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?

Best Basic Deposition Pointers

  

Stellar deposition performances stem from thorough review and pre-trial preparation. An unshakable humble and confident demeanor conviction can have the lifting power of asserting your defense against the med mal allegation(s) brought against you by the rapid-firing queries of the opposing legal counsel. 

Therefore, deposition readiness is very imperative because you could find yourself unsure of how to navigate this new adversarial process to you. This can occur swiftly and without much warning in many circumstances. Therefore anticipatory planning for such an event can make you feel less stressed and downright less overwhelmed. After all, feeling caught off guard is not uncommon nor is it a good feeling under these circumstances. Yet, with the right approach, and the right perspective and preparation from your attorney, you can live and remain confident if you devote the proper amount of time and effort to your pre-trial preparation and cultivating relaxation and de-stressing behaviors. 

So when confronted with this legal entanglement, it is critical to remain grounded so the process becomes less intimidating and reasonably stress-free. Naturally, this experience can be very taxing and stressful, both physically and emotionally, for the uninitiated, but it certainly can be mitigated--to a great extent if handled well. Remember, sitting idle or leaving things to chance is not productive; this is akin to the kiss of death. Such a lax approach places you in a legal jeopardy mode– a tense state of anxiety as opposed to one of prepared confident readiness. You must do everything to empower yourself if you’re to depose well. In essence, you must envision yourself as the “victor” and move past the “victim” mindset to which many deponents fall prey to unconsciously when not proactively taking charge of this career hurdle. 

        Truthfully trying to remove anxiety completely or remain stress-free is nothing but a zero-sum game you cannot avoid, but you can certainly manage it effectively, by trying to implement some of these interventional behavioral modification modalities. For instance, consider implementing yoga exercises, enhanced respiratory techniques, or simply modifications, reading, and/or exercising, etc. The key here is to lessen the “stress factor” burden on yourself. 

        So if you’re honestly seeking to appraise your deposition readiness, then you must ask yourself these questions: how prepared am I for this deposition? Have I been prepped accordingly by my counsel? Do I know this case inside out–strengths vs weaknesses?

Malignant Mischaracterizations

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

Stopping this malignant spread of interprofessional bigotry will require the commitment of many if not all of the members of the PA community. We must not only be alarmed but morally concerned --if not outraged-- about the long-term negative ramifications this may pose to our standing in the healthcare industry. Personally and professionally after 34 years of practice, I have never been more alarmed and concerned about what I am seeing take place in the marketplace these days

Our work history and our Industry credibility speak for themselves when it comes to delivering the highest competent patient care as it has been shown study after study. 

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

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

Do not allow your peers or yourself to be silenced or marginalized. It is simple to see, we

The AMA: A meddling (hypocritical) Organization

 

Every time I hear or read about the AMA meddling in our affairs, I must confess: I get more and more upset & worried about our future. Their constant open disdain of our profession so openly seen on various platforms not only troubles me but should also the rest of us. However, and quite frankly, I am surprised to see how no one in our community doesn’t denounce them for this behavior. Even if nothing else, I’m sure most PAs have felt the sting of these misinformed one-sided campaigns targeting our brand and community at large. 

But just as if this is not enough, the current marketplace is rapidly changing with potentially leaving us stigmatized as being nothing more than an "assistant". A detrimental label to our livelihoods. For instance, the AMA attempts to block or lobby against any PA modernization practice acts. By far the most disturbing and disheartening politics of their rhetoric is sowing fear and distrust in the medical consumer. They seek to undermine our credibility at every turn they can by deliberately overstepping their industry role & by simply fostering PA practice advancement barriers and disinformation. Moreover, professional mischaracterization.

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

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

It does appear, the role and mission of the AMA are incongruent if this is the stance they want to undertake. Furthermore, they are not a “regulatory governmental agency “ nor a “policing” agency but rather an association of an interprofessional fellow group. Perhaps, we, the PA community should remind them they are not in the business of trade restraint & or fomenting interprofessional dissension but rather collaboratively increasing medical access to care. 

Would you all please make your voices heard…

Is there Ageism in PA Academia?

    

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

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

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

In all fairness to PA faculty recruitment practices, I will be the first one to admit that these faculty search committees oftentimes strive for hiring fairness. Fair, perhaps, but in many instances not even close; sadly to say even as holistic their candidate selection criteria are advertised on their job postings. Why? Because even with all the talk of practicing hiring inclusivity and aiming for diverse faculty retentive practices, etc., the reality is a very different one. Particularly in academia when it comes to PA faculty selection. Unfortunately, there remains an unexplained gap; a dissonant one seen in many instances. 

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

To date, after applying for several local PA programs within the past 4 years, having published over 95 non-clinical articles & commentaries in various PA Journals, spoken at various state yearly conferences, & served as an advocate at the state level for my profession through the years, all I have received has been only 2 phone interviews, but no invitations for a face-to-face interview.  Hum...could it be my age? Most PA faculty bios that I have researched seem to showcase PAs under 40 years of age and have practiced for 3-10 years.

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

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

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