The "Awoke" AMA: Are they for real?

    We are in the midst of a global social reset. Many countries including the US are trying to become more transculturally transparent by attempting to discard institutionalized biases & racist transgressions committed in their transactional roles with all traditionally disenfranchised ethnic groups. Also, along the same vein, corporations. profit and nonprofit organizations have begun to effectively address workplace inequalities while the healthcare industry is trying to eradicate past healthcare inequities as well.

    So given that premise, we’re all embarking in crucial conversations facilitating change with elevated empathy, sensitivity and awareness of past poor systemic inequalities. Mostly if not all perpetuated by our so-called/racist systemic myopic biases infringing on minority or marginalized groups. 

    Multicultural health disparities corrections & access to care has been long overdue. Naturally, removing these stereotyped attitudinal beliefs and offensive cultural behaviors will require a huge concerted effort from all healthcare industry stakeholders. But putting into practice this fresh embraced perspective will require the AMA to go beyond lip service to their partnering stakeholders such as the patient community & us as well.

    If they want to be viewed credibly by society and other various industry stakeholders as a vested enlightened & unbiased organization as alluded in their newly revised/embraced diversity policies, then they must openly recognize two fundamental needs of the PA profession/community; namely:

1. Recognize OTP (Optimum Team Practice )

2. Recognize our new professional designation–Physician Associate       

    Anything short of valuing inter-professional differences or seeking ways to grow and embrace their understanding & support of the PA profession would be hypocritical. Thus failing to truly collaborate in building an industry culture where non-physician providers are not empowered to bring their full, authentic selves to the table, nor increase access to healthcare to vulnerable patient communities is not only disrespectful, but downright morally hollow. And worse yet, such a move could be viewed as nothing more than an insincere case of organizational moral self-exculpation in the eyes of many in any transactional role they would attempt to engage in. Especially with prior oppressed social groups.

    For PAs diversity, equity & inclusivity have always been more than ideas, they have been part of our professional DNA and calling when providing care to our patients for the past 5 decades.

   So will the AMA abide by their own modernized organizational policies and revamped organizational image? Perhaps…only time will tell if they are as passionate in rebuilding and maintaining an honest transparent cultural philosophy that is representative of this new paradigm were intolerance of any form of discrimination is openly rejected & ultimately condemned in the name of social justice. 

    In sum, as George Bernard Shaw said it best: "Progress is impossible without change, and those who can not change their minds can not change anything". 

  

Patient Safety Outcome Metrics Disputed: Where is the outrage of the Physician Assistant Community?

         

         The problem with half-truths, or media disinformation is that oftentimes they are actually believed if continually repeated or perpetuated. Unfortunately these incorrect spins can become deeply ingrained in the collective mind of people; especially when. grossly out of context or worse yet, not corrected contemporaneously by the reporting entities. Sadly, and  painfully, a very well known reality to all PAs who have experienced this stigmatization first-hand in their respective careers by the misinformed patient, practice manager or even dept head administrators. Even more troubling to this author is the apathetic indifference of many of our own peers who remain complicit with our detractors or opponents in this regard primarily the data ( patient safety outcome care metrics) reflect very similar clinical care outcomes between our physician counterparts and us-- the non-physician providers as some like to refer when compared by others.

As I am sure, you have noticed our profession has been malaligned for several years now. Whether it is overtly or not, we have yet to surmount a credible vigorous rebuttal campaign with political muscle in Washington,D.C. PAs for Tomorrow, a recently created Specialty interest group, split from the AAPA given their indifference or anemic stance when creating and developing the PA brand. While they may have been proactive in educating many in advancing our interests, at the end of the day they are somewhat limited since they rely mostly on donations and membership dues. Sadly, to this day, The AAPA has not advanced our brand aggressively nor launched a major national advertising campaign aimed @ focusing on our most pressing initiatives in the marketplace today. For example, nationwide OTP acceptance @ once...not 10 years from today, loss of employment parity due to the strong alignment of the AANP (nursing profession) with  strong lobbying supporters.These organizations openly support & fund generously the nursing profession,thus creating friendly Congressional allies. Unlike our community which we lag behind because have not learned “the Art of the deal” by being timid in advocating our own cause, so we remain marginalized...so where's the outrage from the PA community? Obviously yet to be heard.

But, if we continue being passive, uninvolved in our own affairs, the outcome of our professional destiny then will be fated. I hope that this incorrect patient safety narrative spewed by some physician groups through various informational outlets would be the catalyst in becoming the driving force to fundamentally change & awaken us from our collective passivity. 

It is my hope that we can all see that without this outrage, we cannot protect and preserve our significant professional advancement that our predecessors secured in our progressive professional evolution.

Stand up and oppose  professional misinformation or disinformation or even mischaracterization of a great profession that has served you & all of us well. Donate,  speak and or write  to debunk this flagrant lie. You must assert the truth when clarifying or inform others about our magnificent profession.

PAs' & Puerto Rico: Are we there yet?

Patient-centric care: Has the pendulum swung too far?

 

         Frankly, many healthcare providers think so ( including this author ). Until recently, it was not much an issue for many clinicians. In fact, many healthcare providers embraced this about-face from the medical profession’s long-held stance of centuries old practice of paternalism. In the old model the mantra was: healthcare providers knew best,. However, nowadays, supporters of the new paradigm of patient centric-care have altered the playing field to such an extent that one would have never imagined anticipating that it would become one in which dictates the patient always knows best or is always correct.

         Who knew or would have anticipated the proponents and supporters of the “patient autonomy movement” would have garnered so much power in their own advocacy role to technically open the door to patients’ capriciousness creating such havoc. But, truthfully, can a provider assure the patient that their wellbeing and safety will not be jeopardized when the overseeing professional’s clinical judgment or guidance is removed or relegated from the clinical-decision making process all because the imperative mantra of patient satisfaction comes first?

         Isn’t this new imposed “business metric”  by HCOs “patient advocates” or office managers on practicing clinicians absurd?  Of course it is, if your tenure is “indirectly” threatened or being “blacklisted as an insubordinate” all because you were non-compliant with this loaded hypocritical economic metric. For example, I know of several colleagues who lost their jobs for not providing unneeded prescriptions for abusive demanding difficult patients. Since when patients' self-prescribed under our licenses?

         Personally, it infuriates me, when non-clinicians try to justify or relegate a medical encounter to a business transaction always under the pretext of patient satisfaction is paramount to the “satisfaction scores”. Even when superseding acknowledged contraindications even when not clinically indicated. For instance, a known prior documented PMHx of substance abuse/dependency and mental health issues in a given patient. Simply put: quite troubling if not beyond comprehension in these instances.

         Or prescribing antibiotics on non-meritorious clinical presentations, for example patients with clear viral syndromes is a very disingenuous if not a corrupted business practice. Patient satisfaction should not mean “carte blanche” treatments under no circumstances.

         So, are we ( the healthcare industry ) losing sight of what’s truly  really important? Yes, if we continue submissively accepting and practicing medicine under these lines of blurred expectations & downright unethical conflict of interests if you ask me. Burdensome and extremely short-sighted and/or professionally threatening as these mandates might appear, we, the medical community must individually & collectively remain vocal and resolute when denouncing these unrealistic and misguided expectations from other parties.

         To sum it up: respect for patient-centric care, not administrative threats is key to sound patient-provider relationships. Do not allow yourself ever to be pigeon-holed into thinking that a medical encounter boils down to a mere economic transaction or a survey metric. By doing so you’re basically allowing the demise and disrespect of our professional calling and standing in the industry. Moreover, you allow a pervasive view of financial gains trumping patient beneficence, thus allowing the subjective dimension of patients’ satisfaction scores rein unchecked and rein unbalanced, akin to allowing the pendulum to swing way too far...if you asked me.

 

 

 

Political Correctness: Has it gone too far ?

 

      Traditionally, debates were once venues in which civil discourses would dissect & weigh in the pros and cons both, rationally and logically on a contested issue or a perspective with hopes of ( at best ) enlightening or dissuading the dissenting party by effecting change at a fundamental level. But it does appear to this author that in recent times, we have become so entrenched in our ideologies ( as wrong as they might be ) that we are at times blinded by our own amoral compass, skewed political views or simply outdate views of the world in which we live in. So we no longer listen politely to others.

It is during these stances that we fail ourselves to objectively reflect on the  meritorious points of view of the dissenting argument at hand just because we simply refuse to ponder these different or contrarian ideals to what we have been programmed to accept or believe as our own reality or world. Psychologically speaking, these threatened & insecure minds avoid transcending from their comfort zones even though it might be a momentary departure from such. Sadly, they prefer to remain myopic, stunted. This positional view often times fails to effect change by becoming a barrier or a hurdle; often times laying the foundation to biases and/or prejudices. 

        Better yet, another related deleterious effect seem commonly is the self-delusion of “I’m the better one or my position is the correct one”. Again all failing to move the group think forward. Conversely, I do realize the human mind is shaped and conditioned by many factors; from biology to gender, to culture, to education or even to some socioeconomic strata, but one common denominator that many “political correct “ folks have in common is their steadfastness to remain anchored in “filtered” or badly skewed information.

. 

We all have been those folks during certain points in our lives. Why? Because it’s easier to deal with the known rather than stretch and/or exercise our intellect and welcome new perspectives or contrarian points of view. 

This wave of “political correctness” is making our society a handicapped one. One in which researching and philosophizing is too much work. Much like Jesus said, we should be equally desirous to ”give back to Caesar what belongs to him”.       

Mixed Messages –Non-transparency corporate behavior... what corporate executives fail to see.

The business world is rife with contempt, unpredictability and unfairness. And so does the employing marketplace, especially when hearing or reading about uncertain revenue trends, increased regulatory burdens and/or inconsistent or challenging reimbursement models seen across the Healthcare industry. Naturally, many healthcare executive leaders or administrators are quickly to point out & “vent about their financial organizational hardships” and how imperative is for every organizational employee to be fiscally responsible if they are to survive the current & continuous economic turmoil faced everyday.

Unfortunately, given these financial stressors & “reality” to most healthcare organizations, frayed relationships are beginning to rise & negatively impact employee relationships with their CEOs & other deep-pocketed healthcare executives. Mostly due to deceitful dishonest corporate mandates or strategies used to curtail, eliminate or streamline ( roll-back) salary-benefits packages of Advance Practice Providers ( APPs ). These alleged “financial woes” as given & used on many CEO-employee forums rings untrue and is very hard to stomach when there’s a deceitful agenda behind it, particularly if the company is thriving.  

Many clinicians fear and stand to reason this compensational “imbalance” has increased the divide and added to the frustrating rage an element of distrust especially when these executives make their obscene year-end “bonuses”. And since most APPs are not union members, we tend to be the ”sacrificial lambs first”; after all, & often times we don’t have a voice nor representation as other company employees do. 

However, we do not need to see ourselves as the perennial sacrificial lambs as they would like us to think & see ourselves. Our professional interdependence is not a parasitic one rather a symbiotic one, technically that’s what we need to remind ourselves. We must not succumb to believing their “dualistic message” is the final word or amended dictated reality. We are in the driver’s seat sort-of-speak; both directly and indirectly we can exert a profound influence on “advertising” and let’s not forget “public relations”—vital core issues for any business enterprises. 

Yet, keeping in mind that the business world is not regular, simple nor  that industry forces are predictable, it’s best if collectively we remain flexible and adaptive in our transactional dealings with administrative executives.

We must realize that we are worthy professionals. Also, that we’re not doomed to be a submissive, subservient class because of protectionism views or activities exercised by other kindred groups in the industry. Our social reality is one of evolutionary progress as seen through the last few decades. Fallacious arguments and empty rhetoric must be scrutinized so we can think more rationally & proactively while not being fooled by half-truths, misleading corporate data or when sitting at the negotiating table with the non-transparent “bean counters”. 

This day and age calls for a new negotiating perspective for all PAs. One of a “healthy mistrust of authority”. One emphasizing unbiased facts, one requiring transparent probabilities and objectivity to all stakeholders/shareholders involved when seeking to find common grounds & simplify these business discussions. In addition, we must learn to live comfortable with the uncertainties of the business world. The truth is there’s no single guarantee of legitimacy or truth when it comes to the information age, only solid indicators of legitimacy. 

        So try not to put all your eggs in one basket when trying to make an informed decision, but at the same time don’t victimize yourself by procrastinating due to paralysis analysis… especially when debunking corporate fabrications regarding salary/benefit compression. 

Yet, time after time, whether privately employed or hospital employed, many APPs have found when they attempt to establish some form of dialogue to correct this disparity, or at the very least level the playing field then it becomes rather obvious to them we are to blame even though we’re always big revenue producers. How wrong is this? Don’t they realize that truthfulness goes a long way rather than obfuscation. Quite frankly, I would think this is not the role nor the message any transparent ( ethical “magnet” ) healthcare organizations would like to send to their internal/external constituents when portraying themselves as solid patient-centric community partners. Am I wrong? ( think of Enron,& Wells-Fargo for awful examples of unacceptable corporate behavior).

 

You [we] have a choice; our career transactions are not always fated. The days” of skepticism, pessimism, & illusionism are behind us. Moreover, we should be redefining this reality with optimism and a deeply rooted sense of APPs pride. We deserve it and earned it...rightfully ours.

A Professional Membership: How valuable is it?

      Over the last 5 years, I have been asking myself the same question over and over regarding my AAPA membership -- to renew or not to renew? A question that many of us grapple with while others don’t any longer when they receive their annual invitation / renewal letter to join or renew their membership. Much like many of you, I too, have wondered, if not wrestled with this recurring query of mine:  how much is an AAPA membership really worth in light of what we went through regarding the AAPA HOD's ambivalence of the name change for decades? What a better example of collective Paralysis Analysis...for the longest a never ending status quo--essentially.

      However, I suppose, in attempting to answer this question I/you could dissect this or approach it in many different ways; from a financial ( dues ) perspective, or / to from a benefits perspective, or some other perspective: well …you get the picture. Either way, trying to gauge the real value at first is not a simple task as it might seem, especially when you run into a few other secondary questions such as: 1) do the benefits add up?;  2) does the membership dues pays for itself over and over?

        Generally speaking, as anyone can see, and from an investment perspective, it boils down to this: is this a “risky” or a possible “rewarding investment opportunity” that I can’t afford to miss? Or can this reflective question take you beyond the often times expected knee-jerk-reflex response; do I renew or do I not renew my membership because of  X, Y, Z reasons?

        Obviously, whatever your reason(s) is/are, or whether to allow your membership to lapse or to renew, your ultimate decision will require significant consideration(s).  Chances are your expectations & professional needs to some degree will ultimately play into your final decision-making process. However, this has to be placed in context, meaning that both premises are quite different now; particularly compared from when you 1st started your career or evolved through the years. Somehow, like many of you, I feel some professional affiliations no longer offer the value that they once did. I can assure you the list can be long and personal, but that can be subject of discussion for a future occasion. However, let me share next why some PA organizational memberships value have diminished over the years for me.

        Simply because in my view, through the years AAPA's rhetoric gets updated, and/or recycled, but in essence often times these professional organization’s seek to serve only their agenda and in many cases not the group’s collective desired agenda. To a great extent, and pretty much what has been seen in recent years with the dwindling of AAPA’s membership numbers. They will be the first ones to openly admit it (as self-reported in their 2013-15 published strategic report ) about this issue.

        Essentially my personal views parallels with the underlying sentiment voiced by many of you in The Huddle as well as other PA forums/blog sites. Pretty much rooted  on felling an angst  over the past several years of being completely disenfranchised–ignored—from our very own AAPA.

       Therefore, the way I see it, is this: professional affiliation(s) should not pose any dilemmas for any paying due member nor should it have any dubious repercussions as to the overall membership value benefit. But it does for me as well as many others too. Basically in my experience, this has hold true when my membership lifetime benefits did not aligned themselves with my expected & desired goal (result) based on the longstanding hx of hesitation in the re-naming of our profession due to the well  known longstanding impasse in the AAPA’s HODs since 1994-- even this is no longer to be the case as we all know it.

        Thus, one can easily see why past poor organizational performance based on internal gridlock politics and unfinished business history has usurped the value of an AAPA membership in spite of all the buzz of the new elected AAPA leadership and their new polished rhetoric. Truthfully nothing more than “band-aid” politics throughout the history of the academy, even though this could one of the best substantive gain everyone has seen in recent times. Finally, our title has officially been approved by the HOD in May 24th,2021. So are we still going to remain brand-less for another five decades?

        So, if the culture (their mission/vision and corporate behavior) of a national or state chapter organization that you’re professionally affiliated with doesn’t align with your values and needs, then what’s the purpose of the membership?. Much like any other purchased service in our economic system you may want to belong to an organization whose culture aligns with your values and professional needs. Hoping to get a decent ROI for your buck--will we get it now? Only time will tell.

    

 

Second Acts: Reconnecting with the call…a new day

 

        After roughly 7-years of the fast-track in being an Emergency PA @ a Level I Trauma Center had finally gotten to me. This period in my career was preceded by starting out as a CVT Surgical PA x 2 years followed by 6.5 years of General Surgery. It was as if I had run into a concrete wall at full speed & force. The fun of it all when out the door in a hurry. The work-related pressures and/or responsibilities along with the political games had transformed me into a “clinical zombie” of sorts.

        More importantly, I took my own health for granted. But in the flip side there was a silver lining, one that I would have never imagined in my wildest dreams. So I sought to remedy my burnt out feeling as fast as I could. Luckily, I was given the opportunity to become a presenter/lecturer to 2 local PA programs. Also and coincidentally I serendipitously became a medico-legal consultant an expert reviewer. This came about from the many depositions I was involved during my years as a practicing EMPA. Who would have thought this personally perceived career nuisance would lead a to a new “niche” and a new skill set. One to this day has served me well in saving my career and indirectly providing longevity as well.

      As I reconnected with medicine during that period giving me a new career outlook, these impromptu new career-related opportunities led me to recharge my personal and survive that low period. In other words, to basically reconnect and get a “second wind” sort-of-speak. Looking back on these career-related experiences, now I can see how much it help me to remain afloat but to remain grounded and loyal to my early calling. From that point on, I moved and forged ahead into my niche-- a consulting expert.

      Looking back, for a moment I almost became a career changer. After all is very natural to toy with the idea when things have stalled or not going as planned. My plan was to have worked for less than 3 employers through my career. You know, like some of our colleagues [PAs] that have been very fortunate in being employed with only 1 employer throughout their careers. As one of my classmates fortunately did.

        I discovered that life and/or career my not always be a bed of roses, but among these twists and turns that we find ourselves thrown into, there's always hope and growth. And yes, even in some extreme cases of career spoilers, you can still have fun and move beyond the burnout point, but only if you recognize such feelings as negative attitudes that will delay or stunt your career growth and hinder your unconscious resolve to improve your immediate circumstances. Remain receptive to “second acts”…they can spur you to better and bigger things—trust me; I know a thing or two about this.

Two Costly Self-Marketing Blunders some PAs don’t realize

 

As a former co-interviewer, for various employers, I’ve noticed how some qualified job-seekers don’t get it when it comes to presenting themselves professionally to the world during their job hunting process—they are either oblivious or uncaring about their cyberspace presence on any prospective employer’s perceptions. Some PAs even detrimentally downplay two simple but huge elements about their personal identifying information. Many industry experts would quickly point out these glanced overt omissions can have significant ramifications; mostly negatively that is. So herein, are these two offending background items easily seen when their professional credentials are been reviewed. They will be briefly highlighted & discussed. 

1. A listed Unprofessional E-mail Address:

Today’s people e-mail addresses run the whole spectrum, you name it, from normal appearing & sounding to the ridiculous and offensive to the politically  incorrect. It’s probably alright to be creative & unique in showing your personality, but only if you if you’re employed in the media industry. Therefore, you don’t want your e-mail to showcase you as immature, and certainly not unprofessional. Sadly, for many this is their “Achille’s heel”, as many HR folks would attest in a heartbeat. This should not be a laughing matter, especially when something so apparently trivial can cast you in a negative light by hindering your career climb.  

2. An unflattering Cyberspace Photograph:

“Creepy”, ”unprofessional”, and/or “too seductive/sexy”, are often times the deciding factor for the rejection as HR folks quickly point out. One can see these one word descriptors are not exactly confidence builders. This is one of those instances in which you need to tone down a bit the excessive energy that people like to capture in those irreverent spontaneous moments in their lives. Instead, you need a good conservative professional looking head-shot. The goal here is to be deliberatively professionally appearing, conservative and not too over-the-top. Suffice it to say, go for the “banker” or “librarian look” instead of the Madonna look 

Physician Assistants in Name Only: Questionable PAs? II

Through the years I have worked with many accomplished PAs’. But not because I was privy to their resumes or CVs, but more because of the plurality of their titles and/or professional designations listed in their business cards or heavily embroidered after their names in their lab coats. You know…those folks like John Doe, CCRN, PT, R.Ph.,MSW, RT and finally PA-C. Some of them were great, and even flawless clinicians operating at the top of their game or so they thought when dealing with other people. 

But @ a closer look ( to me ) they had an “Achille’s Heel”; one that robbed them of professional respect among the eyes of other medical professionals. Sadly, at a basic level they failed to set themselves apart, meaning to separate their professional identification and/or consciousness from the unfocused “noise” all those other professional titles &/or designations created on the mind of others, including patients too amd their families. 

In other words, by showcasing their “PA-C” after a long list of other tittles they created this wondering feeling in so many others minds (including mine ) such as, have they “transitioned” or better yet, become “acclimated” to their new profession? Do they still need to showcase their accomplishments so heavily? If so, please use the right medium then-- list them in the resume! At least in that way they don't come across as "narcissistic" clinicians.

I get it; many PAs were ( are career ) changers & after all is natural to feel emotionally attached to a prior career, and even remain connected to it to some extent. But, if you asked this author if you want to be respected and taken seriously in your new profession then you must avoid sub-branding yourself unconsciously to the rest of the world. Basically, the way I see it, professional branding is based on singularity of  professional identity. In other words, as to how you perceive yourself as well as how others perceive your role. Clearly professional ambiguity and/or “failure-to-align” with your peers ( the PA community ) should be the last message you convey to others in your professional career dealings with all others.

 

Case in point, Physicians as a group & individually seem to understand this concept better than any other healthcare professionals. Why? Because in all these years, I have yet to see a doctor engage in this practice. And if they have any secondary terminal degrees or other professional designation, it’s always listed after their “MD” and not more than two or three as opposed to the “alphabet soup” seen in many kindred healthcare professionals.

Much like the old Biblical passage says in 1 Corinthians 13:11: “when I was a child, I spoke, I acted  & I  thought like a child, however, when I became a man, I put the ways of childhood behind me.” Shouldn’t  you put those prior careers or professional designations behind you; be truthful & proud of your new professional designation? Stand tall...always!

A Growing Intolerant View of Advance Practice Providers --so why is that?

       All relationships change or evolve over time. And for better or worse, that is a fact of life. Case in point, a good example of that is our very own inter-professional association with our physician colleagues; one which has undergone and continues to undergo some changes even today. Naturally many factors play into this situation.

      Clearly, speaking of factors one can see Advanced Practice Providers SOP ( scope of practice ) has been evolving too in recent years. Therefore, as time has progressed, one can see our interdependent association has lessened during these times. In fact, professionally speaking we are more autonomous these days than we were in the early days as practicing delegated clinicians. Evidence of this advancement can be seen in recently passed legislative updates nationwide. Full Practice Authority with NPs and Optimum Team Practices are the prime examples that come to mind when one sees the evolvement of our scope of practice, for both, NPs and PAs respectively.. 

But, this recognition has come with a price along with an increasing slanderous backlash trend from multiple physician associations and the very own physician community. Particularly the AMA being one of the most vocal & unsupportive organizations of all of them.

  So why is this phenomenon more noticeable these days to the advanced practice providers community?

  Simple, our past paternalistic association with our former paternalistic colleagues mindset has been slowly dismantled and eroded to the point that nowadays patient care is no longer physician-centric as it used to be in the old days. Much to their chagrin, the updated model of team-based medicine has emerged in many respects as more Advanced Practice Providers-friendly if not downright nursing-centric. Obviously, this industry inclusive move has drawn a wedge between physician and non-physician providers. The displacement of their past industry power has shaken the longstanding traditional hierarchical view of the antiquated system. Thus, apparently this subtle status displacement has intensified and fueled their resentment and professional insecurities to the point of openly disparaging and criticizing our quality patient care outcomes very openly. Hence, the daily misledia continues to inaccurately and @ times deceitfully advance biased stories. These half-truths of their irresponsible reporting at times subtlety cloaked in the form or the guise of patient safety concerns are fundamentally wrong when hypocritically shown to the medical consumer.

Sadly, this disturbing painted picture of sub-par care provided by APPs is nothing more than a negative discrediting rhetoric & projected/transferred professional insecurities of their own. 

A MEMO to all Toxic Physicians

 

  TO: to all Toxic Physicians

  FROM: All Non-physician Providers

  SUBJECT: Your Condescending Attitudinal Behavior

  DATES: Continually for the past Five Decades 

       It has been far too long that we have avoided this important discussion. One that's paramount to our working relationship and vital to the survivability of our strained relationship, both in and out of the OR.

       So let's clear the air...shall we. Please, allow me/us the opportunity to bring to your attention the root of the problem as succinctly as I/we possibly can make in a calm and reasoned manner while being free of any patient or work-related stressors. 

        Now that we have your undivided attention in this matter, we would like to point out your difficulty to relate professionally when you are sarcastic, condescending or plain rude when directing patient care activities. This outdated non-trusting paternalistic attitude & transactional behavior not creates tension and fosters animosity between you and the team of healthcare professionals but hospital administrators as well. We do realize the burden of responsibilities that rest on your shoulders are significant. However, pause and reflect for a moment on the fact that your unrecognized incivility will not only turn away your colleagues, & all other ancillary medical staff, but your patient & family as well. 

        So please, consider amending your ways by becoming  a more tolerant and inclusive provider. By graciously dealing and addressing this personality shortcoming  as best as you can you will find yourself more at ease being the "captain of the ship", making it again  a more enjoyable role in your career.

        It's time to discard this antiquated practice model and reap the benefits of inter-professional inclusivity and understanding. Implementing this new paradigm will be less taxing in all your dealings.

Greatly appreciated now and in the future,

The Healthcare team.

 

 

     

My Biggest Professional Fear

 

        This past year ( 2020 ) was quite a year, one of angst for many of us on many fronts given the domestic and worldwide challenges faced during the pandemic. From the political, to the economy, we saw the different repercussions play in our lives during these uncertain times.

        For some it was personal, for others it was professional.  Yet, we the PA Community (as a whole) continued experiencing professional stigmatization @ all levels. And even more so than ever before, based on recent widely seen publicized untruthful assertions by various physician groups about Advanced Practice Providers [APPs] incompetent or subpar medical care outcomes.

 Why are we so Stigmatized?

         As a PA, you well know how nondescript and misleading our professional title can be and it has been for the past five decades. It's very easy to see how we can be a blemished or devalued professional  group when there's a pervasive basic lack of understanding of our Scope of Practice and industry role. The constant repetition of skewed informational inaccuracies to medical consumers and industry stakeholders never ceases to amaze me even in  these days of the "disinformational age" as I like to call it. Plus, we continue being labeled  either overtly or subtlety as "doctors wannabes"   or more derogatorily as "medical school dropouts" in many physician circles/blogs seen nowadays.

        This negative view of our community stigmatizers even emboldens them to foster legislative professional advancement barriers under the guise of patient safety as proposed by the watchdog group called Physician for Patient protection. Obviously [ we ] being depicted as a dangerous, or poorly trained incompetent providers does nothing to engender confidence nor trust in the patient community. This systemic discriminatory labeling tactic creates not only barriers, but also, reduced likelihood of industry collaboration and acceptance of our brand by other non-physician stakeholders by simply planting mistruths; thus allowing them to cement their necessity of power outside their constituents. Easy to see their ultimate goal; stigmatization of an outside group or individual renders them powerless in the competitive marketplace.

Addressing The Industry Stigma--how to mitigate it?

        We as a community ( and individually) can & must create a positive mindful narrative even though we may have less industry support or financial partners advocating for our industry role. Every AAPA. State Chapter Organization, PA Specialty Organizations along with the AAPA should form a marketing coalition to educate all stakeholders and the industry once and for all of the benefits of our unique Brand. Anything short of such a coalition would not restore the perennial myopia when it comes to understanding our position.

        Such a concerted effort can educate influentially many in discarding or reversing their erroneous stereotypical views of us. One that basically would set forth all our contributing benefits to all the stakeholders we interact daily with... including some members of various divisive physician organizations  calling for our professional industry disenfranchisement by continually referring to us as lesser quality providers/care givers.

        The willingness to stand tall and speak up should take center stage when our voice or OTP is threatened. But more importantly we should strive to eradicate all and any anti-stigma efforts by bringing our contributory narrative into the forefront of every single media outlet in the country. 

        By establishing  a perennial continuum of visibility we will raise our stock and overcome their Medical Tribal Stigmatization...anything short of that will lead me to my biggest fear--stigmatization in perpetuity!

                

          

The Hateful Trifecta

 

        As 2021 rolls out, one thing is becoming clear: the anti-PA rhetoric is becoming louder & louder by the minute as seen in the American Medical Association (AMA) public campaign back in November 2020, entitled  “ #stop scope creep... because patient safety isn’t a game”. Shortly after, ACEP ( The American College of Emergency Physicians), and AFPPA ( The American Family Practice Physicians Association sister physician groups are the last two physician communities to go public supporting this hypocritical agenda. These Physician groups positions are morally bankrupt since their campaigns essentially seeks to stall or halt the evolutionary progression of the scope of practice of Advanced Practice Providers, mainly, Nurse Practitioners, Physician Assistants, Nurse Midwives and CRNAs. They have not only benefited from our utilization easing the workload of their members, but also being reimbursed financially in most cases by our care services rendered to the patient population.

        Personally, do no profession owns a monopoly. Moreover, Healthcare nowadays is clearly a team effort, and all members of the team play a vital part in the care of the patient. In my opinion, most advanced practice providers  are not seeking to replace the physician, nor are anti-physicians’ per se, but rather being true physician extenders in increasing access to millions of people every year. And yes, I/we can assure the medical community as well as the patient community we know our role as well as our limitations. Sadly, but surely, there will always be cavalier advanced practice providers out there, but then again they are also seen in many other healthcare professions too including the physician community as well.

        The position of the AMA, Physicians for patient protection and the authors of the book Patients at Risk postulate that patients deserve care led by physicians --- the most highly educated trained and skilled medical healthcare professional. I / we, the advanced practice providers Community do not disagree with this premise nor deny it.

        However, what I/we object and disagree is their disingenuous hypocritical fear-mongering stance & campaign of misinformation to the American Healthcare consumer. They basically seem to build their argument on untruthful statements ( skewed out of context data ) about the safety of the health care services provided by us and other APPs.  

        This fomented inter-professional divisiveness of curtailing the modernization of PA practice at the legislative level should be viewed and considered a significant intrusion into our own affairs, thus limiting healthcare access to our fellow Americans in an already tough fragmented healthcare industry. But make no mistake about this, right now is a critical time which we shall all come together & put these turf battles to rest. Now is the time to openly chastise those who place inter-professional political ideologies or differences above the common good of the American people. 

        As a group of healthcare professionals, we should & need to stop disenfranchising or demonizing Healthcare Kindred professions. It's time for them to stop seeking to score political points with partisan lobbying allies by marketing disinformation to the general public. Quite frankly in my view, this hypocritical industry practice model is very short-sighted, professionally abhorrent if not unconscionably venomous and utterly disingenuous.   

Holding accountable our unprofessional peers.

Could you hold accountable an unprofessional or unethical peer member when providing subpar clinical care? Or fraudulently misrepresenting themselves to the world and industry @ large?

While you might think this is not your primary responsibility to be policing others, it might behoove you to think again. Why? Because, yes, we all have an ethical obligation to address unprofessional/rogue behavior. If whistleblowing makes you uncomfortable then look at the situation from a patient advocacy protective perspective. In other words, as difficult it may be to you in participating in this internal potential reporting activity, look at it from a “beneficence’” point of view.

In life, sometimes coming to terms to act can be difficult and for many of these moral quandaries it sure can lead to instances of ethical paralyses analysis.

And while these situations might be stressful and downright unpleasant or possibly time-consuming experiences, rest assured that you will be doing the right thing if you hold up your duty when time comes along requiring your ethical and moral stewardship.

Moreover, your anticipated stress level can be mitigated knowing that you’re placing the common good of the patient above your own interests as opposed of those culpable transgressing providers that breached  their own Hippocratic oath.

By reporting the wrongdoer to the medical licensing boards or state society you’re weeding out the so called “bad apples” in the community. You will be safeguarding a patient’s life by eliminating the potential harm that a patient would have been placed under the egregious provider. So when dealing or grappling with an unethical or unscrupulous peer provider, be the “Good Samaritan”. Don't coward or turn a blind eye--refuse to be an accomplice of this maladaptive professional behavior. Call it out. Be intolerant of any fraudulent activities...be the vigilant reporter, the vigilant voice your conscience calls you to be.