PA Employment Scams: Beware before signing the dotted line!

    When interviewing for open PA job vacancies don't be misled by false promises presented to you during the job interview process. Many unsuspecting PA job seekers have fallen for these deceitful tactics by unscrupulous employers. Beware do your diligent employer pre-interview research to avoid being scammed. Real information may be hidden from you or not totally truthfully disclosed. 

    Be skeptical, if the numbers (job perks) don’t add up or sound too good to be true, then heed your gut feeling–trust your intuition. Many of your colleagues who have been duped after realizing they were hired to function primarily as “practice scribes” will be reminded of this. This career job-hunting mistake is not only disastrous but sadly very costly too, especially if you have a contract and are locked into it.

    Think carefully and proceed very carefully when dealing with oral contracts, they might still be enforceable in a handful of jurisdictions. Conversely, written contracts are enforceable; at the very least discuss your contract with an attorney to ascertain that you are not being wrongfully hired by a “Snake oil vendor” employer type. Not everyone operates ethically in this business. Unfortunately, a sad reality that some have come to realize.

    Consider contracts carefully if you want to avoid legal entanglements at all costs. Beware of these red flags:

1. You are being pressured to sign the contract immediately w/o having a few days to review it with your attorney, or spouse.

2. Some interview promises are not written/included in the contract, and they state they will provide you with a “revised one” later. So, if something is not written in the actual contract, do not count on it. Rest assured if a dispute or problem arises, once signed that contract is the one that will govern the conflict resolution–much to your detriment. 

    Before proceeding, take into consideration the fact that under the law, being misinformed or somewhat uninformed about contractual arrangements and/or obligations is not considered a legal defense. As the old adage would say: “Buyer beware…”

Universal PA Career-related Stressors & Challenges.

         

        It is a given--all Physician Associates/Assistants (PAs) along their careers encounter "universal" stressors and occupational challenges. Herein in this post, a brief overview of the eight most common are discussed:

Burnout: The well-known demanding nature of medicine, with long hours and high patient volumes, can lead to burnout for PAs. This can manifest as exhaustion, cynicism toward their work, and often developing feelings of inadequacy in meeting their job responsibilities. For example, a PA working in an understaffed workplace might feel constantly rushed, unable to give patients the level of care they deserve, and eventually become emotionally drained and unconsciously disengaged. 

Burdening Workloads: Since the COVID-19 pandemic healthcare provider shortages have markedly increased, thus PAs are often expected to manage a significant workload. This can include seeing a high number of patients per day, performing administrative tasks, and trying to stay up-to-date on medical advancements. In this situation, a PA in a primary care setting might be juggling appointments, prescription refills, and managing complex cases, all while feeling pressure to keep wait times down and increase practice revenues. A reason why many leave medicine earlier altogether. 

Practice limitations: Depending on the state and their supervising physician, or practice protocols, PAs may have limitations on what they can diagnose, treat, or prescribe. This can be frustrating for PAs who are qualified to handle a wider range of cases but are restricted by outdated practice regulations. For instance, a PA in a state with restrictive practice laws might not be authorized to prescribe certain medications they believe would benefit their patients in managing their medical conditions. This creates unsatisfactory & unfulfilled sentiments for any practicing PA.

Heightened Emotional toll: PAs regularly deal with complex difficult situations, including litigious patients, deaths, and serious illnesses. This can take an emotional toll, especially without strong support systems in place or where work-life balance considerations are followed. As an example, a PA in oncology might develop close relationships with patients, making it especially difficult to cope with their passing, or an ER PA dealing with frequent devastating child abuse presentations. 

Poor Compensation Models: While PAs generally enjoy good salaries, some may feel they are compensated unfairly for the level of responsibility required and expected by their employers. This can be especially true if they are performing duties similar to physicians but earning significantly less. This naturally leads to a PA feeling very much undervalued. 

Unsupportive Employers: PAs generally would feel nonsupported when they feel/experience their organizational or practice concerns/issues are not heard or addressed for the common good or their well-being. This can be especially true if they have no voice or “representation at the table”. This has led to the rise of the unionization of PAs at large because they have felt professionally disrespected by their employer. 

Negative Workplace Politics: While PAs generally have good salaries, some may feel they are not being compensated fairly for the level of responsibility they take on. This can be especially true if they are performing duties similar to physicians but earning significantly less. 

Toxic Colleagues: While PAs generally are supportive of other PAs, not everyone conforms to this professional practice. Ego and personality differences sometimes cause or lead to professional tension and conflicts for a myriad of reasons. Among some of these reasons, one can always find distrust, envy, or even personal insecurities coming into play in these negative relational dynamics.

“Straight Talk" About Patients Handoffs Veiled Liabilities: The Signed-Outs & Bounced Backs–what you must consider.

As a hospital-based & former Emergency Medicine Physician Assistant (EMPA) at an urban inner city Level I trauma center, one of my biggest challenges was not only to spot the drug-seeking patients or rule out subtle life-threatening presentations but also to juggle & manage flawlessly two other high-risk types of patients: the “bounced-back” and/or the unimproved “signed-out” ones. Two potential med-mal time bombs waiting to happen most likely if not afforded the right clinical followed—through diligence or taken seriously on your watch, particularly when the liability factor was transferred to you by a recently graduated colleague or an intern (a 1st year resident) completing their work-related required shift. 

Why is that you ask? Well, simply because these two types of patients in some instances are usually either insufficiently or possibly improperly worked up. Thus, easily leading you astray in the already worked up supposedly ready-to-go “signed off” patient-shared presentation from the initial clinician. Especially when the clinical management or your partner’s clinical decision-making process was determined pending the patient sobering up or diagnostics results returning normal or “within normal limits” before you decide on the final disposition. Meaning you have the final say. But, before you discharge that patient, one question you must ask yourself is this: Do I have all the pieces of the puzzle fitting properly before discharging the patient? Again, does the presentation, hx, and findings fit the signed-out given to me? 

Typically these patients can present already “diagnosed” or “labeled” by another facility healthcare provider or simply yet by one of your very own colleagues from a different shift. This “pre-packaging” can easily lull you into a false sense of security. And, therein lies the legal risks & challenge(s). Given these situations & unconsciously you’re more apt to engage in potentially perilous clinical activities or behaviors unlike your usual self-methodical approach when working up your very own patients. These faulty cognitive derailers like the following examples listed next can set you up for significant medical mishaps. Let’s dissect them & expose their perilous outcomes, to both, you the provider, and the patient, the recipient of your faulty or flawed narrow-framed medical decision-making “shortcuts” known as heuristics. Here they are: 

1. Overconfidence Bias. Beware and be careful of either you considering yourself or the other party as competently flawless as you think you are. Be always cognizant of this dangerous mindset because you or your partner may have acted on incomplete information, or hunches, or very limited obtained data for that matter. This type of delusion of grandeur (inflated opinion) may result in catastrophic outcomes if we tend to believe we know more than we do, especially if we never had the “right” information or re-analyzed/re-assessed the presentation and/or signed off the patient altogether.

Remember, even the best of us can have “off days”…no one is perfect…especially at the end of their shifts–when they are most tired, fatigued, and very likely disengaged. 

2. Diagnosis Momentum Bias. This mindset has fooled many clinicians and accounts for “missed diagnoses” simply because you have accepted what someone else or a few others have diagnosed the patient with. 

However, you may not realize or be aware that provider A, provider B, or provider C never objectively proved the patient’s recurring or for instance their unimproved symptomatology. For all practical purposes, you engaged in becoming a “clinical copycat” since the “dx” had already been made incorrectly and you went all along.  So why reinvent the wheel? Again, clinical syndromes are not static, they evolve possibly leading to clinical instability in which you could miss a window of opportunity if fixated with the “signed-out” presented to you. 

3. Search Satisfied Bias. Here the element of premature closure surfaces because either you found or didn’t find what you were looking for in the hx or physical exam. Or better yet, your cursory workup was “okay” or acceptable” at face value. Again, be aware not everything presents classically or the overlapping symptoms may be pointing to more than one condition. This phenomenon is very well known and documented in many trauma-related presentations. Patients can present with different ailments/conditions that can be masked because they have a “distracting injury” or presentation for that matter. Therefore, it's best to do a secondary survey after the first one if no relevant or critical information was obtained initially. The bottom line is that you must remain vigilant and suspicious if the patient’s condition is unimproved or worsening or if ETOH is involved too. 

4. Anchoring Bias. In this situation, your colleague may have simply latched onto thinking his/her “first impression” was right or the only plausible one, therefore holding firmly onto that specific diagnosis. A very detrimental perspective or path to take when a patient’s course begins to prove inconsistent with the first diagnostic impression. Again this undue exerted influence or progressive development if it were to remain uncorrected, can certainly lead to possible allegations of a) failure to dx, b) failure to treat; c) failure to refer, or even d) wrongful death in some cases. This clinical inflexibility is very significant in the eyes of a judge and/or jury when the outcome of care is disastrous in terms of the outcome if there was a foreseeable medical intervention. 

5. Availability Bias. In this situation the clinician simply latches onto thinking his/her “first impression” is right thus holding firmly onto a specific diagnosis. A very detrimental stance to take when a patient’s course begins to prove inconsistent with the first diagnostic impression. Again this undue exerted influence or progressive development if it were to remain uncorrected, can certainly lead to possible allegations of a) failure to dx, b) failure to treat; c) failure to refer, or even d) wrongful death in some cases. This clinical inflexibility is very significant in the eyes of a jury.

Is it hard to be a PA?

     

      Like in all things in life, some things might be easier than others. But how about being a PA? That might be a little more complex to answer. Yet, simplistically speaking it can be both– hard and easy at the same time. In that vein, I will try to put it in perspective for you not so much from a clinical perspective but rather from an administrative one instead. 

      Personally, the way I see it is this: it boils down to individual and/or PA advocacy commitment level. So what difficulties specifically make it hard to be a PA? 

       For one, we (our profession) are constantly trying to prove ourselves over and over to the world that we are legit and belong in the healthcare playground like many other kindred professions. However, despite our rigorous training, and proven track record, we still fifty years later are by far more regulated, we are more unfairly scrutinized at every turn than anyone else. To make matters worse, even today, the Physician community and many nursing groups try to discount our role as healthcare team members or bring us down. 

      Another reason that it’s difficult is to accurately present our credentials to many misinformed or disinformed people inside and outside the industry when our title has “assistant” in it. Amidst this unfortunate conundrum, we [the PA community] have one thing going for us. We are a resilient group and started to move forward in our way of seeing ourselves. No matter how we are viewed or segregated, interprofessionally, whether minimized, or discounted, the patient community has started to realize and value our role and contributions. That’s what has been so hard in the past–the unleveled playing field. 

     Lastly, difficulties will always be present, however, we are starting to gain ground and be recognized, the industry generally speaking is becoming more tolerant and accepting of PA-led patient care, more so these days than when this author first became a physician extender in the late 80s. These days unsupportive employers are slowly vanishing, thus making PA practice less difficult.

      While some PAs are satisfied playing a subservient professional role in their careers, many PAs would argue that this is just setting too low a standard. It is time to assert ourselves and continue removing regulatory barriers or archaic restrictive statutory laws while continuing in our ascending trajectory. 

     In summary, from what I have seen & experienced throughout my career, the ease or difficulty of being a practicing PA while mostly multifactorial, it mainly would seem to stem from the level or degree of a PA advocacy commitment level. Professional passivity indirectly makes it more constraining to be a PA.

PA School Admission Essay Blueprint

        Through the years many practicing solopreneur PAs have launched their advisory services to pre-PAs contemplating a PA career. In addition, and specifically, a few books have been written on how to craft & tame that dreaded PA school admission essay--the subject matter to be tackled in this blog.

        Unfortunately, I don't have the coveted perfect template for this, however, I have a "blueprint" that will assist you in creating that complete essay for you. Upon completion, you should have a fairly good snapshot of yourself that the PA admission committee would extend an interview invitation to you.

        So to write a compelling piece, all you need to do is provide relevant details about yourself as it relates to the entry requirements, needed for that specific PA school program. Here are some suggestions to help you write your own best: authentic narrative

Template:

Introduction:

• Briefly introduce yourself and your previous or current academic background. Mention what interested you about the profession or experiences that led you to this career choice.
• State strongly your interest in this particular program--be specific or mention if their mission aligns with your values or focus in life.
• Briefly mention & explain what drew you into this program and how it aligns with your goals.
• Briefly summarize your skills, qualifications, and desire for a supportive environment.

Body:

Share & mention any specific social campaigns or drives, college community projects, or individuals (faculty)you admire within the organization. Also, share personal experiences or stories that shaped your desire to support a particular cause.

Conclusion:

• Again, reiterate your passion for the program and the organization's mission.
• Briefly summarize your skills, qualifications, and desire for a supportive environment.
• Express your gratitude for considering your application and look forward to discussing your potential contribution further.

Additional Tips:

• Keep it concise (500 words or less or the allotted length).
• Use clear and concise language, avoiding jargon.
• Proofread carefully for any grammatical errors.
• Be honest and authentic in your voice.
• Focus on your unique experiences and motivations.
• Research the PA Program thoroughly and tailor your essay to their specific needs and academic culture.

By incorporating your personal experiences and motivations, you can create a compelling essay that showcases your passion, and qualifications, making you a strong candidate for the applied program of your choice.

Beyond Deceitful Narratives

    Unfortunately, in this current world of media misinformation and/or disinformation, oftentimes it's very difficult to eliminate untruthful, deceitful narratives spewed by elitist social groups, or myopic organizations; specifically on the safety of patient care provided by The Physician Associate/Assistant community compared to other types of healthcare providers. As much as they try to obfuscate or veil the truth, most studies and collected data on PA-led patient care reveal a very different reality from the one usually presented about our inferior, unsafe care to the patient community.

Let's go beyond the quick glance & see what literature truly says about their false talking point:

1. Studies have shown that PAs perform at a level comparable to physicians in areas like diagnostic accuracy, patient satisfaction, and adherence to clinical guidelines. (Sources: JAMA 2009, Journal of General Internal Medicine, 2011)

2. Studies have shown no significant difference in patient safety outcomes between PA-led and physician-led primary care visits. (Source: Annals of Family Medicine 2014)

3. Healthcare System Integration:
The presence of PAs in healthcare systems is associated with increased access to care, particularly in underserved communities and rural areas. Several studies have highlighted the positive impact of PAs on healthcare costs, with their services often resulting in lower overall costs compared to physician-only care. (Sources: Health Affairs 2017, The Journal of Rural Health 2018)

4. Patient Satisfaction:
Numerous studies have demonstrated high patient satisfaction with the care provided by PAs, often emphasizing their communication skills, approachability, and patient-centered approach. (Sources: Journal of the American Academy of Physician Assistants 2012, Journal of Family Medicine 2015)

    The past and even current medical malpractice literature have consistently shown objective data positively showcasing PA practices' safe patient care outcomes. Case in point: a 2019 study published in the Annals of Family Medicine found no significant difference in malpractice claim rates between PAs and physicians in primary care.

    Based on these ( only a handful included) industry reports, PAs' patient-centered care approach makes them valuable members of the healthcare team, contributing significantly to improved access, affordability, and quality of care for patients across all socio-economic strata.

    I hope this information is helpful to you and gives you a comprehensive picture of the role of PAs in healthcare safety and quality. Invite others to go beyond the deceitful narratives.

On Becoming a PA Advocate--Just do it!

 Was PA advocacy on your radar in PA School?

No...not even close. But I believe this might place it in context for you: I come from a lineage of hard-working European relatives from both sides of the family. So it is in my DNA. Despite their/our humble beginnings, it seemed like there was always a sense of commitment and collective effort toward ensuring that every family member had an opportunity to succeed. In my case, to get an education as the 1st born American generation. This emphasis learned at an early age on working together and becoming a “person of value” rather than “success” has contributed to a deep sense of responsibility towards myself and my shared community fellow members. That would be the simple explanation I can think of for that query.

While I came late to the idea of a career in medicine at a young age, my inspiration and motivation for pursuing a career as a PA is steeped in a sense of purpose that extends beyond personal and professional aspirations, but more like "paving the way" to the next generation by repaying a profession that has been very good to me.

Truthfully, I am a self-proclaimed lifelong PA advocate. I have always looked at advocacy as an investment in my own professional advancement and personal growth as an individual. Again, I want to inspire the next generation of talented PAs and PA educators who align with the idea of giving back and enhancing our role in the healthcare industry.

Why did you decide to become a PA activist or advocate as some would say?

Initially in my career, I was viewed as a long-standing “spectator” member and inactive participant in our professional affairs for more than a decade when a friend suggested I should become a “participant” so my voice could be heard given that I was so critical and opinionated about our state chapter organization track record handling our legislative destinies. I accepted the challenge and this career move proved to be not only a pivotal but a foundational incident to my development as an engaged vested professional. Looking back, I would say that made me a better person than I was then. I must say it was a one-of-a-kind learning and a fabulous eye-opening experience. Akin to the old metaphor of "learning how the sausage is made".

Certainly, I am most proud and honored to have served in various roles as a previous member of The Michigan Academy of Physician Associates/Assistants on their Board of Directors. It was an exciting time of growth, development, and innovation that we all benefited by creating a more PA state-friendly practice through our partnering strategic efforts with various stakeholders. I feel humbled and honored to have been a small part of passing PA Act 379 as well as to have worked alongside a great group of selfless talented peers by benefiting from their respective expertise and talents. Having this window of opportunity to observe their dedication and leadership inspired me to think about ways to continue to contribute to the PA family even to the day I retire.

What have been or are some of your interests as a proactive PA advocate? Any advocacy activities that you’re excited to pursue?

First, I want to acknowledge that our role as board members is to be devoted fiduciaries to our constituent peers. We simply are in the room to be their voices and represent our members to the best of our abilities in nonpartisan ways. To me, and others alike this is an extremely important responsibility and one that I take seriously to this day and not lightly at all. 

Building on those past experiences, I remain committed to continuing to tackle other issues that impede the PA profession's progress throughout the healthcare industry. As of today, I think PAs face a significant challenge in removing PA practice barriers and archaic restrictions in Puerto Rico. With this ongoing challenge to our community, I am excited about working with other incredibly talented nationwide fellow PAs seeking to advance our mission of excellence in bringing access to 3.5 million disenfranchised Puerto Rican patients. Sadly,  due to their ineffective island healthcare infrastructure. Have been following this unresolved conundrum, and I vow to assist in moving the needle forward in creating a favorable “practice climate” for ourselves in Puerto Rico through the continuum of my career.

Is there anything you learned from previous Board leadership and servant advocacy that you think will help you in your efforts?

Throughout my career, I have learned many lessons, from team-based co-leadership, co-creating, and the idea that diverse teams produce better outcomes. We have tremendously talented and accomplished leaders in our community, and I look forward to these enriching collaborating experiences.

What do you see as the greatest challenges in the profession? Where are the greatest threats or opportunities?

The accepting embracement by the medical establishment of our brand has always been a source of contention in many respects over the past 5 decades. Albeit somewhat lesser today. And yet one of the greatest opportunities to continue to educate others. Our ability to be fully recognized and embraced is just a matter of time. Also, despite our past progress and ongoing efforts in dispelling misinformation, we must be cognizant that health disparities and inequities will remain an ongoing challenge. Patient-provider concordance and the availability of culturally competent care have proven to lead to better health outcomes. Championing our talented workforce diversity has the potential and has shown to play a critical role in helping our profession meet the evolving healthcare needs of our nation and around the globe too.

Many would like to give back to the profession. As someone who is starting out or is a busy practicing clinician, What advice do you have for those who want to get involved?

There are many compelling reasons to consider volunteering your time either at the state or national level. One of the greatest rewards and most impactful benefits associated with serving your profession is working alongside thought leaders and visionary peers leading to forging long-lasting friendships. There are various ways to get involved that don’t necessarily require a significant time commitment as many mistakenly believe (I know because I was one of them). Consider the profound difference you can make by dedicating even a tiny fraction of your time to the betterment of your professional family. Very few career experiences will compare to this--I know. I have lived it.

 

The Physician & Advanced Practice Providers Communities: A Problematic Unresolved Quagmire

Tension between The AAPA and the AMA as well as many other physician groups can be expected to escalate in the coming years. Over the past several years the physician community and the PA/NP Communities have been jousting with each other & at odds over the Scope of Practice advancement sought by AAPs throughout the country. Clearly, both groups are opposed to each other’s agenda. This entrenched philosophical quagmire is deeply rooted in misunderstandings, misconceptions, and even mischaracterizations that continue to this day. 

Many physicians' views of nonphysician providers are not very flattering ones. In fact, and currently, they are seeking to discredit this class of highly trained healthcare professionals by portraying them as unruly, deceitful unsubordinates seeking to replace physicians with inferiorly trained clinicians. Thus, claiming this places patients at medical risk given the short & inadequate training in their oftentimes misinformed views of APPs training.

Conversely, APPs see their counterparts as pompous and/or abusive team leaders. They rapidly claim and point out that physicians’ disdain for APPs is palpable if not visible in many circumstances. Thus, creating difficult interprofessional dynamics between both groups. Sometimes it is not uncommon to see animosity or acrimonious interactions between the two groups erupt on various social media platforms. 

Much to their chagrin, APPs are not only continuing to evolve but also assume greater bedside clinical responsibilities. Traditionally part of the physician’s patriarchal domain in the marketplace has been decreasing. Therefore this is seen by them as the ultimate professional encroachment & displacement. This threat is unfathomable in their minds. The fact, that PAs/NPs/CRNAs don't feel the need to be subservient practitioners to the past once-revered physician, this stance has not only exacerbated the relationship, but it also has contributed significantly to their interprofessional strain on many fronts. 

So, given the unresolved strained relations between both groups, the question becomes this: can advanced practice providers and physicians come to terms with working collaboratively side by side with such differing interprofessional practice perspectives?  But more importantly, can it be salvaged? restored?

For physicians, the bottom line is they see themselves “as the perennial captain of the ship”. For many of them, is untenable to accept nonphysician providers as associates as shown & evidenced in the many nonsupportive expressed opinions or official stances declared by their many specialty organizations through the years in various media or social platforms. 

Likewise, nonphysician providers feel unless the physician/medical community comes to terms with acknowledging their growing presence and role (raised professional status) in the healthcare landscape, it will remain an impasse.

 One thing is certain– if both groups fail to move beyond & come to terms, then the practice of medicine is going to be a miserable one for all involved stakeholders…including patients since neither group wants to concede acknowledgment to the other. 

We can only hope this quagmire doesn’t remain in perpetuity. But, only time will tell…