Self-made Quotes: A year of Angst for PAs

 

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

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

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

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Fighting Physician Assistant Professional Illiteracy: The Perennial Widespread Battle ©

                           

Image from Gerd Altmann ( Pixabay.com )

There’s a troubling trend in the healthcare industry that in spite of living in the information age the threat & spread of misinformation about the PA community is real and becoming more dangerous. Ask any Physician Assistant who has practiced over the past 50 years. Unfortunately the PA community has lived and endured @ times a myriad of misguided & quite often ill-motivated views & mischaracterizations of our profession by many including the media  Sadly, this negative or distorted representation is simply based on a lack of basic understanding of our profession. In other words, irresponsible reporting & lack of real  basic understanding of our training, our scope of practice, etc. 

Yet, the PA profession has rapidly expanded with doubling the number of educational programs and the number of graduates (i.e. class sizes) that has substantially increased. Moreover our profession is evolving and increasing the access of care in our very fragmented industry. Unfortunately some physician organizations, namely the AMA, ACEP and a few others are portraying our profession unfavorably to lay audiences all across the country. Why? Because curtailing recent further legislative advancements allows them to continue  to monopolize & control Advance Practice Providers since we have grown from our “Assistant” moniker. Plus the world continues to evolve as well as our Scope of Practice. And all due to our excellent track record corroborated by many studies throughout the years time after time.

Surprisingly The AMA's stance and view on our advancement has been extremely unsupportive if not downright hostile and unprofessional of the medical community.. Basically attempting to delegitimize our contributions by insinuating, implying either implicitly or explicitly our care provided to the American healthcare consumer without any data or factual information is disinformation at its best in their so called allegations of inferior or subpar quality provided by us. Basically they based their views on med malpractice data against Physician Extenders ( NPs / PAs / Midwives and CRNAs, etc.)

        Unfortunately, the AMA and sister organizations rather than drawing all providers, payors and patients together is furthering the division with these divisive allegations in the media, print and/or social media platforms. This slam and divisive tactic is not fair to patient nor Advanced Practice Providers since this view / behavior perpetuates the lack of access of care by targeting our community and blemishing our legacy by undermining our role in the healthcare industry.

        The reality of the situation is this: it is a terrible shame that some members of the medical community  choose to make this a matter of competence among various inter-professional medical providers all seeking to meet the medical needs of our society. We could just as easily argue and point out that the physician community is not with their share of “bad apples”. Is always easily to see shortcoming in others but not ourselves. Our Brand less professional identity has been both unintentionally &  intentionally used by those who would perpetuate professional ignorance, sow interprofessional rivalry or /industry divisions for their own gain, thus perpetuating their agenda or “turf battles” as it is known inside the industry or cancel culture --the new paradigm seen in our society.

        I urge the American healthcare consumer, the freelance media writers,and the recruiting consultants or even hospital administrators/physician group practice managers teaming up with any professional medical care provider, to research us--the PA community. So by arming themselves with accurate, insightfully updated information of our proven and solid quality legacy along with our past competent track record our profession has shown through the last five decades, they would come to a better understanding as to who we are rather than blindly accepting biased and skewed information that so many times has been reported w/o any real fact checking behind the false narrative or stories created about the PA profession.

        It is no secret that America is deeply divided today, from a political perspective, from a social perspective and economic perspective  and even a spiritual perspective. How utterly divisive this introduction and continuation of “Cancel Culture” is creeping up in the healthcare industry too. 

        View under this light, this  was and is sadly a deplorable moment & stance the AMA took when the PA profession was targeted unfairly in their article, “Stop the Scope of Practice Creep”. This action perpetuates ignorance and biases outside the medical community, thus, fueling the fires of distrust in the patient-community. As if we need more distrust and a very elitist medica group of providers in an already very fragmented industry..

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PA-Trolling: The New Social Media Venomous Activity by the American Medical Association ©

Physician Assistants know all too well about “cancel culture.”  In fact, we have lived & experienced this discriminatory malady on a daily basis for the past fifty-four years. Even before this term became in vogue in recent years as seen throughout  the various social media platforms, we even knew this firsthand, before it became ingrained in our societal fabric. Fortunately, we have not been cancelled yet, even some Physician groups and/or some of their organizations are on the offensive of their mission-driven agenda of fostering inter-professional divisiveness by undermining the professional legislative gains of PAs & NPs.

But, what is new these days is their open and intense negative rhetoric about our competent quality care provided by us to the healthcare industry as non-physician providers. This venomous activity has been amplified more than ever before as seen in the American Medical Association (AMA) recent nationwide campaign about refraining the advancement and modernization of PAs Scope of Practice throughout the country. Adding insult to injury, are many other physician organizations supportive of this deceitful and shameful blatant disingenuous disinformation and misinformation campaign presented to the American healthcare consumer.

This scaring and disenfranchising message explicitly displayed in the reckless graphic above with the PA profession represented on scrabble tiles with the message “because patient safety is not a game”  was felt to be beyond unconscionable by us-- the PA community. This message was felt to be a full frontal attack on our proven professional delivery track care over the past five decades provided to the patient community.

I personally, recall thirty-two years ago when I first graduated, yes, we did grapple with the subtle resentment shown to us by many practicing physicians. You see, we were relatively unknown at the time, much to the liking of many old school physicians  who would have preferred for us to have remained brand less, until this day. However, and fortunately  medicine has evolved significantly since then. Plus, it will continue to do so at a fast pace

Personally, their assertion that a patient's safety is at risk if their care was or is provided by a physician assistant is simply flawed, false and deceitful.  This very short-sided discrediting narrative can be debunked by  many studies proving our competent and quality care.( see attached references ).1-2  

In fact, many studies and evidence-based research has shown time after time that PAs have provided cost efficient patient-centered Healthcare services with similar health care outcomes as physicians. Could this be why we are constantly discredited and never-ending being marginalized? 3-8

Let's let the facts speak for themselves against the #stop scope creep campaign by the American Medical Association and their sister medical physician associations. Hopefully then the PA-trolling can stop and the American healthcare consumer can become better informed in this Machiavellian disinformation age that so many like to perpetuate for their own nefarious & driven divisive agendas.

In sum, this post is not meant to pin the professions against one another, but rather to point out how their outdated regulatory views on PAs limit patient access by stalling or restricting the modernization of Scope of Practice and respective impact of Physician Assistants over the last several decades.  And even though, we & other advanced practice providers realize that we fall beneath the regulatory hierarchy of physicians, nevertheless we feel  and we know we're highly capable trained healthcare professionals able & poised to increase access of healthcare to the American Medical consumer along with our physician counterparts in this day and age of limited access to health care and politicized world. 

The way I/we see it, deceitful and disingenuous marketing campaigns as this one is not a game either when it comes to our role, industry recognition and professional livelihoods..

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References accessed on 3-11-21

1. Kurtzman ET, Barnow BS. A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians’ Patterns of Practice and Quality of Care in Health Centers. Med Care. 2017;55(6):615-622. doi:10.1097/MLR.0000000000000689.
2. U.S. Department of Health and Human Services, Health Resources and Services Administration. National Practitioner Data Bank. Rockville, MD: U.S. Department of Health. https://www.npdb.hrsa.gov/index.jsp. Accessed November 2, 2020.
3. Jackson GL, Smith VA, Edelman D, et al. Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants: A Cohort Study. Ann Intern Med. 2018;169(12):825-835. doi:10.7326/M17-1987.
4. Rymer JA, Chen AY, Thomas L, et al. Advanced Practice Provider Versus Physician-Only Outpatient Follow-Up After Acute Myocardial Infarction. J Am Heart Assoc. 2018;7(17):e008481. doi:10.1161/JAHA.117.008481.
5. Yang Y, Long Q, Jackson SL, et al. Nurse Practitioners, Physician Assistants, and Physicians Are Comparable in Managing the First Five Years of Diabetes. Am J Med. 2018;131(3):276-283.e2. doi:10.1016/j.amjmed.2017.08.026.
6. Mitchell PM, Wynia R, Golden B, et al. Institute of Medicine. Core principles and values of effective team-based health care. https://nam.edu/perspectives-2012-core-principles-values-of-effective-team-based-health-care. Published October 2, 2012. Accessed November 2, 2020.
7. Doherty RB, Crowley RA; Health and Public Policy Committee of the American College of Physicians. Principles supporting dynamic clinical care teams: an American College of Physicians position paper. Ann Intern Med. 2013;159(9):620-626. doi:10.7326/0003-4819-159-9-201311050-00710.
8. Jabbarpour Y, DeMarchis E, Bazemore A, Grundy P. The impact of primary care practice transformation on cost, quality, and utilization: A systematic review of research published in 2016. Washington, DC: Patient Centered Primary Care Collaborative. https://www.pcpcc.org/sites/default/files/resources/pcmh_evidence_report_08-1-17%20FINAL.pdf. Published July 2017. Accessed November 2, 2020.

Ten Verbal Blunders: Conversational Faux-pas to avoid in your practice.

 

        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 all to often utilized tongue slip-ups can rob you of your credibility if not great trusting rapport that you have developed & enjoyed for years with your patients.

The following statements or phrases are those culprits alluded above:

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  such a statement  would be interpreted as as you didn’t take the time or cared for the cosmetic outcome. Your careless lingual "faux-pa" (statement) basically discounted their trust in your ability @ their professional expectation.

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. In some cases even the most remote ones too. Wouldn't you?

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.“Here it comes a 'little' 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”, downplayed—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”. Instead, you can say, most patient do well after my explanation(s)

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 one if voiced to you. 

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 could be a potential 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. Plus if an early . resolution would come to play, then you will be seen as 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 introduce or close by stating 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. Remember minimizing things don't bode well with people if there was a significant peril or inconvenience they had to go through

9. “I’m the best @ this”:  Based on whose opinion—Consumer’s report? They think not. Perhaps blowing your own horn may come across as pedantic. Probably is best to be forthright by 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 recommendations 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 and ultimately your clinical/professional credibility. 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 being part of your day-to-day communication with your patients. 

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It Takes a Village to Advance OTP

 

For decades many U.S. PAs’ have been frustrated with the name-game change that has left us ‘brand less” in the marketplace. Sadly, to this day it remains unresolved to the satisfaction of our community. As if that was not enough, now we’re facing another intra-professional conundrum—the passage and embracement of OTP not only by policymakers at the state level but by some of our very own peers and AAPA sisters organizations. Most of us wonder if this situation will divide our community since over the last few years we have not been able to present ourselves as an united front like our counterparts, the NP’s have done.

Make no mistake about it. This is going to be an intense advocacy fight for our rights and role in the marketplace. If we do not rise to educate legislators, insurance companies  and others, our dream will never materialize and will never become a reality either. Whether you are a novice or a seasoned PA, the truth of the matter is that we need everyone to be involved and engaged.

 With resilience and determination of some state chapters, a handful states have finally recognized OTP or some form of it, naturally this did not happened overnight, but its possible and attainable when everybody commits their time, their skills and resources.  What better example of this than a modernized  legislative act known as  PA 379 in Michigan & the other recent states that have modernized their state PA Practice Acts as well--Wisconsin being one of the last ones. 

How were they able to accomplish such feat? Simple...it was all because they pooled their resources and had a clear vision and were single-minded in this regard/state chapter mission.

I know at times some PAs may feel OTP is beyond their reach. To those, I will remind them this: you have sacrificed and invested significant amount of time, monies and maybe blood and tears. Isn’t your profession/ career worth fighting for? Think about it...you have come along way—you owe it to yourself to be fully recognized for your skills, your professionalism so you can practice at the highest level of your scope of practice recognized by the law.

So don’t stop believing in your professional possibilities, do not allow others in or out of our community dissuade your social, economic & professional destiny by allowing others misperceptions or disinformation stall our progressive advancement in the legal arena. Keep in mind you’re not alone in this quest even though you may find some negativity or apathy among your peers or outside stakeholders.

Our message should be simple: OTP fundamentally is patient-centric care since it increases access to health care services nationwide to all patients. I believe is important to emphasize this along with the longstanding legacy of our quality care provided over five decades. We must share the same best professional advocacy practices.  When we do these things, we become the agents of change in the world like Mahatma Gandhi said in is famous quote. " Be the catalyst in your village" so OTP can be nationwide recognized.

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