A Thought on Physician Fragility.

    Isn't medicine about serving & caring for the less fortunate-- our ill /sick fellow society members? So why is it that modern healthcare seems more entrenched in partisan politics than the so-called politicians in Washington? Our patient community needs healthcare access and expert medical advocacy when it comes to medical policy-making...not legislative barriers, inter-professional intolerance (aka turf battles) flexibility. The lack of cooperation, inclusivity, and tolerance is obviously absent when physician groups' behavior departs from Team-based practices.

    How so? (you ask). Well, there are quite a few examples if one looks closely throughout the country. For example, many Medical Boards and Medical state chapter societies are seeking to label non-physician providers as unsafe clinicians. This new position not only seeks to discredit our industry value but rejects both, the mature flexibility and cooperation all physicians should embrace when working with PAs to best serve patients together.

    Is difficult to see the Physician community be so threatened by APPs. This "Physician Fragility" mindset should not be a problem. Physicians and PAs work together in teams and with other healthcare providers every day. Evidence has shown that when PAs have the flexibility to practice at the highest levels of their education and experience, patients benefit most as a result. Unfortunately, many seek to foment division and regression by proposing Scope of Practice restrictions. These partisan legislative moves only seek to reinforce archaic PA practices/regulations. These proposals already decrease access to care in many socio-economically disadvantaged communities or rural ones too. Also, situations like these consequently increase the physician's clinical burden by having to spend more time caring for an older sicker patient population. Hence another factor leading to burnout and/or early retirement.

    One doesn't have to be a "Rocket Scientist"  to see the results of myopic restrictive regulations do not serve patients well. In addition, there is no evidence these kinds of regulations improve patient care or that they are even necessary. The point is, that these proposed regulations are a screen for a disguised restriction of trade. Basically, in search of a problem where there's none.

    Even more disappointing, is the refusal to acknowledge our professional evolution and growth from mere assistants. Their denial seeks to seriously undermine skill  & desire to be professionally respected along with our request to promulgate & support PA-friendly policy regulations that make sense for PAs We know firsthand and understand the challenges and needs facing our profession better than anyone.  Therefore, if they are as patient-centric as they say they are, then, all Physician groups should stand to eliminate any additional layers of bureaucracy that limit healthcare access to patients.

    In the end, Physicians and PAs are all members of the same team when it comes to providing the  American patient with high-quality healthcare. There is no reason why PAs and physicians can mutually resolve/settle this important issue by reaching across the aisle and putting these attitudinal views to rest. 

FAQs: About PAs

        Through the years and throughout my career I have been asked many questions about PAs. While many different ones have been asked of me, seemingly they all seem to revolve around the four ones I will be covering in this piece/blog.

1. What is the Importance of  PAs in the Healthcare Industry? 

PAs are vital to the Healthcare Industry. The Affordable Care Act, which was enacted in 2010, recognized PAs for the first time as one of three primary care providers ( PAs, Nurse Practitioners, and Physicians ). The law also empowered & enabled PAs to basically lead patient-centered medical teams. Team-based care is at the core of a PA’s training. PAs practice with Physician-led teams and in a collaborative relationship with other members of a patient’s healthcare team. This combination is a major source of their strength & pride.

2. What can a PA do for me? How are PAs educated and trained?  

PAs are experts in general medicine. They undergo rigorous medical training. All PAs must graduate from an accredited PA program and pass a certification exam in general medicine to be licensed and certified. Much like physicians and NPs, PAs must complete extensive continuing medical education throughout their careers.

PAs diagnose, treat, and prescribe medications. Their education is modeled on the medical school curriculum, PAs learn to make diagnostic and therapeutic decisions while working with Physician-led teams & in collaboration with other members of the healthcare team. PAs are certified as medical generalists with a foundation in primary care. Throughout their careers, many PAs practice in two or three specialty areas, giving them deep experience and the flexibility to meet the changing needs of their patients, plus their employers and communities. Also, many PAs serve as surgeon's assistants & can be found in all surgical specialties.

PAs are trusted professional healthcare providers. Studies have shown that when PAs practice to the full extent of their abilities and training, hospital readmission rates and lengths of stay decrease, and infection rates go down. A Harris Poll found extremely high satisfaction rates among Americans who interact with PAs. The survey found that 93 % regard PAs as trusted healthcare providers, 92 %t said having a PA makes it easier to get a medical appointment and 91% percent believe that PAs improve the overall quality of care experience.

3. What is the demand/outlook for PAs in the marketplace?

PAs are in heavy demand. Three-quarters of PAs receive multiple job offers upon passing their initial licensing and certification exams. Studies show that the most financially successful hospitals maximize their use of PAs. The PA profession has been named by several top media outlets, including Forbes and USA Today, as the most promising job in America. The demand for PAs increased more than 300 percent from 2011 to 2014, according to the healthcare search firm Merritt Hawkins. As of December 2016, there were more than 115,500 PAs nationwide who interact with patients upwards of 350 million times annually, & 4,500 throughout Michigan & approximately 74 PAs throughout the HMC system ( i.e. clinics, urgent care, etc.) 

4. Where can I get more information about PAs?

You must  go to these PAs main websites:  www.aapa.org  & www.mapa.org

On Becoming a PA: An unplanned path.

There are many essays and blogs in cyberspace about folks stating knowing about their early calling in life such as: “I have always known that I would be a doctor” or "I was destined to be a physician". Well sorry to say or disappoint, but this piece is not one of those stories.

Nor will I use the clichéd stories of how an ill relative or a friend or a close family physician served to be the inspiring force for me to consider a healthcare career as a physician provider. But rather the opposite instead—namely a Physician Assistant. In fact, unlike so many other college students’ paths to medicine, mine was truly a circuitous one when compared to so many others that I have known or read about through the years. I suppose my path was different or as some would say atypical for that matter. 

Unlike those stories and truthfully, I was never ‘pushed’ nor ‘talked’ to going into medicine by my parents. However, medicine didn’t even cross my mind until I began enjoying my natural science courses, which I felt, I would end up pursuing a graduate degree in molecular biology. Early in my college preparation, I saw myself leaning towards becoming a bench researcher in the lab after graduating from college. I even entertained the thought of becoming a medical technologist. Moreover, during that time I was setting my sights on landing a co-op job experience as a research student at Argonne National Laboratory or some other prestigious national known research facility.

Yet, halfway into my 3rd year, I began to feel an affinity for medicine, so to be sure that I truly was interested in a medical career and not with the romantic idea of becoming a doctor, I decided to explore employment opportunities in a medical or a hospital setting. In a stroke of luck, I was able to land a job as a Pharmacist’s Assistant at a local Catholic Geriatric hospital while completing my 1st undergraduate studies. Luckily this particular experience gave me a different perspective if not a very insightful one into my final desired career path. 

        As I neared graduation, my options became clearer, and my desire to remain in medicine albeit in a different role was cemented; it was clear that my future would require a more definitive game plan from my behalf. So for a year or so, I methodically researched all about the different allied health careers, from “A” to “Z” and while the infinite options were considered and entertained, no would-be profession back then matched or resonated closely with my envisioned future as much as the unheard Physician Assistant Profession did for me. And as you can imagine, the rest is history as they say…    

                                                                               

The AMA: A two faced-organization.

 

False ideological narratives, political hypocrisy, and obtrusive partisanships are increasingly destroying our world, our country, and society at large. From the terrifying mischaracterization of objective realities to openly deceitful blatant lies spewed by many, it seems that this moral bankruptcy has reached an all-time epidemic high in recent years. We need to address this world/societal pernicious and myopic view rather fast. But, of course, how can we, the few, correct this unsustainable dizzying trend when everyone else supports it– the exact opposite?

We see this with former reputable leaders or former highly regarded business entities or even academia, including The AMA, who have spent countless hours pushing false narratives about the PA profession. Even openly dismissing our solid and rightfully earned a place in the healthcare industry as legitimate credible healthcare providers. But it turns out, this has & continues to be a two-faced manipulation and hypocritical stance. 

For example, the AMA peddles safety skepticism on our patient care outcomes and vigorously calls for PA practice restrictions. Physicians for Patient Protection, a national physician nonprofit watchdog group, pushes & spreads misinformation and even outright lies by mischaracterizing our outstanding 5 decades of cost-effectiveness when it comes to PA care improving access and quality of care. 

This type of hypocritical monopoly just shows their modus operandus: push these lies continually to the American medical consumer, and they will be bound to unquestionably believe it hence securing their marketplace monopoly. They practiced subtle pandering in years past, however, that’s no longer the case. Nowadays they are very open about it by creating and forging “the national stop the Scope of Practice Creep”. But, now this deception is out in the open calling for immediate denialism (SOP statewide restrictions) on APPs' progressive evolution). 

The juxtaposition between the AMA’s and AAPA’s position on this point of contention has fueled significant animosity between both organizations. They both staunchly vouch for their constituency rights in the marketplace. Naturally so, given the natural outgrowth & replacement of our old moniker “Physician Assistant '' to Physician Associate passed by the APPAs House of Directors hod. The stark contrast of philosophical differences couldn’t be worlds apart between these two organizations. It is beyond staggering. 

It's not a surprise that they no longer have any professional trust given the fostering of an arrogant acrimonious AMA perspective when it comes to PA practice. For the majority of the PA community, we have learned privately that our counterparts (Specialty Physician Organizations/groups) prefer the old physician patriarchal interprofessional relationships as opposed to the emerging collaborative team practice model. 

So what must we do to eradicate this malady? Answer, educate, educate, and tirelessly educate some more about the intrinsic value we bring to the table. Be a proud PA activist; we Physician Associates/Assistants matter now more than ever before. 

There is no way to excuse this kind of veiled bullying behavior, especially in an already fragmented & polarized healthcare industry. It is damaging to our society and the future well-being of our patient community. This virtue signaling is horrendously bad, they know they are being deceitful. Sadly, to this author/us, this is a grave betrayal of trust and epitomizes the moral bankruptcy of the AMA. They should be reminded they have a huge platform and therefore an equally huge responsibility to tell the truth and be inclusive and deliberate in practicing interprofessional acceptance transparently. 

We, society, policymakers, and all industry stakeholders must hold the media, medical societies, physician groups &The AMA, and or any unethical organization accountable. Demand them to immediately cease promoting & fueling skepticism, misinformation, and mischaracterization about The PA community!!!

Simply continue demanding the truth by holding them accountable in all their professional transactions with us–the PA Community as well as the medical consumer.

The Return of Interprofessional Apartheid in Medicine.

Nowadays professional practice boundaries between Physicians and PAs are no longer specialty-specific. Yet, some would like to return to those days. In fact, in many instances, this is especially true outside surgical or interventional medical subspecialties. Clearly, over the past several decades this crossing of professional boundaries has become less distinct due to the evolving clinical proficiency of PAs into the practice of mainstream medicine. As the delivery of medical services has become more of a patient-centric team-based model, we have also seen this advancement of Scope of Practice accelerate in order to meet the demands and needs of an industry that is constantly and rapidly evolving @ a dizzying speed. 

The reframing of clinical practice in which PAs undertake many tasks previously performed by physicians is not a new phenomenon. During the past several decades this has been the case in conjunction with the advancement and evolution of technology and SOP. 

This phenomenon has significantly shifted the traditional (limited) role of PAs as merely assisting Physicians in the provision of medical services. These forces have come into play favorably to our community by allowing us a much much more autonomous role as professional skillful providers than we were back in the beginning. Thus, to imply or merely see us only as “Physician Assistants” would be very myopic since it is a very inaccurate description of our roles. Particularly when seen from a glance perspective rather than looking deeper & understanding & knowing the real nuances of this antiquated industry professional misnomer. 

Essentially such a position would be akin to being misinformed or misled by an incorrect understanding of an idea or concept. On a closer look is not a case of two separate Healthcare domains with one profession being superior to the other, but rather the case of two close professions simply seeking to advance medical care to the American medical consumer from a common perspective: one of increasing quality and access of healthcare collaboratively. 

Reductions of many practice paradigms are becoming the order of the day in the practice and delivery of medicine. So does this mean that PAs have to remain Siloed inaccurately in non-descriptive professional terms? Do we still see ourselves as merely assistants to the Physician community? The simple answer to these questions is no, because in practice we provide physician-like services ourselves much like our counterparts do–the physicians. Anything short of recognizing PAs as skillful & cost-effective Physician Associates would continue to be divisive rhetoric of a continued industry interprofessional “Apartheid” mindset seemingly rising nowadays again. After all, our rigorous training parallels the medical model very closely, and so does our mission, vision & philosophy…so shouldn’t we put semantics aside, and continue moving our industry forward?