How to Convert a Clerkship (Rotation) into a job offer

       Ever thought of converting a rotation into a job offer?  Many graduating PA-S II should begin planning their careers while there are still training. Technically speaking, what better time than when you’re rotating through a particular clerkship to make a favorable impression on a would-be employer rather than wait until after your graduate.    

     So why not get a head start now before you’re forgotten and/or lost in the shuffle? It’s easier than most students would think. But you must be willing to implement 6 actions during this time while you’re “apprenticing” as a student; all while uncovering essential information while exercising professionalism & educating yourself as a regular job-hunter would in their job search. Thus, researching the practice, employer early not only will help transition you into your 1st job but also do well in your final grade as well.

           In this article, I will share six tips from an insider that will help get your foot in the door, to land that coveted job of yours, here they are:

 Tip # 1: Be an Invested Mentee:

          Always assure them know with your enthusiastic disposition that you are willing to participate, learn and contribute from all patient presentations even as a student rather than being a passive selective observant. You must build an unforgettable positive picture of yourself by showing a willingness to be actively involved even in the minutiae of any case. Implicitly and explicitly express & remind them of your “availability” even beyond what’s commonly assigned or expected for a student in a clinical rotation. Always maintain a highly visible profile/presence. Conversely don't be a pest or dead wood.

 Tip # 2: Be an open-minded Mentee:

           Even if you think you’re not interested in a particular aspect of the specialty. Let’s say geriatric cases are very appealing to you but not doing lumbar punctures per se, then that could be a minus against you. In other words, you would be sabotaging your chances if this surfaces in the open. This would be tantamount to the “kiss of death” if you were to vocalize such disinterest or infer it to a preceptor during the rotation. Develop the attitude and mindset that you want to learn every skill possible under the sun for that or any other rotation. Minimize disqualifying yourself from potential consideration or from building your skill set early in the game. The more varied your skill set the more marketable you are when faced with competition.

 Tip # 3: Be a Truthfully Humble Mentee:

           Do not be arrogant. The difference in being confident is being aware and assured in your abilities & limitations. Especially when responding to “pimped questions” by the mentor. Even unintended non-malicious deceptiveness never bodes well with hiring potential employers.

 Truthfully, is always best to say you do not know the answer or are unsure, however, you would do your best effort to research the answer to the question posed rather than guess at the answer your preceptor is looking for. Surely you will be more respected if you know and acknowledge your limited knowledge at hand. Not knowing or being a “walking Harrison’s” is not a “crime” nor a sign of “weakness” as sometimes we’re led to believe.

 Tip # 4: Be an Appreciative Mentee:

      Grateful people are remembered fondly; so be mindful and thankful for everyone you met during the rotation including administrative staff, ancillary clinical staff, and housekeepers or operators, etc. Not expressing your gratitude for their time and/or effort in assisting you in your development is not only inconsiderate but downright the surest way to fall out of favor if an opportunity ever presented itself in the form of a job offer. The key here is to have ready and pass a few handwritten thank you cards, or a batch of homemade cookies or brownies. Nothing says “thank you” better than such a selfless gesture and token of consideration in their eyes. 

 Tip # 5 Be a Professional Mentee:

       Nowadays healthcare workers are increasingly hurried –and patients as well. This makes it easy to be abrupt, stressed out, or easily become impatient with others. Remember we’re all humans and occasionally can say or do things that may come across as inconsiderate or at worst, self-centered. The key here is to always take “the high road” when dealing with others. Respectful interactions mean treating others as you would like to be treated yourself. By conducting yourself under this philosophy you are showing your cultural sensitivity and a high degree of maturity that very few can match. In summary, being friendly towards others makes you a standout in the minds of those whose path you crossed even if they meant no ill will towards you.

  Tip # 6: Be an "Investigative" Mentee:

             Always be cognizant of the practice or organizational cultural values, strengths, and weaknesses and see if they match yours as a potential workplace you would like to be part of when starting out of school. It’s perfectly acceptable to express or demonstrate your interest in returning as an “employee”. If that’s the case, covey this during the near end of the rotation to different team members, key preceptors, and/or hiring authorities.

        “Investigate” before leaving by asking if they would consider hiring somebody with your background and personality profile. Go ahead, and submit a resume, but only if they are as interested as you are. You uncover the fact that they would be willing to consider “grooming” you once on board. Be ready with your elevator sales pitch -- to explain in 30 seconds or less your desire to join the group, but more so how would you fit in. Yet, more importantly, how will they benefit from hiring you instead of someone else. For most employers that always seem to loom big in their minds, and/or the biggest hurdle to overcome for newly minted PAs. 

A Profile of the Lawsuit-Prone PA: Could you be one of them?

 

       Throughout our clinical year in PA school, we heard over and over the importance of obtaining a good history and documenting an accurate physical exam. Yet, there have been many times we forego obtaining a detailed history and performing a thorough physical exam because we think we can “cut a few corners” once we have become “seasoned” or “experienced “or even by simply relying on—possibly unnecessary—diagnostic testing.

         Tragically, this “false sense of security in technology”, and disregard for clinical thoroughness has led many PAs down the wrong path. Particularly, when the patient suffered an adverse outcome. Much to their career’s detriment, some PAs never realized that they incurred in significant self-liability risk exposures when adopting these detrimental clinical style practices or attitudinal views.

         Unfortunately to their chagrin in these instances, they found themselves embroiled in lawsuits alleging two common types of negligent claims committed: either by “omission” or “commission”, stemming from their poor history-taking style. All this stems from the fact that many do not know how to elicit a good, detailed history from the patient or simply due to clinical laziness. In other instances, due to insufficient time. Often is not so much what was not queried, but how was it asked? In other words, not probing for historic temporal specificities regarding onset, duration, frequency, location, etc. of the ailment/illness. In essence, the root of this clinical complacency habit can be seen most commonly when asking closed-ended questions as opposed to using open-ended questions.

          Case in point, a chief complaint of chest pain can have multiple etiologies as the underlying cause. Non-rephrasing or not re-querying a patient until a detailed history and thorough physical exam have been performed can lead the PA easily astray in his/her decision-making process. Thus, at best potentially robs the patient of an optimum outcome or an aggressive strategy if called for & at worse places the PA provider @ legal risk. Particularly when dealing with some life-threatening situations, thus muddying the clinical picture or presentation at hand.

Plus, another significant derailing factor is the lack of considering & documenting the clinical decision-making process along with listing respective Differential diagnoses along with the potential probabilities and what diagnostics were undertaken or other data refuted the likelihood of them in the workup.

Physician Assistants: Unsung Presidential-like Healthcare Professionals

            

        When it comes to naming the toughest job on the planet many are quick to point out that being President of The United States is at the top of the list. It’s not difficult to see why and understand this at first glance, but at a closer look, the same could be said about a few other professions too. However, I would submit to you that we [PAs] are about as close as any other ones. How might you say? Literally or metaphorically speaking, we [ PAs] are akin to the president in many respects, to a certain degree & in a general sense the same intense collective challenges, scrutiny & tremendous unrealistic expectations by so many others.

        Much like the president nowadays, facing daily increased pressure with compounding transactional complexities, requiring intense flawless decision-making moves, so do us practicing medicine in a fragmented, chaotic industry notorious for its very unforgiving litigious atmosphere and the ever-increasing world of burdensome regulations.

       Similarly, we’re expected to be assertive, but not domineering in our dealings with others, deliberative, but not appear indecisive all while advocating and empathizing without overpromising when being called to be stewards of the imperfect healthcare system (i.e., money-hungry Big Pharma, profit-making 3^rd party payers, an inefficient tort system and the list goes on).

       Also, historians and political observers agree there has been an increased disdain for the oval office in recent years. For instance, the press media was once considered less sensationalistic in their coverage of our presidents’ limitations like FDR’s wheelchair-bound existence or JKF’s notorious extra-marital affairs. Naturally, we the PA community are all too familiar with this surge of intense inter-professional disrespect in recent years, and the cyclical cyberspace backlash is also part of this malady. The never-ending misguided and misinformed portrayal of the PA community or being devalued in the broadcasting and print media has not gone unnoticed by our community, nor is it new nor will break our spirit. Just like past presidents, who must be balanced true diligent advocates, perpetually being strategic visionaries, in that stance, we similarly embody the positive traits of all our great presidents even though our job may be viewed as nonpresidential. Yet, while we might not sit in the oval office,  our jobs are often times the second or the 3^rd “toughest job in the world”,,,akin to the president's in my view.        

Keeping the Faith despite the stories they tell

      As the year comes to a close & after 34-plus years as a practicing PA and medical educator, I've never seen the level of inter-professional and intrap-rofessional intolerance seen nowadays in the healthcare industry. It has become practically Toxicity on steroids. All boils down to constant daily undermining transactional attacks of one form or another, whether very subtle to openly overtly. I see this daily in how some people and professional groups have made their personal and professional intolerant ideologies an urgent mission to be instilled and implemented @ any cost.

     The PA community, unlike any other group, has taken the brunt of this divisive assault that has become deeply ingrained in the medical profession, and more importantly, the ever-deepening damage it’s doing to all providers and patients alike throughout the western world and our country.

      From the moment the AMA went public minimizing and discrediting our profession, our industry contributions, etc. the opposition has been relentless & fierce. Among the numerous insults and accusations that have been hurled our way by those frightened by our success have been some of the  following:

● We’ve been called “Physicians wanna-be”.

● We’ve been called unsafe providers.

● We’ve been called unqualified deceptive healthcare providers.

     Just to name a few here. The one thing we haven’t been called yet? Probably has been visionary...That is thanks to the tireless work of thousands of our brothers and sisters seeking daily improved quality access to health care along with very few brave supporting physicians who seek to accept our brand & integrate us harmoniously into the very fabric of a fractured flawed industry.

      Fundamentally, I’m proud of them and those who see our adjudicative value.  I’m proud of our community for how hard we fight together for what we believe in despite all the industry naysayers.

       Shouldn't “Do No Harm” be the mantra by which we all measure our individual and collective actions by believing in giving everyone equal access to health care, in upholding the highest standards of medical ethics, and in unleashing a new era of life-saving medical breakthroughs? Shouldn't we also believe in allowing all professional medical providers to practice under the law to the highest scope of their practices thus helping everyone lead a healthier and happier life, regardless of who they are ( DPM, PA, NP, CRNA, OD, etc.)?

        Upon further reflection, I am hoping that we can overcome the forces that threaten the health and well-being of every American. We have a long way to go, and the forces arrayed against us are powerful. Yet, most of our fellow Americans and my fellow medical professionals/comrades realize this. We undoubtedly want a fair leveling playing field in which medical services are provided efficiently and transparently--nothing more nothing less. Is that simple.

        If we could only stop this bickering, finger-pointing we could elevate an industry beyond our imagination for 2023 and the years to come. Thank you for your professional tenacity, pride & hopeful outlook during these turbulent times. Keep the faith...despite the stories they like to tell.

My Pre-PA Journey

      There are many essays and blogs about folks relating to knowing about their early calling in life. For instance, such as: “I have always known that I would be "A" or "B", etc. You know the drill. Well sorry to say or disappoint, but this piece is not one of those stories you see quite often.

     Nor will I use the clichéd stories of how an ill relative or a friend or a close family physician served to be the inspiring force for me when considering a career. In fact, unlike so many other college students’ paths to medicine, mine was truly a circuitous one compared to so many others that I have known or read about. 

       Truthfully, I was never ‘pushed’ nor ‘talked’ into going into medicine by my parents or anyone else either for that matter. However, medicine didn’t cross my mind until I began enjoying my natural science courses as a freshman and sophomore, and junior in college. I felt I would end up pursuing a graduate degree in molecular biology. I even thought about being a bench researcher in the lab after graduating from college or becoming a medical technologist. 

        Basically during this time, I was setting my sights on landing a co-op job experience as a research student @ Argonne National Laboratory--- far from becoming a PA  back then. 

        Halfway into my 3^rd year, I began to feel an affinity for medicine as a potential occupational possibility, so to explore that late interest in a medical career and not with the romantic idea of becoming a doctor I decided to explore employment opportunities in a medical or a hospital setting. In a stroke of luck, I was able to land a job as a Pharmacist Assistant while completing my undergraduate studies. 

        Luckily this particular experience gave me a different perspective, a very insightful one on my desired career path. As I neared graduation, my options became clearer, and my desire to remain in medicine albeit in a different role was cemented; it was clear that my future would require a more definitive game plan from my behalf. For years, I methodically researched in depth about the different allied health careers, from “A” to “Z” and while the infinite options were considered and entertained, no would-be profession back then matched or resonated closely as much as the Physician Assistant Profession did for me.

             And the rest is history as the saying goes…    

                                                                                                                                           

One PA's dream

          

        PAs are a very diverse group, if not an eclectic one. Yet, having been one myself for the past 34 years, I know and feel like I am no different from my peers. We all have and share some same professional needs and career desires, Nevertheless, I believe and feel this dream of mine is pretty universal...I suppose. So. let me depict that dream for you, if I may.

        I get up every morning and stick my head under a hot shower head after shaving the night before. I get my lunch bag ready and I shuffle off to work while listening to the radio on my commute. Once in the hospital, I checked the surgical board seeking for added “emergent” cases that were added in between the elective cases. scheduled for that day  Shortly after, I meet with the ortho team (residents) and we go over the service patients list and divide the workload accordingly before reconvening at the end of the day one more time.

       However, as much as I try to keep my mind on my work, I can not help myself having fleeting visions of my dream in my head throughout the day. In that dream, every PA is respected, but moreover recognized & treated professionally by all other team members including the hospital administrators, the department heads or managers, etc. In that dream, PAs are not viewed as second-tier providers when compared to other Advanced Practice Clinicians or even by some misinformed recruiters or better yet: misinformed patients

       In that dream, we are recognized with legislative equity and parity, without regulatory barriers or reimbursement constraints. In that dream, not only do we continue validating our established reputable industry legacy, but we surpass it by taking ourselves to new heights of professional respect and universal recognition even in the eyes of the detractors.

        While no one has the luxury of daydreaming @ work all day long, nor do we think we may have a choice in the matter of improving our group destiny, the truth is, we can if we convincingly unite as a single voice and educate and speak out against those who seek to divide us or deprive us of our remarkable great professional advancement over the past half-century.

         Hopefully, in the near future, it will no longer be a dream but an affirmed daily reality!

The AMA: A Policing Organization?

       Every time I hear or read about the AMA meddling in our affairs, I must confess: I get more and more worried about our future. Their constant open disdain of our profession so openly seen on various platforms not only troubles me but should also the rest of us. However, and quite frankly, I am surprised to see just a few in our community denounce them. Even if nothing else, I’m sure most PAs have felt the sting of these disinformed one-sided campaigns targeting our brand.

       But just as if this is not enough, the current marketplace is changing at a rapid pace potentially where the perception and the stigma of being an "assistant" have never been more detrimental to our livelihoods.  For instance, the AMA behind the scene attempts to block or lobby against any PA modernization practice acts. By far the most disturbing and disheartening politics of their rhetoric is how to attempt to sow fear and distrust in the medical consumer. Clearly, they seek to undermine our credibility at every turn they can by deliberately overstepping their industry role by simply fostering PA practice advancement barriers.

       Similarly, and nefariously they have undertaken other lobbying efforts to jeopardize similar PA practice modernization bills throughout the country all under the mantra of "patient safety". When asked directly about these interprofessional restricting marketplace activities, they always default to their skewed anecdotal statistics. They steadfastly continue claiming their actions were/are solely based in the interest of public safety despite the robust available data today, fifty years later proving our solid industry track record regarding comparable patient care outcomes--- a very solid one indeed.

       Unfortunately, they have chosen to discredit the PA community through these unilateral overzealous partisan protectionistic lobbying moves without creating a spirit of collaboration or bipartisan dialogue. I/we do not believe this to be the trait of a transparent organization as they like to claim. Furthermore, I/we believe these lobbying activities are not appropriate nor in the best interest of creating a professional partnership between both groups. 

       It does appear, the role and mission of the AMA are incongruent if this is the stance they want to undertake. Furthermore, they are not a “regulatory governmental agency “ nor a “policing” agency but rather an association of an interprofessional group.

      Perhaps, they should be reminded they are not in the business of trade restraint & or fomenting interprofessional dissension, but rather collaboratively increasing access to care. 

Would you all please make your voices heard…

Justice for All through Health Courts

     

    

A Personal Book Review

  

      

     In his book How Doctors Think the author Jerome Groopman, MD presents an interesting perspective of human nature and clinical practice. He candidly discusses the causes of Medical Errors. In his own experience after much personal and professional reflection throughout his long career, he concludes that besides poor listening skills, detached clinical involvement, and lack of crystal-clear communication among patients and providers, “Diagnosis Momentum” is one of several derailers leading clinicians astray in their medical decision-making process.

 

        He also believed that many clinicians closed the diagnostic process loop prematurely. Thus, failing to begin a new diagnostic process on those patients with “difficult or elusive diagnoses”. This flawed approach or significant diagnostic short-sightedness is compounded because the clinician feels that all venues have been exhausted and there are no other differential diagnoses to consider given the fact that other providers sinched the most common presumptive dx, albeit wrongfully diagnostically speaking. Or our own clinical prejudices take us down the same path that others have ventured erroneously, therefore, failing to prove or uncover a disease state of the patient. 

        He also draws heavily from his colleagues & what he had learned from his colleagues (referrals) also seems to confirm his belief that whenever a misdiagnosis was involved in a negative outcome, it was always due to the rationalization that it was all due to psychosocial issues rather than organic issues. He also felt that many became less humane but more prone to stereotyping their patients.

        Dr. Groopman states clearly his thesis in the book introduction. Here he claims that a lack of inquisitiveness can increase clinical nearsightedness in any clinician.

 

        Fortunately, is not all doom and gloom, since medical error awareness has taken center stage in our industry. Systemic errors are increasingly recognized as many of the underlying factors contributing to medical misadventures.

 

         By understanding cognitively our shortcomings and negative attitudes, then we can begin improving healthcare delivery safety. But more so, by discarding those bad habits and incorporating our newly found knowledge and ethos can improve diagnostic reasoning.

 

So, yet another painful lesson can be learned from our practices. We need to maintain our patient advocacy call and vigilance up at all times and not let our professional guard down. We can no longer afford to be paternalistic nor disengaged or indifferent to the plight of our patients if we are to discard risky clinical outmoded practices. We can do better…we must do better. Without a doubt a great read for any clinician whether you're a novice or a seasoned veteran.

 

 

Strained Interprofessional Relationships: When PAs are ( unfairly) Scapegoated by Disingenuous Employers.

             Let me be direct and possibly blunt: 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 quick 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 every day.

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

            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 or hired as sub-contractual if hires 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. Our professional interdependence is not a parasitic one but 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 enterprise.

            Yet, keeping in mind that the business world is not regular, 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, we’re not doomed to be a submissive, subservient class because of protectionist 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, and misleading corporate metrics when sitting at the negotiating table with deceitful greedy employers. This day and age calls for a new negotiating perspective for all PAs. One of a “healthy mistrust of authority”. One that emphasizes searching for unbiased facts, probabilities, and objectivity to all stakeholders involved when seeking to find common grounds & simplify these discussions. In addition, we must learn to live comfortably 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 skewed information lacking indicators of legitimacy. So try not to put all your eggs in one basket when trying to make an informed wise decision, but at the same time don’t victimize yourself by procrastinating due to paralysis analysis… especially when debunking some questionable corporate fabrications.

            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 always to blame even though we’re steadfast 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) healthcare organizations or employers 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 corporate sins) – not exactly the pristine corporate behavior per se that they would like us to believe…right?

            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 PA pride.  

Biased Tell-tale PA Faculty Hiring Practices

        For all my colleagues who are considering transitioning into teaching, one word of advice: you must do it before you're older than 40 years of age. Otherwise, you could be considered past your teaching prime...regardless of how experienced or accomplished you have been in your PA career or professional journey.

        How do I know? What makes me an expert? Simple –I have lived it, so I am speaking from my very own firsthand experience. Sadly, implicit and explicit ageism exists even to this day in PA faculty hiring and retention practices. 

        And what I am about to say/share with you in this post, I suspect most likely will not be embraced by some if not by most of my peers.  Moreover, I am very aware & very prepared for the barrage. Yet, I feel it is my duty to be truthful and transparent on a few PA taboo issues such as this one– the huge Elephant in the room, sort-of-speak and everyone tends to be oblivious to it. 

        In all fairness to PA faculty recruitment practices, I will be the first one to admit that these faculty search committees often times strive for hiring fairness. Fair, perhaps, but in many instances not even close; sadly to say even as holistic their candidate selection criteria is advertised on their job postings.

        Why?  Because even with all the talk of practicing hiring inclusivity and aiming for diverse faculty retentive practices, etc., the reality is a very different one in academia when it comes to PA faculty selection. Unfortunately, there remains and unexplained gap; a dissonant one seen in many instances.  

        For example, while earning & shortly after obtaining my master's degree and working full-time as an EMPA, I was able to be a PA adjunct faculty member in one program and a guest lecturer at another one in the state. All while receiving excellent evaluations from my PA and non-PA undergraduate students from another local university. Doesn't my decade long teaching track record account for anything?  

         To date, after applying for several local PA programs within the past 4 years, having published over 95 non-clinical articles & commentaries in various PA Journals, spoken at various state yearly conferences, & served as an advocate at the state level for my profession through the years, all I have received has been only 2 phone interviews, but no invitations for a face-to-face interview.  

        If we (they) are as serious as they say they are in hiring qualified diverse faculty members, then they may have to rethink their hiring policies or protocols when hiring younger & much less experienced peers over older/senior seasoned colleagues. Because ageism (the unspoken practice) is still alive and practiced in many subtle ways is detrimental to potential experienced PAs by sidelining and disallowing them to be enriching contributing faculty members to the next generation of PAs. 

      Furthermore, practice what you preach w/o exceptions if you're a social justice advocate and authenticity & credibility is a core value of your system. Better yet, actively combat this myopic hiring practice. Lastly, who gets to be your faculty is just as important as who gets to be your PA student.

PAstroika: Metric or just a trendy Buzz word?

In recent years we have seen trendy terms & concepts come and go. However, when “transparency” became entrenched in our day-to-day vocabulary, our day-to-day expectations and/or dealings with all businesses, it kind of felt different. It truly began feeling right, not to mention it felt hopeful when it came to any type of transactional accountability expectations between two parties.

Used in a transactional and transformative business new paradigm context, it seemed like we were moving in the right direction—one leveling the playing field. For a moment, it seemed transparency represented a new higher standard of corporate behavior sought, expected or even aspired by all parties involved—external and internal customers included. Particularly when seeking to build mature & respectful relationships among both stakeholders.

But in recent years, we the PA community have disappointingly witnessed 1st hand how difficult this process has been for some companies to engage in it, and adhere through their public promise to embrace transparency and reform. 

The offending TV Networks

Unfortunately, I can not think of a more hypocritical & unprofessional  example of this issue than the unflattering portrayal of the PA profession through the TV major Networks. For instance, one of the most recent derogatory media references was when our profession, was  ridiculed in a satiric comedy show titled “Night life” aired on Feb 23rd, 2015. Essentially in this particular episode our education & training was utterly mischaracterized and trivialized as nothing more than “scut monkeys” pushing paperwork while trying to become physicians. 

As if that wasn’t enough, on March 4th,2014 the PA profession was again disparaged on prime time TV on the O’Reilly Factor broadcast. 

Similarly, he [ O’Reilly ] basically grossly misrepresented our rigorous PA training and the quality of our care-giving services by stating that we were akin to “Lenny”— a fictional community college graduate metaphor he used to compare our background against physicians. Contextually through his commentaries that night he implied the American healthcare consumer receives subpar care when care-giving services are provided by the Physician Assistants’ community.  

To this author and the PA community this Fox News report was extremely offensive, denigrating if not to mention unfair and unbalanced. It makes one wonder what ever happened to fact checking when reporting not only on a professional group, but anything else too. Almost a la “Rolling Stone” magazine "Faux pas" before the days of cancel culture. 

Along the same vein, even ousted Nancy Snydeman, MD former NBC New’s Chief Medical Editor misspoke about our background/role and our limited prescriptive abilities when caring for patients in a segment aired March 11th 2011.  In her defense and unlike the other TV show producers, she later, tried to correct her statements on her Facebook page the next day. Somehow, it felt insincere.

        So how did they slipped into these non-transparent behaviors? 

Essentially, at the core of their mischaracterized broadcasted reports was the fact they did not bother to research nor present factually the issues. Instead, would have they sought a more balanced reporting, these probably would have shown/depicted a very  more balanced group of highly schooled and skilled healthcare professionals: namely Physician Assistants community

        Unfortunately, journalistic integrity is dead & all three networks choose to forego their journalistic responsibility and the end result was the grossly and inaccurately misrepresentation of a highly validated & well-respected, cost-effective care-givers professionals to the healthcare consumer. 

Sadly, these examples illustrate the inherent egregious blunders each TV network committed and failed to apologize for their offensive and insulting aired transgressions. Generally speaking, these dismissive organizations not only lost value in the eyes of the PA community, but credibility as well tto this author. Clearly, not correcting the error will resonate negatively in our minds when it comes to TV network transparency. Thus, allowing their overt corporate arrogance to alienate us. 

Isn’t “transparency” bi-directional? 

If we as clinicians, are urged and expected to talk openly about our mistakes, foibles, and disclose harm done to patients and apologize promptly and sincerely, shouldn’t we expect the same from the business/TV industry? I /we would think so.

Therefore, doesn’t the PA profession deserve the same degree of respect, transparency in return?

         So far, it does appear that being transparent to the healthcare consumer is not nearly as important as garnishing high TV ratings, even if it’s disparaging a venerable profession. Frankly, these examples illustrate the inherent egregious distasteful blunders each network committed while failing to apologize for their offensive and insulting transactional transgressions.

These transparency Faux Pas certainly open the doors to speculation and debate on some companies understanding of this expected new transactional behavioral accountability. In short, transparent relationships do matter if you expect to have a trusted engaged readership, and/or viewership in these cases.  

In the world of the competitive diminishing market share & good customer relationship management, one thing is (and should be) key--transparency must be at the top of the list; anything less than that would be a problematic agenda for a TV producer and/or reporter…don’t you think?

Ten Verbal Blunders: Credibility liability in our practices.

Through the years I have seen some of the best clinicians instantly loose all credibility when letting a verbal blunder slip into the verbal interaction @ hand. At a glance what appears to be an honest assertion or an insignificant remark to us, it might not be so to a patient.  Moreover, these tongue slip-ups can rob you of your credibility if not great trusting rapport that you have enjoyed for years.

The following statements or phrases are those culprits alluded too:

1. “It’s not a big deal”: While the single closure of a wound might have not been your very best that day after countless other ones through the years, for the patient  this statement  would be received as you didn’t take the time or cared for the cosmetic outcome. Your careless statement basically discounted their trust.

2. “It’s a slam dunk”:  Sure, easy for you to say since you’re not the recipient  of an unfamiliar procedure or intervention for an anxious or distrusting individual of the medical industry. Patients like to be informed of all attendant risks…not some or partially. 

3.”You’re making this more difficult than it really is”: Your empathy just went out the window with that negative reassuring comment –if you thought it was one. Best practice would be to say, “I will do my very best to minimize any pain or discomfort or possible complications”. ‘I/we will get you through this together”.

4.“Bee sting” : The sight of a needle is anxiety provoking even in the “toughest folks” or “weekend warriors”. Downplaying the discomfort even with the best of techniques doesn’t help anyone under these circumstances. Pain or discomfort should never be “embellished”—just be truthful from the outset. Is best if you tell them you will be as gentle as you can be. Again, never say  ”this won’t hurt you”.

5.”There’s nothing wrong with...” This dismissive statement simply translates into the patient’s mind that you doubt his/her concern or complaint being legitimate. 

Before closing the door diagnostically speaking it might behoove you to do some preliminary testing or investigation. Avoid early diagnostic closure, ( aka Anchoring—a medical heuristic ) especially if there’s a unexpected or bad medical outcome.

6.”Guaranteed, this will...” get better and/or resolve in 2 days…2 weeks… 2 months. Assurances are best to leave out of discussions, rephrase outcomes or your expectations in terms of probabilities instead. For instance:..”my best guess is…” by using this statement,  the patient will be less disappointed if the course of the illness or ailment takes longer to resolve or improve.. Early resolution, and you are a hero—simple as that.

7.”Sorry for the delay, we’re busy today.”  Patient’s view their time just as important as yours. If there’s a delay notify them @ once and explain that you will be late. They will be appreciative if you can re-schedule or give an approximate time of seeing them. Saying you’re busy is not as good as saying an impromptu situation caused the delay thus requiring your immediate attention before seeing the patient. Always close or state you appreciate their patience & understanding.

8.”Oopsie”: Not something you want to say when a mishap or an error happens. This word does not mitigate the bad outcome or the unintended consequence even though you might think so. Be honest and use a direct approach when explaining what went wrong or possibly caused the departure. Stick to honesty.

9. “I’m the best @ this”:  Based on whose opinion—Consumer’s report? They think not. Perhaps stating how many X-Y-Z procedures you have done with safe outcomes might be more prudent and less arrogant-sounding to their ears. Moreover, it would be best if your supervising attending physician or colleague would endorse you by saying or praising your accolades even though there’s nothing wrong feeling you’re the right person for the job or task at hand.

10. “I have nothing ‘ else’ for you…I wished“: Short of a terminal illness which you can always consider palliative or hospice care, you must consider exhausting all medical resources and/or venues before uttering this “I/we’re give up” on you. We must keep a balanced perspective (naturally) and accept that we are not to engaged in practicing futile medicine, but we must not abandon ship to soon if there’s some significant statistical chance of medical recovery. 

Sometimes another medical perspective is reasonable and needed. Remember, each and one of these statements, words or phrases could easily undermine your patient’s trust. Place yourself in your patient’s shoes if your to be the recipient of these verbal faux pas. You would feel resentful or upset at the very least. Don’t you think?   

So, before you engage your tongue …you must engage your brain to avoid these verbal blunders be part of your day-to-day communication. 

An Open letter to all PAs

    If you are a proud  and professionally engaged PA, chances are you would be intolerant and very critical of the recurring mischaracterizing narrative about our profession. This growing anti-PA narrative seeks to sow doubt in the patients’ minds mostly by disparaging our highly studied/documented  great patient care outcomes across the board through the past 54 years.

    Stopping this malignant spread of interprofessional bigotry does require the commitment of many if not the entire PA community.  We must not only be alarmed, but morally concerned --if not outraged-- about the long term negative ramifications this may pose to our standing in the healthcare industry. Truth be told, I personally and professionally after 34 years of practice never been more alarmed and concerned about this than I am seeing take place in the marketplace & various media outlets these days.

    Our work history, our Industry credibility speaks for itself, especially when it comes to delivering the highest competent patient care as it has been shown study after study. 

    But most importantly, and pressing is the fact that we don't have a moment to lose. And if you think about it, we are at a crucial crossroad determining the battle for our survivability. Make no mistake, about this: our fate is in our hands--not in the AAPA’s. Moreover, we still remain “brandless” to most Americans. It is very clear, we still are viewed as a subservient professional class to the various stakeholders & physician communities. Even the mainstream media has failed to be objective when it comes to describing the physician assistant community contributions to the healthcare industry.

    And quite honestly it is up to each and one of us to get active and vocal by joining together and educating, and advocating for our very own cause. I do believe that we should entertain the idea of creating a PA Watchdog organization  in order to secure our own vested interests given the current anti-PA climate. Naturally, coming together in seeing this shared vision come to fruition will help police those seeking to erect barriers or foster industry inequities by eliminating all prejudicial interprofessional ignorance.

    Just remember, become an educational activist in your profession. Do not allow your peers or yourself to be silenced or marginalized for that matter. It is simple to see, we need everyone to come together and have our voices heard.  After all, “PAs” matter too!

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 objective 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 to us when compared by others.

As I am sure, you have noticed our profession has been maligned 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, splintered 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 lobbying allies. Unlike our community which we lag behind because we 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 more mischaracterization of a great profession that has served you & all of us well. Please, donate, speak and or write to debunk this flagrant lie. You must assert the truth when clarifying or inform others about our magnificent profession.

The Opioid Crisis: Who is really to Blame?

        Finger-pointing for this debacle and health crisis has been widespread, albeit skewed and unjustly zeroed on the medical community. In my opinion, much of it is unfair since I have yet to come across any reading that has taken a more objective in-depth look at the causative factor and asked unbiasedly why it happened in the first place. In other words, place the problem in its proper context by examining the genesis of this debated conundrum and ask ourselves– who is really to blame?.

        Critics have mostly blamed Big Pharma for their greed and the federal government & states for their poorly slow response to this devastating societal tragedy. But one would be remiss if the blame would go non apportioned accordingly, meaning forgetting to recognize or at the very least attribute other entities directly or indirectly responsible for this public health nightmare; to basically go one step further, right?.

So who else should be held responsible? Well, for starters how about JCAHO? The Joint Commission Accreditation Hospital Organization, the quasi-governmental bureaucratic agency that led the well intended campaign named “Pain the 6th vital sign”  back in the late nineties. Based on their researched studies, they spearheaded this idea/project & placed the healthcare industry in a very untenable position since the medical community had failed to address the undertreatment of pain for decades, thus pressuring medical providers to correct this deficiency in the management of chronic pain. Obviously this industrial guilt trip became deeply rooted leading to over prescribing.

By their views, we were told to step-it-up and so we did, because they told us so. Sadly and mistakenly, we failed to pause and reflect on the foreseeable consequences of this moral dilemma. Yes, we must and have accepted to shoulder this imperative responsibility in our clinical practices/careers. Unfortunately, this self-created malady is a classical example of “The Law of Unintended Consequences” – an undeniably painful reality to this day. 

The medical community has strived and will continue to do so when it comes to addressing & dealing with this complex clinical phenomena by becoming more educated & becoming more prudent prescribers. A work in progress to this day, but improving.

           As all stakeholders have become aware of this difficult problem, we should avoid this past pressurized demand. Furthermore, avoid singling out a particular group & stop pointing vilifying fingers. But more importantly, recognize & accept the fact we all played the “over prescribing role” in this disgraceful national opioid epidemic. Simply, we must do it.

ReplyForward

The Hateful Trifecta

 

In 2021 & 2022, one thing was & is becoming clear: the anti-PA rhetoric is becoming louder & louder by the minute as seen by the American Medical Association (AMA) back in November 2020, entitled “ #stop scope creep... because patient safety isn’t a game”. Also, ACEP ( The American College of Emergency Physicians), and AFPPA ( The American Family Practice Physicians Association are the last physician communities to go public with this agenda. These Physician groups are morally bankrupt since their campaigns essentially seek to stall or halt the evolutionary progression of the scope of practice of Advanced Practice Providers ( APPs), mainly Nurse Practitioners, Physician Assistants, Nurse Midwives and CRNAs.

Healthcare is evolving, not to mention nowadays is 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 be a true physician extender. 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 & physicians too.

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 health professionals. In fact, rest assured The Advanced Practice Providers Community do not disagree nor dispute with this premise.

However, what this author/we object and disagree with is their hypocritical & disingenuous fear-mongering media campaign of misinformation to the American Healthcare consumer. They basically seek to build & present their skewed argument on untruthful statements about the safety of the health care services provided by us.  

This fomented inter-professional divisions of curtailing the modernization of PA practice at the legislative level should be viewed and considered a significant barrier to the increasing and facilitation of healthcare access to our fellow Americans in an already fragmented healthcare industry. But make no mistake, right now is a critical time to put these turf battles to rest. Now is the time  to place inter-professional political ideologies or differences aside  for the common good & betterment of a siloed industry.  As a group of healthcare professionals, we should & need to stop demonizing, disenfranchising or canceling other Healthcare Kindred professions.

It's time for them to stop seeking to score political points with partisan constituents by marketing disinformation to the general public. Quite frankly in my view, this hypocritical industry practice model is very short-sighted, professionally divisive,if not completely unconscionably unsustainable.