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.

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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!