The Resilience of the Pen

        In the journey toward a fulfilling career, particularly in the demanding realm of biomedical writing, the road is often fraught with unexpected challenges and discouraging feedback. However, it is through these trials that we cultivate resilience and build a legacy that stands the test of time. This post & article serve as an inspirational guide for any aspiring biomedical writer, illustrating how to turn setbacks into stepping stones on the path to success.

        The journey of a budding writer is often filled with excitement and a deep passion for translating intricate scientific ideas into accessible and impactful narratives. Picture yourself, a novice writer, clutching a manuscript intended for a prestigious medical journal, filled with hope and ambition. Yet, instead of receiving constructive feedback, you face a harsh rejection from the editor—a moment that could easily extinguish your dreams. This experience, though painful, is not uncommon; yet it is the pivotal moment that can either break you or propel you forward in your writing aspirations.

        Unfortunately, the sting of rejection can be overwhelming and devastating, leading to self-doubt and a questioning of your abilities. It is natural to feel disheartened and to consider retreating in the face of such criticism. However, it is precisely at this moment that resilience should become essential. Rather than allowing a single negative opinion to define your worth, recognize that it is merely one perspective among many. The key is to harness that initial disappointment and transform it into motivation—a defining moment if you will in your career, propelling that momentary momentum loss.

        My own journey began over 15 years ago, marked by a similar experience of rejection. Instead of succumbing to despair, I chose to view that moment as a catalyst for growth. I understood that the editor's harsh dismissal did not reflect my potential but rather their preference for a different voice. This realization ignited a fire within me, driving me to seek out opportunities that would nurture and hone my talent and allow me to flourish and re-establish my desire and visionary purpose.

        Fifteen years and numerous writing credits later, my journey stands as a testament to the power of my personal resilience and unwavering determination. It serves as a reminder to anyone that setbacks are not the end of the road but rather opportunities for growth and learning. For those entering the field of biomedical writing, remember that challenges are part of the process. Embrace them, learn from them, and let them shape your character and view them as stepping stones
rather than career hurdles.

        As you navigate your own path, keep in mind that the validation of others does not define your voice. Seek out mentors and collaborators who believe in your abilities, and be open to constructive criticism while discerning it from negativity. Trust your instincts, follow your passion, and never let the fear of rejection dim your enthusiasm and/or vision.

        The journey of a medical writer may not always be easy, but the rewards of educating and informing others are immeasurable. By cultivating resilience and staying true to your passion, you can turn obstacles into triumphs and carve out a successful and fulfilling career. Let my story of transforming scorn into success inspire you to forge ahead, share your unique talents, and pursue your dreams with unwavering conviction. The world needs your voice—let it shine brightly even amongst the naysayers.

Doctorate Degrees for Physician Associates on the Rise

        Over the past decade or so, the landscape of healthcare has been undergoing a significant transformation, marked by the rise and increasing prominence of doctorate-level healthcare professionals such as Nurse Practitioners (NPs), Physician Assistants (PAs), and Psychologists and Physical Therapists. This evolution raises important questions about the responsibilities and roles of these non-physician doctors within the healthcare system, particularly regarding the traditional position of physicians. While the expansion of healthcare providers aims to enhance patient care and accessibility, it has also sparked significant resentment among physicians who feel their expertise and authority are being undermined. This op-ed explores the implications of this trend and the underlying reasons for the discontent among physicians.

        The rise of doctorate-level healthcare professionals is largely a response to the growing demand for healthcare services, especially in underserved areas. NPs and PAs are equipped with advanced training and education, allowing them to perform many of the same functions as physicians, including diagnosing conditions, prescribing medications, and managing patient care. This shift is seen in the industry as a necessary adaptation to a healthcare system strained by rising patient numbers and a shortage of practicing primary care physicians. However, the perceived encroachment of these professionals into what has traditionally been the domain of physicians has led to palpable tensions within the medical community in recent years. At times, interprofessional battles, finger-pointing, and disparaging narratives designed to raise confusion in the patient community.

        One of the primary reasons for physician resentment is the perceived dilution of medical care authority. Physicians undergo extensive training, often spending over a decade in education and residency to hone their skills and knowledge. This rigorous preparation fosters a sense of pride and professionalism that some physicians feel is being compromised by the rapid expansion of roles of Advanced Practice Providers (i.e., NPs, PAs, & CRNAs, etc.). Many physicians subjectively argue that while these professionals are valuable, they lack the depth of training required to handle complex medical cases, which can lead to potential adverse risk outcomes for patients.

        Additionally, in their mind, the evolving role of doctorate-level healthcare professionals raises concerns about the quality of care. Physicians worry that patients may not receive the same level of expertise and comprehensive understanding of medical issues when treated by NPs and PAs. This concern is exacerbated by the fact that many patients may not fully understand the differences in training and qualifications between these providers and physicians. As a result, physicians fear that the public may inadvertently place their trust in less experienced skilled practitioners, leading to suboptimal health outcomes and siloed medical care.

        Moreover, the financial implications of this trend cannot be overlooked. As healthcare systems increasingly rely on NPs and PAs to fill gaps in care, physicians may find their roles diminished, clearly leading to increased market competition & in many cases reduced job security and income. The shift towards a more collaborative model of care can create competition for patients and resources, therefore fueling further resentment among physicians who feel their expertise is being undervalued in favor of much “cheaper” (cost-effective) alternatives even though it has been debunked by extensive research studies.

        In conclusion, the evolving role of doctorate-level healthcare professionals presents both opportunities and challenges within the healthcare system for all stakeholders. While the intent is to improve access to care and address physician shortages, it is crucial to acknowledge the concerns of physicians who feel their authority and expertise are being undermined by this industry trend.

        However, the physician community must accept and understand that as the healthcare landscape favorably continues to change for AAPs, all stakeholders need to engage in open dialogue, ensuring that the roles of all healthcare providers are clearly defined and supported while maintaining patient care as a top priority. Balancing & incorporating the contributions of NPs, PAs, and PT, Psychologists along with physicians, will be key to fostering a collaborative synergistic environment that ultimately benefits the healthcare system as a whole.

Covid-19: The Lessons learned—Navigating The Polarized Political Discourse: A Call for Temperance and Rationality Above all else.

        In an era marked by heightened political tensions and rampant weaponized misinformation, it is crucial to approach these discussions with a sense of collective responsibility and temperance. This commentary explores the importance of civil critical thinking in the face of egregious thinly veiled misinformation from authoritative health organizations during the pandemic. I advocate for a more rational discourse that transcends partisan divides and encourages a collective move towards informed decision-making and away from half-truths, or even disinformation.

The Impact of Misinformation

        While everyone is entitled to their opinions and political views, it is essential to recognize the detrimental effects of misinformation propagated by organizations such as the CDC, NIH, and the WHO during the COVID-19 pandemic. The erosion of trust in these institutions due to their partisan political leanings has led to a significant loss of credibility among the American people. 

        And who is to blame for that travesty? Therefore, individuals and patients must prioritize the evolving scientific evidence over pseudoscience, which often emerges from the fearmongering and protective financial interests and/or agendas of these organizations, as we witnessed during this time.

A Call for Rational Discourse

        The current political climate has been rife with plenty of demonization and vilification of opposing viewpoints. This behavior naturally stems from unfounded, myopic, and utopian perspectives that fail to acknowledge historical context and Public health's competing complexities. It is vital for leading organizations and the public health communities, like the NIH and CDC, the WHO, to maintain an apolitical stance, focusing on evolving evidence-based practices rather than engaging in partisan policies and pocketbook politics as we witnessed during the pandemic.

Moving Beyond Partisan Divides

        To foster a more constructive dialogue, we, all healthcare stakeholders, must discard the tribal mindset that pits one group against another. The notion that "my tribe is better than yours" only serves to deepen divisions and hinder progress. Instead, we should strive to learn from the past, particularly from the disastrous jousting legacy of the previous scientific and public health communities that did not serve well the administration of sound public health measures along with their vitriolic narratives and inconsistent interventions and varied points of view.

Conclusion

        In conclusion, as we seek to better navigate the complexities of political discourse during future potentially divisive pandemics, let us commit to a more tempered approach and stance in these matters. By prioritizing sound scientific integrity and fostering deep, respectful civil dialogues, we must commit to working towards a more balanced, restorative, informed, nonpartisan approach than we did with the COVID-19 pandemic. 

        It is time to move forward, leaving behind the divisive partisan tactics of the past and embracing a future grounded in reason and nonpartisan collaboration.

Proactive Patient Management: Avoiding the Pitfalls of Reactive Clinical Care

In the fast-paced world of medicine, clinicians often find themselves racing against time to manage acute patient crises. However, this reactive approach can result in dire consequences, as it often involves intervening only when patients are already in critical condition, a situation colloquially referred to as "circling the drain." This article emphasizes the importance of proactive patient management and the necessity of early intervention to prevent patients from reaching such critical states.

The Risks of Reactive Care

Reactive care is a common pitfall in clinical practice, where action is often taken only after a patient's condition has significantly deteriorated. This approach not only jeopardizes patient outcomes but also places an unnecessary burden on healthcare providers who must then engage in "catch-up medicine." The consequences of failing to anticipate and address potential health issues early can be severe, leading to increased morbidity and mortality rates, as well as heightened emotional and legal stress for all parties involved.

The "Window of Opportunity"

In medicine, timely intervention is crucial. The "window of opportunity" refers to the critical period during which appropriate and decisive action can significantly alter the course of a patient's condition. Missing this window due to inattention or delayed response can lead to irreversible outcomes. It is imperative that clinicians remain vigilant in monitoring their patients and act swiftly when early signs of deterioration are detected.

Foreseeability and Its Role in Patient Care

Foreseeability involves the ability to predict potential complications based on a patient's current health status and risk factors. Dismissing or ignoring foreseeability is inexcusable in clinical practice, as it undermines the very foundation of patient-centered care. Clinicians must employ a forward-thinking approach, utilizing all available data and clinical judgment to anticipate and mitigate potential issues before they escalate.

Legal and Ethical Implications

In extreme cases where patients suffer due to delayed intervention, even apology laws, which are designed to provide legal protection for healthcare providers who express regret, may not suffice to mitigate the consequences. These situations highlight the ethical obligation of clinicians to prioritize proactive care and uphold the highest standards of medical practice to prevent avoidable harm.

Strategies for Proactive Management

1. Regular Monitoring and Assessment: Implement routine check-ups and continuous monitoring to detect early changes in patients' conditions.

2. Comprehensive Risk Assessment: Utilize comprehensive risk assessment tools to identify patients at high risk of deterioration and tailor management plans accordingly.

3. Interdisciplinary Collaboration: Foster communication and collaboration among healthcare teams to ensure a holistic approach to patient care.

4. Patient Education and Engagement: Empower patients through education and active involvement in their care plans, enhancing their ability to recognize and report early symptoms.

5. Utilizing Technology: Leverage technology such as electronic health records and predictive analytics to track patient health trends and anticipate potential complications.

By shifting from a reactive to a proactive approach in patient management, clinicians can significantly improve patient outcomes, reduce the incidence of critical health crises, and ensure a more efficient and effective healthcare delivery system. Embracing this proactive mindset is not only a professional responsibility but also an ethical imperative in the pursuit of optimal patient care.

Briefly Debunking Untruths about PA Quality Care.

 

        Despite the Physicians Protecting Patient Safety group's campaign and its skewed, untruthful mischaracterization of the quality of care provided by Physician Associates/Assistants (PAs), let me be clear about this blatant wrongful assertion. As of today, numerous studies over the decades have shown that [we] PAs consistently provide patient care services comparable in quality to those provided by physicians. This equivalence is evident across various healthcare settings and patient populations, highlighting the cost-effective integral role PAs play in delivering effective and efficient healthcare.

Brief Key Studies and Reports--

1. The Congressional Office of Technology Assessment: This comprehensive study found that "PAs provide health care that is indistinguishable in quality from care provided by physicians." This conclusion underscores the clinical capabilities of PAs, hence, affirming our role in delivering very high-quality medical care.

2. The American Surgeon (2004): This study identified PAs as "a valuable adjunct in improving quality of patient care," particularly in surgical settings. This study basically highlighted how PAs contribute to enhancing healthcare delivery through our skills and teamwork.

3. 2009 Rand Report: The Rand Report also reviewed multiple studies involving PAs and confirmed [we] PAs provide care of comparable quality to our counterparts physicians. This report is a significant endorsement of the PA profession, showing our effectiveness in maintaining very high standards of patient care.

4. Nationwide Study (2005): This study found that Medicare patients were generally satisfied with the quality of healthcare they received, regardless of whether it was provided by a PA or a physician. This indicates that [we] PAs across the board meet patient expectations and contribute positively to patient satisfaction.

Additional Examples and Sources--

• Journal of the American Academy of Physician Assistants (JAAPA): Additionally, various studies in JAAPA have demonstrated that PAs achieve similar outcomes to physicians in managing chronic conditions like diabetes and hypertension, with comparable patient satisfaction scores.

• Health Affairs (2013): An article in Health Affairs highlighted the critical role of PAs in expanding access to care in primary settings and in maintaining quality without compromising patient outcomes. This study emphasized PAs' contribution to addressing healthcare shortages.

• BMJ Open (2015): A systematic review in BMJ Open assessed PA care in emergency departments, concluding that patient outcomes were comparable to those managed by physicians. This supports the reliability and effectiveness of PAs delivering patient-care services even in high-pressure environments situations.

• Cochrane Review: A Cochrane Review on mid-level providers, including PAs, found that we deliver care equivalent to physicians in terms of patient outcomes and satisfaction, particularly in primary care settings. This review underscores the consistent quality PAs provide.

• The New England Journal of Medicine (2011): An article discussed the integration of PAs in various healthcare systems, noting their ability to provide high-quality care and improve access, particularly in underserved areas.

        These studies and reports collectively highlight the high standard of care provided by PAs, demonstrating our essential contributory roles in the healthcare system. Our ability to deliver care comparable to physicians is not only well-known but more importantly well-documented as well, thus making us vital contributors to patient health on increasing access in this broadly fragmented weaponized healthcare landscape.

"It Won't Happen to Me"

 

        You never want to think that one day you might get entangled with a medical malpractice claim. And in the realm of healthcare, the belief in infallibility among professionals can lead to a dangerous practicing mindset. This article explores the psychological and systemic factors that contribute to the perception that medical malpractice claims are unlikely to affect healthcare providers. By examining these elements, we can better understand why many professionals may feel immune to the consequences of their actions, despite the reality of the risks involved.

The Illusion of Infallibility

        Healthcare professionals often undergo rigorous training and education, which can foster a sense of confidence in their abilities. This confidence, while essential for effective patient care, can sometimes morph into an illusion of infallibility. Many practitioners believe that their extensive knowledge and experience shield them from making mistakes. This mindset can lead to complacency, where the potential for error is underestimated, or overlooked, and the seriousness of malpractice claims is downplayed.

The Role of Experience

        Experience in the medical field can create a false sense of security much like medical Heuristics.. Many healthcare professionals may have spent years without facing a malpractice claim, reinforcing the belief that they are less likely to make errors. This phenomenon is often referred to as the "it won't happen to me" syndrome, where past success leads to overconfidence in future performance. However, the reality is that even the most seasoned professionals can make mistakes, and the consequences can be severe.

Systemic Factors

        The healthcare system itself can contribute to the perception of infallibility. In many cases, the culture within medical institutions emphasizes success and minimizes the discussion of errors. This can create an environment where mistakes are hidden rather than addressed, leading to a lack of awareness about the potential for malpractice claims. Additionally, the fear of litigation can discourage open communication about errors, further perpetuating the belief that such claims are unlikely to occur.

The Impact of Technology

        Advancements in medical technology can also play a role in fostering a sense of infallibility. Many healthcare professionals rely on sophisticated tools and systems to assist in diagnosis and treatment, which can create a perception that human error is less likely. However, technology is not infallible, and over-reliance on it can lead to critical oversights. The belief that technology will prevent mistakes can contribute to a dangerous complacency mindset among many healthcare providers.

The Importance of Humility

        Recognizing the potential for error is crucial for all healthcare professionals. Embracing humility and acknowledging that mistakes can happen to anyone is essential for fostering a culture of safety and accountability. By understanding that no one is infallible, healthcare providers can take proactive steps to minimize risks and improve patient care. This includes engaging in continuous education, participating in peer reviews, and encouraging open discussions about errors and near misses.

Conclusion

        The belief in infallibility among healthcare professionals can lead to a dangerous disconnect between perception and reality. By understanding the psychological and systemic factors that contribute to this mindset, we can work towards creating a more aware and accountable healthcare environment. Acknowledging the potential for error is not a sign of weakness; rather, it is a crucial step in ensuring the safety and well-being of patients. Ultimately, the mantra should shift from "It won't happen to me" to "It could happen to me," thus fostering a culture of vigilance and continuous improvement in healthcare.

A New Day: The Rising Trend of Unionization Among PAs.

 

      A significant shift is underway within the healthcare industry over the past few years. More and more healthcare providers are choosing to unionize instead of maintaining their "exempt" status. Traditionally, many medical professionals, due to their specialized skills and roles, have been classified as exempt, often associated with the employer's employment structure within an organization. However, recently, there has been a marked increase in unionization, driven by various factors, including tiring workloads, low compensation, job insecurity, and the need for a stronger professional voice. In this post, I will examine both sides of the issue as set below.

Unraveling the Shift Towards Unionization -

Several key factors are driving healthcare providers toward unionization:

1. Workload and Burnout: It is well known that Healthcare providers often grapple with high-stress environments and demanding workloads. Unionization offers a way to collectively advocate for more manageable work hours and appropriate staffing levels, which are critical in mitigating burnout--worsened during the COVID-19 pandemic and ever since.

2. Compensation and Benefits: Many healthcare professionals feel that their benefits & compensation packages do not reflect the intensity and demands of their work. Unions can negotiate for fair or better wages, improved benefits, and other financial protections.

3. Job Security and Stability: In the backdrop of healthcare mergers and acquisitions, job security can be uncertain. Unions provide a unified strong collective voice to safeguard jobs and resist arbitrary layoffs or even employment benefits reduction.

4. Professional Voice and Advocacy: Unionization empowers healthcare providers to have a stronger say in organizational administrative decision-making processes, especially those mostly affecting patient care standards and ethical practices.

5. Response to Administrative Pressures: As healthcare organizations become more corporatized, providers may feel constrained by administrative decisions. Unions can serve as a counterbalance, advocating for patient care over financial metrics.

The Advantages of Unionization -

• Collective Bargaining: Unions basically enable workers to negotiate as a collective group, which can lead to improved salaries, benefits, and working conditions.

• Enhanced Workplace Protections: Unionized environments often have clearer protocols for addressing grievances and protecting workers’ rights, seldom seen with exempt employees, thus, contributing to a safer and more supportive work environment.

• Professional Autonomy: Unions can advocate for maintaining professional standards and autonomy, ensuring that healthcare providers have a say in the delivery of care.

• Legal and Advocacy Support: Unions provide legal representation and support, which can be crucial during disputes with employers or in advocating for systemic changes.

The Disadvantages of Unionization -

• Union Dues: Membership typically involves paying dues, which can be a financial burden for some workers.

• Potential for Strikes: While strikes can be an effective negotiation tool, they can disrupt patient care and pose ethical challenges for healthcare providers.

• Reduced Individual Negotiation Power: Union contracts can limit individual workers’ ability to negotiate personalized terms of employment, such as unique compensation packages or flexible schedules.

• Management Resistance: Unionization efforts can lead to friction between staff and management, potentially affecting workplace collaboration and morale.

Recent Examples of Unionization in the Healthcare Marketplace -

• Resident Physicians: In recent years, resident physicians at institutions such as Stanford Health Care and various University of California hospitals have formed unions to address issues mitigating excessive work hours, inadequate compensation, and the need for better employment support systems.

• Nurses: Organizations like the National Nurses United (NNU) have also successfully advocated for better staffing ratios, improved working conditions, and higher pay in numerous hospitals across the United States.

• Allied Health Professionals: Groups such as Physical Therapists and Physician Assistants have also embraced unionization to address specific interprofessional concerns related to their roles and responsibilities within various healthcare systems.

Conclusion

      The trend of unionization among healthcare & PAs' alike is an emerging response to the complex challenges faced by the industry today. While unionization offers significant advantages in terms of collective bargaining power and workplace protections, it also presents challenges that both healthcare workers and administrators must navigate bi-partisanly. 

      As this movement continues to grow, all stakeholders need to engage in constructive dialogue to ensure that the needs of all healthcare workers are balanced with the imperative of delivering high-quality patient care in an ever-changing industry.

Beware of the Job PostingTrap: A Cautionary Tale for PA Job-seekers

 

        The seemingly endless presence of certain job advertisements raises a critical question for job seekers: why does a position remain unfilled for months on end? Industry experts often view such persistent postings as a significant red flag, signaling potential issues within the hiring organization. For Physician Assistants (PAs), navigating the job market requires careful scrutiny to avoid detrimental career moves. 

        This article will explore four common pitfalls associated with these long-standing job advertisements, offering crucial insights for both novice and experienced PAs.

        One of the most frequent reasons for persistent job vacancies is a non-competitive compensation and benefits package. Simply put, qualified professionals are unlikely to accept positions that undervalue their skills and experience. Employers who offer inadequate compensation often struggle to attract and retain suitable candidates. This suggests that previous employees may have left due to dissatisfaction with their earnings, finding themselves significantly underpaid compared to their peers in similar roles. In today's competitive market, fair and equitable compensation is paramount, and PAs rightly expect to be valued for their contributions.

        Another significant deterrent for PAs is a pervasive culture of micromanagement. Many healthcare organizations, particularly those with rigid departmental structures or physician groups with autocratic leadership styles, foster environments that stifle professional growth. PAs thrive in collaborative settings where they have clinical input in patient management and autonomy within their scope of practice. Environments where every intervention requires approval and clinical judgment is undermined create a sense of professional stagnation. Sadly, some physicians and administrators still view PAs as mere subordinates, failing to recognize their valuable expertise and the principles of Optimal Team Practice (OTP). Progressive employers, however, embrace OTP and foster PA-friendly environments, recognizing the benefits of collaborative practice.

        Deceptive employment tactics represent a third significant warning sign. Organizations struggling with retention may resort to misleading recruitment strategies. Promises of "continued mini-residencies" or "PA-friendly" onboarding programs are sometimes used to attract unsuspecting new graduates, only to fall short of expectations. These tactics prey on the trust and inexperience of those entering the profession. Such practices demonstrate a lack of genuine commitment to employee development and well-being, prioritizing short-term recruitment over long-term retention. As the adage goes, "if it sounds too good to be true, it probably is," and PAs must exercise caution when encountering such enticing offers.

        Finally, the organizational culture plays a crucial role in PA job satisfaction and retention. Before accepting a position, PAs should thoroughly investigate the prevailing workplace dynamics. Is the culture autocratic, physician-centric, nursing-centric, or business-centric? These different cultural orientations can significantly impact a PA's professional experience. A mismatch between a PA's values and the organizational culture can lead to feelings of being undervalued, unheard, and unappreciated. This can result in professional dissatisfaction, burnout, and ultimately, a desire to seek alternative employment. A lack of intra- and interprofessional respect and recognition can quickly erode job satisfaction.

        In conclusion, today's PA job market demands heightened vigilance. Persistent job advertisements often conceal underlying issues that can negatively impact a PA's career. By carefully considering the competitiveness of compensation, the prevalence of micromanagement, the potential for deceptive tactics, and the prevailing organizational culture, PAs can make informed decisions and avoid costly career missteps. Thorough pre-employment research and verification are essential tools in navigating the complexities of the modern healthcare landscape. Heeding these warnings can save PAs from professional disappointment and pave the way for fulfilling and successful careers.

Four Workplace Devaluating Challenges all Physician Associates must Avoid

 

        As a surgical PA, I’ve experienced both supportive and challenging work environments. While some employers understand and value the PA role, others demonstrate a lack of awareness and understanding, leading to frustrating and devaluing work experiences. This article aims to shed light on these common workplace issues, offering insights for managers and administrators seeking to foster positive and productive relationships with their PA staff. While acknowledging that difficult PAs exist too, the focus here is on systemic issues that negatively impact the retention of PAs. Listed below are the devaluating circumstances leading to the resignation.

1. Workplace (Cultural) Unfairness:

        PAs thrive in fair and rewarding partnerships with physicians and healthcare administrators. Key to this is workload equity and work-life balance. Unfortunately, during times of organizational financial duress or hardships, PAs are sometimes disproportionately targeted for departmental cuts and streamlined services, often due to their “exempt” (non-unionized) status. This practice can lead to depleted PA staff carrying services excessive burdens without adequate resources, ultimately impacting patient care and satisfaction. Such unequal treatment fosters distrust and resentment, leading to high turnover and increased liability for both employees and employers. Healthcare organizations should avoid making PAs the perennial “sacrificial lamb” during times of financial austerity. Budgetary adjustments should be implemented fairly across all departments and staff members.

2. Unclear Organizational Roles:

        The PA role should be well-established and accepted in many successful organizations. However, corporate indifference or apathy can create confusion and hinder effective integration. PAs are legally and ethically obligated to consult with and refer patients to their supervising or collaborating physicians based on the patient’s condition, standard of care, and their own education and experience. This well-known team-based approach has been successful for over five decades. For organizations to fully benefit from having PAs, there must be clear role definitions, strong corporate support, and, most importantly, mutual respect and transparent communication. A synergistic, symbiotic interprofessional relationship is crucial; a parasitic “us vs. them” dynamic definitively does not bode well, hence creating power struggles and undermining collaboration. Achieving this requires a commitment from all parties to avoid pushing selfish, unilateral agendas or unreasonable managerial expectations.

3. Disrespectful Organizational/Workplace Setting:

        Like any professional group, PAs seek respect and meaningful input and feedback into matters affecting their profession and their organizational roles. They want to be acknowledged for their skills and expertise. Being treated as “technicians,” “scut monkeys,” or “gophers” is deeply offensive and creates a negative work environment. Fostering a culture of respect requires organizational familiarity and a clear understanding of the PA profession by all staff, clinical and non-clinical members. Implementing workplace interprofessional sensitivity training can create a harmonious environment where PAs can thrive both personally and professionally.

4. PA Self-Governance: A Must Component

        A key issue of poor PA utilization is the lack of self-governance by PAs within many organizations. Why should PAs be the only healthcare professionals without a voice in their own affairs? Placing PAs under the oversight of non-physician departments, such as Anesthesia (CRNAs) or Nursing, as was the author’s experience early in his career, can leave them feeling unheard, disrespected, and without adequate representation. This can be especially problematic if the department head is not a fellow PA. These circumstances create a significant disadvantage for PAs in the workplace. This outdated model should be eliminated.

Conclusion:

        These four devaluing workplace challenges can significantly demoralize and devalue PA staff, thus leading to job dissatisfaction and high turnover. Addressing these issues is crucial for creating a positive and productive work environment where PAs feel valued, respected, and empowered to provide the best possible patient care. By fostering fairness, clarity, respect, and self-governance, healthcare employers & organizations can unlock the full potential of their company PA workforce.

The Biased Media: The Never Ending Unfair Battle for PAs [Part I]

 

           The PA profession's portrayal by the media in the past was simply downright biased and disrespectful. I have witnessed it all—fear, hate, intolerance & extremism seem to have been the order of the day. Sadly and specifically the PA community was targeted repeatedly by misinformers. These very narrow-minded myopic detractors were not only seeking to advance their nefarious agenda, but, to detract from our proper recognition.

For the past 50 years, our profession has made great strides in many areas and respects. And while we have come a long way, it is, unfortunately, true that some physicians still try to dissuade the industry of our value even to this day.

          But even more disturbingly, & more recently, the nursing community in their ascent and quest for professional empowerment and recognition is behaving similarly to physicians at an interprofessional level.

As if this was not enough interprofessional incivility among healthcare professionals, we must also contend with another new bully-- the prejudiced media. Their reported opinionated, non-factual articles, and/or exposès, bring another discrediting force to the general medical consumer. In other words, another voice to confuse and undermine our great time-tested validated profession.

Tangible Examples of the offending Print, Radio Media & TV Networks

            Never in my mind did I ever imagine the New York Times (NYT) running stories of allegedly greedy dermatological PAs serving as “puppets” for their unscrupulous supervising employing physicians. Once again, they peg this issue & problem squarely on the “unsupervised PA assembly line” as the sole factor in compromising patient’s safety and/or welfare, rather than zeroing in on the root factor, the real culprits—uninvolved, greedy, and uncaring/exploitative dermatologists/physicians. 

            Also, a few years back in the PA Bashing bandwagon, we can find Glen Beck & Stu his sidekick in his morning radio show. Stu was playing “doctor” and giving Beck a mini-mental exam like the one the president underwent recently during his annual physical examination. At one point he made a joking remark by saying: “I will have my Physician Assistant write that down”. In this statement a PA was nothing more than a scribe or a MA.

            But there are more unimagined offenders, like “Dear Abby”. Even her… dissed us in one of her columns (July 11, 2016). She critically spoke without understanding our scope of practice when an elderly couple's husband became ill and they both were out of town and were seen & attended by a PA at a local Urgent care facility. While the article states the patient (husband) was pleased with the care received, she pointed out there should have been an MD on the premises to address all the concerns of the unhappy wife when she was unaware the provider seen was a PA.   

            Unfortunately, I cannot 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 “Nightlife” aired on Feb 23^rd, 2015. Essentially in this particular episode our education/training and role were utterly mischaracterized and trivialized as nothing more than we all are basically “scut monkeys” pushing paperwork while trying to become physicians.

            As if that wasn’t enough, on March 4^th,2014 our profession was once 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 caregiving services by stating that we were akin to “Lenny”— a fictional community college graduate metaphor he used to compare /describe our background against physicians.

 Contextually through his commentaries that night he implied the American healthcare consumer receives subpar care when care-giving services are always 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 fiasco when they published their nonfactual piece regarding a rape case @ Duke University.

            However, the list doesn’t end there, but Dr. Matt Hahn a PCP in Maryland also attacked our profession by saying that we’re poorly trained. Furthermore, he resented our success and went publicly to state we’re unsafe providers despite he hosted/precepted GWU PA program students as described in his posted blog on demos.org (“Are more Physicians Assistants Good or Bad for America’s Health”, June 1,2013).

            Along the same vein, a few years back Nancy Snydeman, MD former NBC News’s Chief Medical Editor misspoke about our background/role and our limited prescriptive abilities when caring for patients in a segment aired March 11^th, 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. Shockingly she was the keynote speaker in our national AAPA conference during the Clinton years. 

            Contempt comes to mind if nothing else when see how our community has been wrongfully portrayed(see part II).

            

The Biased Media: The Never Ending Unfair Battle for PAs [Part II]

 Continued from Part I

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

            Essentially, at the core of their mischaracterized printed or broadcasted reports was the fact they did not bother to research nor present factually the issues. Instead, should they have shown/depicted a much more balanced view of a group of highly schooled and skilled healthcare professionals: namely us (PAs), we certainly would have been more appreciative of such a portrayal. Unfortunately, all three networks chose to forego their journalistic responsibility and the ethics of news reporting leading to these grossly and inaccurately misrepresentations of our highly validated & well-respected profession.

            Frustratingly, these media PA coverage examples illustrated the inherent partisan egregious blunders each TV network committed and failed to apologize for their offensive, irresponsible, and insulting aired transgressions. Generally speaking, these dismissive organizations not only lose value in the eyes of the PA community but credibility as well. Clearly, not correcting their errors will only resonate negatively in our minds when it comes to media transparency. Thus, allowing their corporate & journalistic arrogance to alienate us even further.

So the question in the mind of this author and perhaps many of my peers is the following: Isn’t “transparency” supposed to be 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 media outlets?

            Therefore, doesn’t the PA profession deserve the same degree of respect, and 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, or even if it’s disparaging a venerable profession. Frankly, these examples illustrate the inherent egregious distasteful blunders the media outlets committed while failing to apologize for their offensive and insulting transactional transgressions.

            It is obvious that these transparent journalistic Faux Pas certainly have opened 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?

Plus, even though the “assistant” moniker did help our cause, nor shouldn’t we sit idle and allow this to hamper or stall our progression nor eliminate our corrective voices and participation when the time requires it.

These negative attitudes of exclusion are the surest sign of divisiveness in our society. And, yes, I do not consider myself overly sensitive, but truthfully, this form of stereotyping & ridicule contributes nothing but continued misperceptions and misunderstandings. Looking closely at these factors, we can easily conclude we no longer need interprofessional segregation but rather interprofessional acceptance & tolerance for a common goal for our patients.