequestering measures that go along with the fiscal cliff. The continuing gap of respect between NPs and doctors. And the pervasive lack of good management, and systemic waste, at all levels of healthcare."

Terry asked you to share your silver lining of nursing - what motivates you to return to work each day, despite the struggles and barriers you're facing as a profession?

Here's what some had to say:

• "The silver lining is the individuals and families you will go on to help by improving their health and easing their pain. You will likely be part of many small ‘miracles.'"  - Sallie
• "No matter what the job looks like, people will always need nurses/healthcare. We have job security and millions of Americans aren't that lucky. We're spoiled to think that we should love what we do every minute. The fantasy that work is the source of happiness is actually the root of a lot of misery. The goal is to be grateful for your work, whatever it is." - Kimberley
• "I think in the end, we nurses will win out. We always do." - Sean
• "The silver lining comes from within; it's not something you can describe, or explain. It is something that you experience. When you're able to provide a service, compassion, treatment or just the shred of hope, that can be the silver lining. Often with nursing, it is the things that we do, that we don't see, that will have the greatest impact. " - Danielle  
• "Look at your education and training as a gift that you, as a NP, will use to improve the lives of others. There are so many facets to nursing; you have to find your niche and create our own happiness and self-fulfillment." - Barbara

Check out the blog to read Terry's full post and all of the articles. While you're there, share your silver lining with us.

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

This week, we released our end-of-year compilation, Top 10 Articles of 2012. The selected articles, blog posts and guides were the most visited content of the year by you, our readers.

Check out the list to see each complete article and all of the comments you posted, or read below for a preview of what you had to say about the No. 10 and No. 1 posts.

 10. DNP Capstone Selection

• "I have started a BSN-DNP program of 3 years. I am already starting to think of my capstone. I have several areas that are dear to me. I want to do something that will instill change. I would love to make my mark in this world positively in my nursing career. Some of my areas of interest are: stopping smoking and alternative medicine, e.g., hypnosis." - Wendy
• "I want to focus my translational project on increasing the African American population on the bone marrow donor registry. African Americans tend to have low representation on both blood and tissue donor registries/programs. Being an African American myself with a son with SCD, it is an important topic to me." - Angelia

1. 2011 NP & PA Salary Survey Results

• "Any ideas on why PA salaries dropped so significantly?" - Kristin
• "This is very discouraging. Why have NP salaries not gone up? I do the same job as a psychiatrist in my work environment and make $130,000 LESS than they do...and the DNP won't help by the looks of it." - Cheryl
• "I have been working/studying in the medical field for nearly 10 years and make only half of this! I have half a million in debt to education...will likely get just slightly more than the above salaries in job offers next year unless I take nursing home/inpatient/obstetric call and continue the 80 hr/wk nightmare. Both NPs and PAs have a good life and I am envious." - Jason
• "I just learned that pharmacists in my area earn over $137,000 in the hospital/hospital clinic setting. I knew they made more than we did but this is ridiculous. I know they are smart & go to school & get their PhDs but talk about costs driving up healthcare." - Christine
• "And again, men out earn women doing the same job. Why do we allow this to happen." - Maryanne

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

On www.advanceweb.com/NPPA, our most commented articles were:

• Teams, Practice Models and Patients: "As a full time clinician my team and I have been doing outcomes research on an interdisciplinary model of stroke rounds in an acute care setting. The four habits mentioned in this article we have used in our model. In fact I recently took a trip to London, England where I visited an NP at St. Thomas's Hospital who showed me their team efforts to taking care of stroke patients. They seemed ahead in working as a team as I toured the stroke unit. The NP and physicians shared the same workroom/office on the unit and all the therapists needed for care of stroke patients were centralized right there on the unit. The NP relayed that she found it inconceivable that it could be any other way because, ‘We're a team,'." - Lana
• International Medical Graduates and PAs: "I am a foreign medical graduate and I completed all my USMLE exams, including step 3 with good scores(90s), but unfortunately I am not able to secure residency. I decided to get admission to PA school, which can allow me to be in this profession. I contacted a few programs in North Carolina, and asked whether they can waive the requirement of a bachelor's degree from a US institute, and I ended up with the same response from all of them: that I am not eligible until I complete a bachelor's degree all over again from a US institute, and it doesn't matter even if I complete it in arts or math. I was really amazed by them, I explained to them that I am an ECFMG certified physician, which enables me to get residency, but you are even denying me an admission in PA school. On one hand, the US needs healthcare professionals who can serve people in underserved communities and on other hand, they are ignoring this huge population of FMGs trying to make some difference in their personal, professional and social lives. Currently I am trying to find programs who can allow me to join the PA profession." - Parth
• My Four Favorite Derm Cases: "Trauma to toe: Define shoes -- Crocs or plastic open toe is not a shoe. Protective footwear on open bikes -- motorized or not is lacking everywhere! Along with Helmets...should be required. Love the pictures." - Sandra

On www.facebook.com/advancefornppa, our most popular posts were:

• "Are you an NP student who will graduate in December? We're looking for a new nurse practitioner to write blog posts about his or her first year in practice. (We've already lined up a first-year PA!) If you are about to graduate and would like to share your experiences in writing, send an email with your info and some blog post ideas to Kelly Wolfgang at kwolfgang@advanceweb.com."
• "Want expert advice on avoiding malpractice claims? Register for our FREE December webinar!"

On www.twitter.com/ADVANCEforNPPA, our most retweeted tweet was:

• "According to HEALTHeCAREERS, the 3 most in demand PA specialties are ortho, ER and cardiology. http://www.healthecareers.com/article/top-3-physician-assistant-specialties-in-demand-by-employers/171532"

Also on Twitter, our most favorited tweet was:

• "My First Day of Rotations: The first month of a job is the worst and you basically have that for a whole year. http://community.advanceweb.com/blogs/nppa_5/archive/2012/12/03/my-first-day-of-rotations.aspx?utm_source=twitterfeed&utm_medium=twitter"

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

We hope you had a great Thanksgiving holiday! We got a lot of great comments from readers over the last week on www.advanceweb.com/NPPA. Here are just a few:

• On the article Nurse Practitioner Residency Programs and Healthcare Reform: "As technology advances and more knowledge is required to deliver healthcare, the DNP degree is the natural progression our profession should presume. Other allied health professions have transitioned to doctoral education and I think it is time for nursing to embrace both higher academic and clinical standards. I think it is unjustifiable for MSN programs to incorporate 400-500 clinical hours and allow one to presume full accountability of patient care, especially when new APRNs are entering the profession without significant RN experience." - Jason
• On the article State Breakdown of the 2010 National Salary Survey of NPs & PAs: "I have been an NP for twelve years and prior to that a nurse for over 30 years. As times changed, PAs were from a broader chemistry or biology background with varied experience. All PAs must have so many clinical hours prior to entering their programs now. NPs typically have 5 or greater years of nursing experience before returning to school. What the public sees us do is the same. Our training is different in that PAs use a medical model and NPs a nursing model, but lately this is overlapping." - Aileen
• On the article International Medical Graduates and PAs: "I easily finished my associate degree in nursing online and now working as RN in an emergency unit. But I would not be qualified to take a nurse practitioner program because my grades in anatomy and chemistry were from medical school." - Perry
• On the article 2011 NP and PA Salary by Geographic Setting: "Do Nurse practitioners have any legal right to request to see the income they are generating to a private practice?" - Donna

Weigh in on these topics and more by visiting the latest articles, updated daily, from ADVANCE for NPs & PAs.

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

On Twitter, we retweeted a few great NP week photos. If you're not our Twitter fan yet, head over to our page to see the great things NPs and PAs are doing across the country, and get the latest from ADVANCE! Here's what we had to share:

• NP Week Gift Table
• NP Student Passed Her Boards
• Salt Lake City Mayor Passes NP Week Proclamation

Also in the spirit of NP Week, we shared the testimony of ADVANCE for NPs & PAs editorial board member KC Arnold at a hearing about proposed increased regulation of NPs in Mississippi. The proposed changes came in the wake of the continuing investigation by the Drug Enforcement Administration into allegations that many nurse practitioners at the G.V. "Sonny" Montgomery Veterans Affairs Medical Center have been prescribing narcotics without DEA licenses or required physician oversight, the Clarion Ledger reported. Arnold and more than 100 other NPs stood up for the profession, stating the struggles NPs face when operating clinics. We asked Facebook fans, "Has a pain prescribing scandal led to misdirected scrutiny in your area?" Here's what readers had to say:

• "There is always someone breaking the rules and messing things up for others!"
• "I wonder if the NPs were lead to believe by administration that they didn't need their own DEA number. I know ignorance is no excuse, but I still find this interesting."

On LinkedIn, members have reached out this week with a few requests. If you're not already a member of our LinkedIn group, go to http://www.linkedin.com/groups/ADVANCE-NPs-PAs-2066022?goback=%2Egna_2066022 to join. There, you can share the latest news, professional concerns, and happenings in the NP and PA worlds. Last week, readers submitted the following:

• "Looking for a preceptor in Wisconsin Fox Valley area (Oshkosh, Appleton, Green Bay). Any connections are very appreciated! Not needed for at least 1 year. Just trying to stay ahead of the game!"
• "Can anyone recommend a good school from which to recruit NP grads in the Salt Lake City area?"

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

Happy NP Week 2012! This year, we are recognizing nurse practitioners across the country with the AANP theme, "Your Partner in Health." We'd love to know what your facility is doing to celebrate. Send your photos and stories of your festivities to kwolfgang@advanceweb.com to be featured in our Comments & Feedback column online and in print. Last month, we shared the ups and downs of PA Week. Let's see how NPs compare. Who do you think knows how to throw a better celebration?

As many know, this is an exciting time to be an NP. Last week, we learned that pending final approval, the consolidated AANP-ACNP organization will be renamed the American Association of Nurse Practitioners. In exactly one week, we will learn the outcome of the AANP members' vote for merger approval. If you're an AANP member, tell us: How did you vote?

Of course, NPs can't take the entire spotlight this week. We received a comment regarding PA education on our article "Taking PA Education to the Next Level." Reader Greg said, "Why not get rid of PA and NP programs? Have medical school only. Complete three years. Two didactic take STEP 1, one of rotations. Take a test (STEP 2 [I know it's normally after your fourth year]). If you want you can be done right there, but you have the credentials and training to continue later in life." What do you think of his proposal? Can you imagine a world without NP or PA school? Check out the article to read his full comment, plus 66 others, and weigh in.

If you want to learn more about PA and NP education, check out our Student and New Grad Center. There, you can find information on both degrees, certification, workplace issues, and more. You can also read our latest posts from our NP & PA Student Blog and New Grad NP Blog. And don't forget to check back for information on our upcoming virtual fairs, job fairs and webinars.

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

With the election just one day away, political reporting is at a fever pitch. At ADVANCE, we have compiled extensive coverage of healthcare's role in the election. If you haven't done so yet, browse our articles for some last-minute information on the candidates and more. We will also be compiling your reactions to the election results. If you'd like to share your opinion on the outcome of the election and what it means for the future of healthcare, email kwolfgang@advanceweb.com.

In the world of NPs and PAs, another vote caught your attention. On our news piece "Boards Approve AANP-ANCP Merger," reader Sue commented, "When both organizations merge, will the new organization be called ACNP? How does this correlate with ANCC? Will ACNP and ANCC both continue to certify NPs?" Those questions have not yet been addressed by AANP/ANCP leadership, but ADVANCE will continue to report on the merger as it happens. If you have specific questions, let us know in the comments below and we will pose them to both organization presidents for clarification.

This month, we had a lot of big news affecting NPs and PAs. For the most up-to-date information, visit our Front & Center news section online or in print. This month, you can read about:

• A new credentialing alternative for NPs in emergency medicine
• The 100,000^th certified PA
• The 2013 GAPNA Board of Directors

and more!

We also have a free webinar offering this month, "Managing C diff in Long-Term Care." The event will be held live on Nov. 14 from 4 to 5 p.m. EST, but if you're unable to make it at that time, you can watch the archived version when it becomes available on our site. To view and register for all of our upcoming events, visit http://nurse-practitioners-and-physician-assistants.advanceweb.com/Web-Extras/Online-Extras/Editorial-Webinars.aspx.

If you are looking for other online learning opportunities be sure to visit our Test Center to earn CE/CME credits. This month, our 2 credit offering is on the topic of peripheral diabetic neuropathy, the complication of diabetes mellitus characterized by a loss of sensation in the extremities. Other opportunities include topics in cardiology, geriatrics, infectious disease, pharmacology, and more.

If you're not chatting with us on Facebook, Twitter and LinkedIn, "like", "follow" and "connect" with us and start sharing in the conversations! If you are, keep following and spread the word.

ADVANCE for NPs & PAs staff is bracing for Hurricane Sandy near Philadelphia, Pa. today, and we wish the best to all those along the East coast who are suffering from the storm's damage.

Across the country, NPs and PAs are still heating up our communities with the latest in healthcare. On our article "NP Residency Programs and Healthcare Reform," some NPs are speaking out. "Nurses continue to make things hard on the profession as well as the public with these outlandish practice requirements. We are purposely trying to compete with physicians. Additionally, those of us who are not from as privileged backgrounds as others seem to be slowly and slyly weeded out in an attempt to throw us out or under the bus," Denise, RN, BSN, MHA, NP student, said. Do you agree with her assessment? Read more about these programs and share your thoughts with us.

It is not just through education that NPs have found frustration. Reader Terry commented on our article "Establishing an Independent Nurse Practitioner Practice" with the barriers she has seen NPs face as a SCORE counselor. "The biggest stumbling block has been obtaining insurer contracts and receiving adequate reimbursement for services," Terry said. If you are an NP practice owner, have you encountered these problems? What were your resolutions?

Reader Neelia commented on our National Salary Report 2011 with further issues affecting NPs. "I started out as new grad at  about $40 per hour. Now I make $50-$70 per hour depending on the location with travel, housing and a rental car paid. It's all about negotiating. I can only encourage other NPs to negotiate for what you are worth. It's up to the NP to explain your worth and value and what you bring to the clinic." The best way to see the changes in NP salary and compensation is to share your most current information with us. Our 2012 National Salary Survey of NPs and PAs data collection ends in only two days on Wednesday, Oct. 31. If you haven't taken the survey yet, do so now!

There also isn't much time before the 2012 presidential election. ADVANCE compiled extensive election coverage with special attention to healthcare workers. With our election coverage, you can see:

• ADVANCE 2012 Election Survey Results
• How Healthcare Professionals' Views are Shaping the Election
• How Hospitals are Handling Medicaid Expansion
• The ACA's Impact on Healthcare Jobs

...and much more!

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