Sunday, August 23, 2009

PA name change.

This has been an issue for a long time, and has been debated in PA circles ad nauseum. When our profession was first created. Dr Eugene Stead, the professions founder, wanted to name us Physician Associates. The AMA at them time, in their infinite paranoia (think of the DO profession, and pretty much the AMA reaction to anyone else in healthcare) thought that the name "associate" was misleading, and could lead people to think of PA's as physicians, or physicians in training. What a crock. The Yale program (Yes we have Ivy league programs), still to this day calls their graduates Physician Associates, and at the hospital there, they are titled as such.

There are many in our profession who think of the "assistant" title as denigrating, and demeaning. Count me among them. Patients and the public frequently misconstrue us as "medical assistants", and while I have nothing against medical assistants, that implication is insulting. Assistant implies that I have nothing to offer besides helping a physician with a specific task. It implies a lack of training.

PA's own their own practices. They serve as FLAG officers (yes, admirals, etc.) in the military, when VP Cheney was sick, he wasn't cared for by an MD initially, he was cared for by a PA. In most specialties, PA's function with a HIGH level of independence, and autonomy. In one of the ED's I work in, specifically, Waseca Medical Center, the ED is solely staffed by PA's. There are NO MD's in the ED. Overnight, we cover the floors as well. Guess what, in the fall of 2008, the ED had the HIGHEST patient satisfaction scores in the COUNTRY..not just the state, the COUNTRY. Does that sound like what an "assistant" does?

More here

It is time to return to our roots, it is time to return to the name that Dr Stead initially intended for our profession. We have outgrown the old one.


Thought I would resurrect this, as I like this discussion, and my desire for a name change has only become MORE resolute


GatorChamp said...

I agree with your reasoning on why you think the title should be changed, but I think if we change it, it would hurt the growing alliance we have with the AMA. Recently, we (PAs) got a voting member on their board of directors, which is a a huge step in a collaborative effort. Also, what sets us apart from NPs is the fact that we have no intention of being independent practicioners. With changing our professional title, I think it would be looked as if we are trying to break ourselves from the physician-pa team concept.

On a side note, I've recently discovered your blog through the PA forum and I really enjoy reading your posts.


Bad Medicine, Good Solutions said...

Hmm. I'm still wary of this one. I went to look up definitions of associate, and it can vary depending on use/entry. At times it implies equals and at other times it implies an entry level worker, subordinate, friend, etc.

ER Physician said...

I don't think "associate" is appropriate. It's misleading. What if Nurse Assistants were called Nurse Associates? Similar situation. Could be very misleading to the layperson. What about law firms? Dewie, Cheatum, Howe and Associates. To me that means they have many more attorneys. "I'm an associate of Attorney Cheatum". To me this implies a lawyer colleague. If they're a paralegal they probably don't use this term.

Physician Assistants are more often assumed to be a physician by the layperson (how many times has someone called you Doctor?) than assumed to be lower on the "totem pole" based on their title.

How do you think physicians feel when they are called a "provider"? How often do you see this written in the media, used by insurance companies, etc? The term "provider" was not around before midlevels. I did not go to provider school. I went to medical school. Many physicians resent this greatly and changing PA to "Associate" sounds to me like one more way to "blur the line" and confuse the public.

physasst said...

ER Physician,

Let me try to answer your concerns, first, PA's have no desire for a change in practice parameters, at least not now. Are you really trying to compare NA's, with a name change with our profession, really? I mean, seriously, do you want to go there?
WE ARE physician colleagues. We don't, and shouldn't consult a physician on every single patient, and therefore, have grown from outdated titles, and descriptions.

I am called doctor many times during a shift, and I always, ALWAYS correct the patient, although I don't spend a great amount of time on repeatedly trying to correct a patient.

Also, lastly, YOU SHOULD BE CALLED A, implying all, and I mean ALL MD's usurped the title from the PhD's, the true "Doctors", and have never corrected that. After all, you provide Healthcare, do you not?

GET over it, you are a healthcare provider, some are PA's, some are MD's, some are DO's, and some are NP's...get over yourself.

physasst said...

Oh, and BTW, here's Webster's definition... join together; connect; combine bring (a person) into relationship with oneself or another as companion, partner, friend, etc. connect in the mind to associate rain with grief
Etymology: < L associatus, pp. of associare, join to < ad-, to + sociare, unite with < socius, companion: see social
intransitive verb join (with another or others) as a companion, partner, friend, etc. join together; unite

1.a person with whom one is associated; friend, partner, fellow worker, etc.
2.a member of less than full status, as of a society, institute, etc.
an3.ything joined with another thing or things

1.a degree or certificate granted by a junior college to those who have completed the regular two-year course an Associate in (or of) Arts

2.joined with others in some venture, work, etc. an associate justice
3.having less than full status an associate membership
accompanying; connected

Hmm. sounds an AWFUL lot like what we do........Hmmmmmmm

MLP said...

I haven't made up my mind on this one yet...Both have good points. Assistant is a little demeaning.


Whatwhat said...

ER P sounds like they're trying to "blur the line" between themselves and someone who's worked in the ER for much longer than they have. Their lack of awareness (not to mention respect) is their very own foot for their own fodder.

ER Physician said...

Whatwhat I think you are correct. Notice the respectful tone of my post and the anger/resentment I get back in responses.

Not trying to compare you with a Nurse's Aid, but you have to admit the comparisons to different fields do carry some weight in terms of what it might mean to the layperson.

What's the most curious to me is that you then question physicians being referred to as "Doctors". I can promise you if you talk to any old school physicians, they will tell you they were never called "provider" before mid levels. Doesn't bother me greatly but as long as we're talking about titles thought I'd mention that.

But to imply physicians shouldn't be called "Doctor" is a crock. That's where you really show your hostility.

physasst said...

ER P, I never claimed that you SHOULDN'T be called a doctor. Merely that we are ALL healthcare providers. That's what we do. The landscape has changed. It will continue to change. Our profession was created because physicians were avoiding primary care, and in particular, avoiding primary care in rural and underserved areas. We have grown substantially from those days. We now work in virtually every specialty, and while we work with some autonomy, we are still DEPENDENT practitioners. We have never claimed, unlike our NP brethren, to want to practice with complete independence. But we are also growing, and while we serve in the "team" model, we are colleagues of the physicians. NOT subordinates. There is a big symposium coming up on health education reform, and this is going to be one of the biggest topics regarding medical student education, and the need to change it to a more "TEAM" oriented focus.

Anonymous said...

Your argument about them being flag officers is bs. An optometrist could be a flag officer as well.

ER Physician said...

I'm all about the team approach, but as long as my name is on a mid level's charts, things are going to be done my way. That's just the rules of the road in my ED, in today's medicolegal climate. If you want to say we're colleagues that's fine, doesn't bother me one bit.

I respect PAs for what they do, just weary of the line being blurred because the layperson, I believe, would be mislead by the "Associate" title. It's all just semantics but associate, in my mind, means someone who makes indpendant decisions without supervision from other "associates" when used in this context. That just isn't the case, at least not when PAs work in an appropriate setting.

physasst said...

ER Physician,

I can certainly appreciate that, and the vicarious liablility concern is a real concern. Which is why, my feeling is that if a PA is seeing patients on their own, their patients SHOULD NOT always have to be signed by a physician. And in fact, most states don't require it. For many states, it is merely a select number of charts per month. Which is and should be more of an educational process. Otherwise the PA should take the responsibility. We are still dependent practitioners, but it really is a matter of how you define that dependence. If you cannot develop trust in, and rely on PA's to present those patients which are concerning them, and allow them to see all of the patients in which they are comfortable seeing (and this will vary greatly by the PA, their abilities, and experience level), then you are not using them properly. I understand your concern about public perception, but what about ours?

OH, and BTW....WE HATE the term, and I mean HATE the term midlevel provider.

ER Physician said...

I don't work with PAs on a regular basis. In the times that I have, I've run across some who have been exceptional. Also a few that I wasn't so fond of. What bothered me the most is the ones who I didn't know well who would never come to me with anything. I figured they were either really good, or didn't know when they needed to grab me and I always hoped it was the latter. Those are the ones I would go over their charts a little closer.

It's all about the kind of relationship between the PA and physician and the PA's skill level. I would never have asked them to tell me about every strep throat or anything like that, but all things considered I'd rather them interact with me more often as opposed to not at all or very little.

Based on your blog it sounds like you are one of the exceptional ones. Just keep in mind, day one after PA school is a very different story. I had five hours of lecture every WEEK throughout my residency program, and presented every case to attendings who taught me a lot, also was at a busy trauma center.

So after paying my dues, and now looking back on my training, I don't think any of it could have been excluded and made me competent. Every last day served some purpose.

My point is---I respect PAs and their role, but if it's my ER I want to see every chart and sign every chart, and I don't think PAs should work without that level of supervision in the ER setting. This is not a knock on you or your skill set or fund of knowledge, just my personal opionion and what I'm comfortable with.

As for PAs taking full liability with no MD on the chart, I'm not sure your colleagues would want that because it will lead to increased med mal premiums and could drop your pay. This is the first I'd heard of this being considered though.

ER Physician said...

Meant to say "former" instead of "latter" in first paragraph....

Anonymous said...

We all choose to be PAs not Medical Doctors. We knew and understood the limits of our jobs and that we assist the Doctor. I did not go to medical school or do I feel I have their knowledge and back ground to work fully independent. Our tiltes are appropriate and accurately descrbe our relatioship with the Doctor. If you want to be independent then go to Medical School not PA school. I am very proud to be a PA but I applied to Medical school so I can be a Physician not a wanna a be.

Anonymous said...

The above commentor is right on. To somehow believe PAs will become equal to Medical Doctors or Doctors of clinical practice (Dentist,Psychologist,Podiatrist ect.) is just ridiculous and bizarre. PAs fill a mid-level role that is helpful but NOT essential. The health care is built on these foundations: Medicine, Nursing and Denistry. End of story.

physasst said...

Well, I don't know about you, but I don't specifically "assist" any doctor. I see my own patients, and treat them accordingly. When needed, I involve a physician. Who doesn't really matter to me, just whoever is on the other hallway. Otherwise I see my own people and treat them. I saw 27 patients yesterday, and only had the physician see two, and one was just a friendly hello because they were being admitted, although I had already gotten the bed and spoken to the service. I've seen 12today so far, including a complex multi layered laceration, and an extensor tendon disruption. My SP hasn't had to staff any of them yet. That's not to say that a patient won't come in soon that WILL need a physician to look them over. I'm not "assisting" anyone in particular, I am caring for my patients.

Anonymous said...

It may surpise you that others have just as grueling a schedule as you. I am A Nurse Anesthetist that covers a rural hospital anesthesia services with another Nurse Anesthetist. My schedule is on one week 24/7 then off one week. I typically work 80 to 100 hours during that week. I cover surgery/OB/ER and pain management services. It is a challenging schedule day and night to "care" for my patients.
Your blog is interesting to read.
Thank you

Anonymous said...

correction: My work is typically 60 to 80 hours. The 80 to 100 hours is during ski season so not typical of every week on.
Thank you,

physasst said...

Doesn't surprise me at all, I have several very close friends that are CRNA's, and I have the utmost respect for what they do. Many people in medicine work hard, and long hours are part of the gig. It's that way for all of us.

Anonymous said...

Nurse Anesthetist work long difficult hours that correspond to the surgeons that they work in association. One correction I would make to your response is that ARNPs work under their own licenses performing clinical nursing not medicine. Anesthesia is one of the many clinical specialties that ARNPs have provided safely and independently throughout the USA for many years.