Sunday, April 18, 2021

Fighting Physician Assistant Professional Illiteracy: The Perennial Widespread Battle ©

                           

Image from Gerd Altmann ( Pixabay.com )



There’s a troubling trend in the healthcare industry that in spite of living in the information age the threat & spread of misinformation about the PA community is real and becoming more dangerous. Ask any Physician Assistant who has practiced over the past 50 years. Unfortunately the PA community has lived and endured @ times a myriad of misguided & quite often ill-motivated views & mischaracterizations of our profession by many including the media  Sadly, this negative or distorted representation is simply based on a lack of basic understanding of our profession. In other words, irresponsible reporting & lack of real  basic understanding of our training, our scope of practice, etc. 


Yet, the PA profession has rapidly expanded with doubling the number of educational programs and the number of graduates (i.e. class sizes) that has substantially increased. Moreover our profession is evolving and increasing the access of care in our very fragmented industry. Unfortunately some physician organizations, namely the AMA, ACEP and a few others are portraying our profession unfavorably to lay audiences all across the country. Why? Because curtailing recent further legislative advancements allows them to continue  to monopolize & control Advance Practice Providers since we have grown from our “Assistant” moniker. Plus the world continues to evolve as well as our Scope of Practice. And all due to our excellent track record corroborated by many studies throughout the years time after time.


Surprisingly The AMA's stance and view on our advancement has been extremely unsupportive if not downright hostile and unprofessional of the medical community.. Basically attempting to delegitimize our contributions by insinuating, implying either implicitly or explicitly our care provided to the American healthcare consumer without any data or factual information is disinformation at its best in their so called allegations of inferior or subpar quality provided by us. Basically they based their views on med malpractice data against Physician Extenders ( NPs / PAs / Midwives and CRNAs, etc.)


        Unfortunately, the AMA and sister organizations rather than drawing all providers, payors and patients together is furthering the division with these divisive allegations in the media, print and/or social media platforms. This slam and divisive tactic is not fair to patient nor Advanced Practice Providers since this view / behavior perpetuates the lack of access of care by targeting our community and blemishing our legacy by undermining our role in the healthcare industry.


        The reality of the situation is this: it is a terrible shame that some members of the medical community  choose to make this a matter of competence among various inter-professional medical providers all seeking to meet the medical needs of our society. We could just as easily argue and point out that the physician community is not with their share of “bad apples”. Is always easily to see shortcoming in others but not ourselves. Our Brand less professional identity has been both unintentionally &  intentionally used by those who would perpetuate professional ignorance, sow interprofessional rivalry or /industry divisions for their own gain, thus perpetuating their agenda or “turf battles” as it is known inside the industry or cancel culture --the new paradigm seen in our society.


        I urge the American healthcare consumer, the freelance media writers,and the recruiting consultants or even hospital administrators/physician group practice managers teaming up with any professional medical care provider, to research us--the PA community. So by arming themselves with accurate, insightfully updated information of our proven and solid quality legacy along with our past competent track record our profession has shown through the last five decades, they would come to a better understanding as to who we are rather than blindly accepting biased and skewed information that so many times has been reported w/o any real fact checking behind the false narrative or stories created about the PA profession.


        It is no secret that America is deeply divided today, from a political perspective, from a social perspective and economic perspective  and even a spiritual perspective. How utterly divisive this introduction and continuation of “Cancel Culture” is creeping up in the healthcare industry too. 


        View under this light, this  was and is sadly a deplorable moment & stance the AMA took when the PA profession was targeted unfairly in their article, “Stop the Scope of Practice Creep”. This action perpetuates ignorance and biases outside the medical community, thus, fueling the fires of distrust in the patient-community. As if we need more distrust and a very elitist medica group of providers in an already very fragmented industry..

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PA-Trolling: The New Social Media Venomous Activity by the American Medical Association ©




Physician Assistants know all too well about “cancel culture.”  In fact, we have lived & experienced this discriminatory malady on a daily basis for the past fifty-four years. Even before this term became in vogue in recent years as seen throughout  the various social media platforms, we even knew this firsthand, before it became ingrained in our societal fabric. Fortunately, we have not been cancelled yet, even some Physician groups and/or some of their organizations are on the offensive of their mission-driven agenda of fostering inter-professional divisiveness by undermining the professional legislative gains of PAs & NPs.


But, what is new these days is their open and intense negative rhetoric about our competent quality care provided by us to the healthcare industry as non-physician providers. This venomous activity has been amplified more than ever before as seen in the American Medical Association (AMA) recent nationwide campaign about refraining the advancement and modernization of PAs Scope of Practice throughout the country. Adding insult to injury, are many other physician organizations supportive of this deceitful and shameful blatant disingenuous disinformation and misinformation campaign presented to the American healthcare consumer.


This scaring and disenfranchising message explicitly displayed in the reckless graphic above with the PA profession represented on scrabble tiles with the message “because patient safety is not a game”  was felt to be beyond unconscionable by us-- the PA community. This message was felt to be a full frontal attack on our proven professional delivery track care over the past five decades provided to the patient community.

I personally, recall thirty-two years ago when I first graduated, yes, we did grapple with the subtle resentment shown to us by many practicing physicians. You see, we were relatively unknown at the time, much to the liking of many old school physicians  who would have preferred for us to have remained brand less, until this day. However, and fortunately  medicine has evolved significantly since then. Plus, it will continue to do so at a fast pace


Personally, their assertion that a patient's safety is at risk if their care was or is provided by a physician assistant is simply flawed, false and deceitful.  This very short-sided discrediting narrative can be debunked by  many studies proving our competent and quality care.( see attached references ).1-2  


In fact, many studies and evidence-based research has shown time after time that PAs have provided cost efficient patient-centered Healthcare services with similar health care outcomes as physicians. Could this be why we are constantly discredited and never-ending being marginalized? 3-8


Let's let the facts speak for themselves against the #stop scope creep campaign by the American Medical Association and their sister medical physician associations. Hopefully then the PA-trolling can stop and the American healthcare consumer can become better informed in this Machiavellian disinformation age that so many like to perpetuate for their own nefarious & driven divisive agendas.


In sum, this post is not meant to pin the professions against one another, but rather to point out how their outdated regulatory views on PAs limit patient access by stalling or restricting the modernization of Scope of Practice and respective impact of Physician Assistants over the last several decades.  And even though, we & other advanced practice providers realize that we fall beneath the regulatory hierarchy of physicians, nevertheless we feel  and we know we're highly capable trained healthcare professionals able & poised to increase access of healthcare to the American Medical consumer along with our physician counterparts in this day and age of limited access to health care and politicized world. 


The way I/we see it, deceitful and disingenuous marketing campaigns as this one is not a game either when it comes to our role, industry recognition and professional livelihoods..


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References accessed on 3-11-21

  1. Kurtzman ET, Barnow BS. A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians’ Patterns of Practice and Quality of Care in Health Centers. Med Care. 2017;55(6):615-622. doi:10.1097/MLR.0000000000000689.
  2. U.S. Department of Health and Human Services, Health Resources and Services Administration. National Practitioner Data Bank. Rockville, MD: U.S. Department of Health. https://www.npdb.hrsa.gov/index.jsp. Accessed November 2, 2020.
  3. Jackson GL, Smith VA, Edelman D, et al. Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants: A Cohort Study. Ann Intern Med. 2018;169(12):825-835. doi:10.7326/M17-1987.
  4. Rymer JA, Chen AY, Thomas L, et al. Advanced Practice Provider Versus Physician-Only Outpatient Follow-Up After Acute Myocardial Infarction. J Am Heart Assoc. 2018;7(17):e008481. doi:10.1161/JAHA.117.008481.
  5. Yang Y, Long Q, Jackson SL, et al. Nurse Practitioners, Physician Assistants, and Physicians Are Comparable in Managing the First Five Years of Diabetes. Am J Med. 2018;131(3):276-283.e2. doi:10.1016/j.amjmed.2017.08.026.
  6. Mitchell PM, Wynia R, Golden B, et al. Institute of Medicine. Core principles and values of effective team-based health care. https://nam.edu/perspectives-2012-core-principles-values-of-effective-team-based-health-care. Published October 2, 2012. Accessed November 2, 2020.
  7. Doherty RB, Crowley RA; Health and Public Policy Committee of the American College of Physicians. Principles supporting dynamic clinical care teams: an American College of Physicians position paper. Ann Intern Med. 2013;159(9):620-626. doi:10.7326/0003-4819-159-9-201311050-00710.
  8. Jabbarpour Y, DeMarchis E, Bazemore A, Grundy P. The impact of primary care practice transformation on cost, quality, and utilization: A systematic review of research published in 2016. Washington, DC: Patient Centered Primary Care Collaborative. https://www.pcpcc.org/sites/default/files/resources/pcmh_evidence_report_08-1-17%20FINAL.pdf. Published July 2017. Accessed November 2, 2020.

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