OTP Initiatives: The new Great Divide—does it need to be?

 

As a professionally diverse community of healthcare providers you couldn’t find a hotter topic of debate these days than OTP. As we continue to evolve and grow, we continue to face challenges and threats both at the internal and external level. And as a group, we are familiar with these ever evolving and/or recurring challenges that present as barriers, hurdles, etc. while often times demanding change of direction or even collective agreement on these various threatening perspectives.

OTP initiatives, depending on which camp you stand is something some of our own appear to be struggling with. On one hand the proponents seem to like the idea of its immediate relevant practice benefits in the marketplace, yet, conversely, the opponents seem to fret some uncontrollable potential repercussions such as physician groups becoming unsupportive or distancing themselves from the PA community. Proponents feel this initiative will level the playing field in the marketplace, by assuring us employment parity. Therefore, they hope and wish to move forward. Sadly, some opponents & even some PA organizations are openly favoring the status quo ( i.e. PAEA, ARC-PA )—not exactly a visionary position by these leading organizations. Myopically they view OTP as a de-stabilizer mostly of our outdated statutes & legal co-dependency in our working relationships with physicians. This in-fighting is becoming scary stuff, by creating confusion & fostering paralysis analysis in many levels.

But more scarier is the fact that some physician organizations( i.e., The AMA, the AFPA,etc.) are trying to forestall our rising momentum by using delegitimization tactics by undermining our calling into question of our role and efficacy. It’s obvious in this gate-keeping bullying role, all they’re trying to do is maintain/foster our longstanding legal co-dependency. Thus, now we find ourselves in the fight of our lives since restriction of trade can become a very tangible reality in our careers.

For OTP supporters we know how imperative & crucial this is—we must not allow the ongoing perpetuation of their self-serving selfish agendas, of lies and misinformation.

We have seen plenty of “intimidating “naysayers” about our profession throughout our evolution and development. Rest assured these situations are not new to us. Rest assured, that we will never cower from inside detractors nor from outside non-supporters.

I know that our firm resolve will prevail because we have celebrated so many other victories for so many other threats and/or struggles we have faced. I/We OTP supporters must stand strong and not waiver in these times of turmoil and internal strife regardless of how bleak or detrimental OTP detractors characterize it..

The time is now, not to hesitate but to move forward and modernize PA practice Acts all across the land. Let’s do this together,  recognizing OTP is the next chapter in our history, rightfully ours…we have earned it!

Why are Physician Assistants’ so misunderstood by everyone—even Physicians?

 

For all the accolades the PA profession receives from time to time in the print media, we, for all practical purposes still remain an enigma in many circles. And one can see this paradox very easily when we are misperceived or mischaracterized by the various media outlets; including reporters, writers, all disparaging us and referring about us with incorrect or very outdated information. So the question becomes this: why are PAs so misunderstood by everyone else including physicians? As a PA myself, I will try to explain these contributing factors objectively, however, it will become clear that these explanations are based on my experiences and observations acquired and developed over the past 30 years. Nevertheless, I will attempt to be objective & as factual as possible when dissecting this subject matter into its respective root causes listed below.

1.    A New Profession—As a profession, we just celebrated our 54^th anniversary this year. As a result, one can see that our “recentness” unlike other more established occupational fields such as medicine, nursing or engineering that ours is so new in the workforce that it can easily lead to misperceptions, or even gross mischaracterizations. Unfortunately, this becomes part of this problem when all the stakeholders are unaware or unfamiliar with who we truly are as a professional group.

                 2. A Misnamed Profession— Tragically our professional designation has not kept with the ever evolving healthcare industry. Painfully we [ the PA community ] have grappled with the name change game far too long. Moreover, our hesitancy and ambivalence have perpetuated this awful professional misnomer which continues to fail us in so many ways. For instance, it mischaracterizes our scope of practice to other stakeholders or it does not distinguish our concept from other less trained groups. This archaic inaccurate professional designation robs us of other stakeholders to clearly comprehend our role in the team-based model nowadays practiced nationwide.

              3. A Silent Profession—Collectively, we have become a timid, non-assertive group of healthcare professionals. In one hand  we’re professionally insecure, while on the other, as a community we have a sense of professional complacency. We seem to see ourselves as “I am just the PA”, this acquired an difficult to discard self-abnegation mindset makes us look powerless. It’s very obvious this psychological chain that bind us does nothing to help or advance our agenda, particularly when so many other kindred allied health professions  are feeling emboldened and empowered in advancing their agenda even if it ruffles others along the way.

 It becomes clear that this attitudinal behavior of ours is a significant barrier that must be discarded at once if we’re to move forward and not implode along the way. Resilient we must be, but truthfully without a “Darwinian outlook” (seeing ourselves as the fittest in the marketplace) then we will not.

                 4. Non-partnered Profession-- Symbiotic business relationships are very much needed if not a must. Nothing could be more detrimental than isolation or detachment from a business perspective. We have witnessed the meteoric ascension of the nursing profession (namely NPs) because of the open business community support. It has been very noticeable how these strategic business alliances have advanced their agenda and boosted their marketplace confidence. Three examples of this can be seen with their recent partnership with The AARP and their longtime associations with Johnson and Johnson, The Robert Johnson Foundation (a provider of corporate financial support of various nursing research projects throughout the years). This is one area where we have failed to pursue aggressively and miserably.

5. A Disrespectful Media— Sure we have all seen the titles: “PAs the hottest career” or “Fast track to a profitable career”, on the covers of Forbes or US News magazines.  But these are not the articles I’m referring to because they seek to provide a quick road map for thousands of graduating High Schoolers or college grads seeking potential objective information to aid them when making a final career choice.

I’m referring to the articles where PAs are bashed to the nth degree by insecure  virulent physicians or others trying to dissuade our significant industry contributions under the patient-safety rhetoric. This activity is inexcusable whether is mockingly done or the blatant inconsistent reporting which never ceases to amaze me. This media liberty taken upon themselves should be stopped because these negative descriptors of our profession does us a great disservice. How you may ask? When you hear, read these inaccurate pieces it becomes clear no fact checking has taken place. By showing a lack of basic understanding of our profession it does more harm to our name by delegitimizing our name or devaluing our credibility. Especially when our training, qualifications are questioned or minimized to the lay public. Sadly, with so much technology and availability it still boils down to ignorance and lack to exercise responsible reporting in my view.

                 6. Brandless Profession-- It continues to astound me to this date that we lack a strong professional identity (a distinctive brand). Thus, is it any wonder why so many stakeholders don’t get who we are or what we exactly do? How can they? Basically, the onus is on us—no one else, if we expect people to know our “brand” then we will need and could use some more name recognition but only if our leaders/community pursues a wide systematic marketing campaign across the country. Raising PA-awareness for all practicing PAs across all communities will bring us to the XXI-st century and create a connection with others who we work with—something so much needed, we’re not “doctors-wanna-be” or “glorified scut monkeys”. Let it be known that we’re accomplished professionals in our own rights (period). We no longer should be viewed as a subservient profession, we ought to stamp out this seemingly never-ending need to clarify or justify our industry role.

In sum & simply said, we need to be more vigilant, more active (engaging) with the world if we expect to be respected, recognized, appreciated and ultimately understood. The days of “I’m just a PA” should be over. Instead, we should be epitomizing/practicing the essence of this quote: “Change isn’t made by asking permission, but rather asking for forgiveness-- later” (Seth Godin, author of Tribes: We need you to lead us). Thus, misunderstanding of our profession would be much less…I would think.

 

 

“The Opioid Crisis: The way I see it…”

      The other day as I was driving home after work, I recalled listening to a brief NPR report on the Opioid Crisis. For the rest of the day I couldn’t help myself to think how did we get into this awful mess in the first place. Specially now several years later after all the deadly costs associated with this ongoing public health calamity ravaging so many communities throughout the country with no end in sight.

           I think we must have to acknowledge that this mess did not arise form ignorance nor stupidity…or did it? But, at a closer look it arose, instead from corporate unethical behavior & deplorable corporate greed. Retrospectively, in essence, all the circumstances & factors seem to have been ripe for the back then perfect storm (the creation of the Opioid crisis in the US/world as we know it today).

         During that time JACOH came out with a call for the medical community of prescribers to take stock of their ineffective role of controlling pain across the boards. Hence, “Pain: The Six Vital Sign” campaign ensued furiously. Naturally Big Pharma  probably felt this was their “green light” and moral justification to flood the market with opioids, after all it was us-- the medical community-- who undertreated (knowingly) pain for decades. Did we get framed for material gain alone or for their wider and deeper corrupt ends? Or didn’t the apparent consequences appeared foreseeable to all 3 stakeholders?  

        Perhaps, civic altruism let us astray during esthat time as in so many witnessed cases throughout history. Or perhaps as some of us would quickly point out or say, nothing more than The Law of Unintended Consequences playing itself out at its best. Or did we forgot to seek scientific guidance or take moral stock of our practices.

 As all 3 stakeholders scrambled to lay the blame ( point fingers for this unimaginable fiasco ) it becomes clearer to this author that we the medical prescribing community have been by far the most vilified group directly or indirectly by the media when in reality equity apportionment is missing to this day in most articles, op eds, essays, etc. covering this controversial subject matter.

 At this fork in the road, we should all continue to strive and remain committed to the vigorous pursuit of the truth (wherever that may lead) and persistent attention to the purposes for which these truths may be put in service. Moreover, how our actions or transactional inactions may compromise reflections of our individual and collective ethical values. The way I see it, we felt impotent in mitigating the opioid crisis when we had an opportunity all because we abdicated our role of patient advocates. Initially we should have spoken the truth even when it would have been difficult to disagree with the industry prevailing point of view..

 The way I see it, we should have known better... even big Pharma.

Self-made Quotes: A year of Angst for PAs

 

            Everybody likes to be quoted—including myself. I will be the 1^st to admit. So for this piece I basically decided to do sort of a satiric piece as if I was being interviewed by a medical writer by basically expressing my personal views using industry observational quotes…but with a twist:.

1. “If we’re perceived as ‘Paper Tigers’ when it comes to renaming our profession, then might as well capitulate and close the coffin now”
2. “Physicians will look at you sideways and probably rise an eyebrow if we try to assert and establish ourselves as ‘Physician Associates’, but conversely they would develop ‘Risus Sardonicus’ when we bring in the monies or revenues to the practice—after all is all about the master-servant relationship”… right?
3.  “For the AAPA trying to keep our profession brand-less, is not only a travesty, but more importantly brainless from a marketing point of view if you asked any practicing PA”.
4. “The recent surge of inaccurate media reports of our profession makes it more challenging to built professional equity when your ‘professional currency [legacy] is constantly being drained [ attacked]’. But is even more tougher when your primary lender [ The AAPA ] has defaulted and skipped town”.
5. [ Assistant ] “It got to go; Physicians, nurses, administrators and many other stakeholders, realize that ‘Associate’ is more appropriate. What’s of interest they have known this for some time now, even our leaders have been using the ‘let-us-downplay-this’ card sort-of speak for the longest. 

6.  “Have we not proven ourselves yet? It’s obvious, aside from surgery we no longer assist. I suppose myself and many of my peers either missed that ‘memo’ or quite simply don’t live nor practice back in the day like our predecessors did”.
7. “I confess, in my totally biased opinion, it seems nowadays we’re treated & considered like ‘2^nd tier providers’. When did this all began, I thought this would never happen according to Obamacare…at least that’s what I was told!”.
8. “Everybody is calling to reform our inefficient and chaotic industry, but truthfully it becomes nothing short than a ‘mud fest’ when all participants try to arrange or better yet super impose their agenda deceitfully –meaning unethically to some extent”.
9.  “If no one is watching over Big Pharma, where is the FDA then?”
10. “They [ AAPA’s HOD ] are difficult to work with as I have been told by my sources, and I can see that, after all, the actions or their ideologies speak volumes; they are still rooted back to 1992. So, I submit to you this: ’How can you move a profession forward when your leadership infrastructure is not only myopic but a little behind the times’. Last, I checked, it was 2021”
11. “It saddens me greatly to see a specific repugnant cultural behavior being practiced in our industry still in this day and age—namely bullying. Physicians’ demean their medical students, nurses demeaning their own too and we’re no different either at the end of the day if you asked me. So why is it we can not be like other industries were there is real civility, collaboration and even celebration of their top performers”.
12. “Right now PA morale may be low in some areas of professional practice. Yet, we’re not feeling sorry for ourselves, if anything we’re a tough & resilient group of professionals. We’re moving forward, we’re continually pursuing and striving for professional excellence in midst of our detractors Moreover, the PA community has always been a visionary one; it’s what truly define us. Personally, I think is part of our unique ‘PA DNA’”.

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