A Profession on the Move

     The idea of modernizing Physician Assistant (PA) practice through Optimal Team Practice (OTP) has sparked significant debate within healthcare. As our profession grows, we continually encounter challenges, both from within and from outside the PA community.

    OTP, along with the recently incorporated name change to Physician Associate(former Physician Assistant), is a particularly contentious issue. Most in the PA community see immediate advantages, like improved job prospects, while a few others worry about potential downsides, such as damaging relationships with physician colleagues. Supporters and proponents believe OTP will ensure fair employment opportunities. However, organizations like PAEA and ARC-PA prefer the current system, seemingly viewing OTP as a threat to existing regulations and establishing working relationships with physician organizations like the AMA and AOA. This disagreement is causing confusion and division.

    Worse yet, physician organizations like the AMA and AFPA are actively opposing our progress, questioning our role and effectiveness. They're trying to maintain the legal requirement for physician supervision, which jeopardizes our careers and limits patients' access to care.

    OTP supporters understand the importance of this initiative. We must stand strong against misinformation and misleading claims. We've faced similar opposition in the past and successfully overcome it. We will not be intimidated.

    Our collective strength and determination will see us through, as they have before. We, as OTP supporters, must remain resolute despite the negativity and pessimistic predictions.

    The time to modernize PA practice is now. Let's move forward together, embracing OTP as the next logical step in our profession's evolution—a step we've earned.

Physician Associates: Rebranding...A New Day with specific Mandates

    For a long time, we Physician Assistants (PAs) were often misunderstood and misrepresented, even ridiculed within the healthcare industry. Media outlets frequently spread misinformation and inaccurate descriptions of our profession.

    In this author's mind, this raised the question: why were PAs so misunderstood by everyone, including physicians? As a PA myself with 35 years of experience, I’ll--attempt to--explain some key reasons for this. While these explanations are based on my personal observations, I’ll strive to be as objective as possible.

Here are the main past contributing factors with minimized residual effects still lingering:

1. A Relatively New Profession: Celebrating only our 54th anniversary, our profession is much younger than other established fields like medicine, nursing, or engineering. This “newness” contributes to misperceptions and mischaracterizations, especially when people are very unfamiliar with our role, background, etc.

2. A Misleading Name: Our original title, "Physician Assistant," didn't accurately reflect our evolving role in healthcare. This misnomer confused others about our scope of practice and didn't distinguish us from other lesser-trained groups. It hindered understanding from others as to our contribution to the team-based care approach in many people's minds-- physicians included.

3. A Historically Voiceless Profession: In the past, we were less assertive as a professional group. A “just the PA” mentality held us back and prevented us from effectively advocating for ourselves, unlike other allied health professions. This passive approach was a significant obstacle until we rebranded ourselves as Physician Associates and exhibited a stronger group-independent mindset developed in recent years.

4. Lack of Strategic Partnerships: Strong business relationships are crucial. The success of Nurse Practitioners (NPs) demonstrates the power of external support, such as their partnerships with AARP and the Robert Johnson Foundation being strong vocal professional supporters. We haven’t pursued similar partnerships as effectively as they have and continue to do so. We must embrace this mindset ourselves, and seek, to foster interprofessional coalitions if we are to be competitive in the marketplace.

5. Disrespectful Media Coverage: Inaccurate and even mocking media portrayals of our profession have been damaging. These reports often lacked fact-checking and demonstrated a poor understanding of our training and qualifications, thus, undermining our credibility with the public. Our community must be proactive for which we have undertaken this responsibility more vigorously than in the past. Yet, much work remains to be done in educating others about our brand.

    Over the past 35 years as a surgical PA, I’ve witnessed many changes in healthcare, including the rise of managed care, risk management crises, the introduction of the Affordable Care Act (ACA), the COVID-19 pandemic, and the global expansion of our profession.

    Certainly, we have come a long way. However, with our rebranding as Physician Associates, we’ve entered a new era. The confusion caused by our old name is finally behind us but the work continues.

The Politicization of The Covid-19 Pandemic Management and the Manipulative Spread of Public Health Misinformation

Introduction

    As we all know, the COVID-19 pandemic triggered an unprecedented global health response, yet its management was flawed & plagued by accusations of misinformation and politicization, particularly concerning strategies promoted by leading public health officials & institutions like the CDC and NIH. Critics alleged that profit motives, especially regarding vaccine promotion, overshadowed if not trumped sound public health scientific-based principles, including considerations of natural herd immunity vs vaccine acquired.

Public Health Institutions and Shifting Messages

    Sadly in many instances, The CDC and NIH, crucial sources of guidance during health crises, struggled to maintain consistent messaging during the pandemic. Early shifts in guidelines, and scientific ambivalence particularly regarding mask-wearing and social distancing, generated public confusion and accusations of misinformation, despite being based on evolving scientific understanding (Funk & Tyson, 2020). This perceived inconsistency eroded public trust and confidence in some pockets of the medical community and the public at large.

    The rapid development and deployment of COVID-19 vaccines became a central strategy. However, the emphasis on vaccination, coupled with the expedited approval process and marketing by pharmaceutical companies like Pfizer and Moderna, fueled concerns that profit was prioritized over a more holistic public health approach that might have considered the role of natural immunity (Doshi, 2021). Conversely denying the efficacy of other tried and true less expensive pharmaceuticals. Namely Hydroxychloroquine and others.

Media Polarization and Profit-driven Reporting

    The media significantly shaped public perception of the pandemic, often reflecting existing political divisions. Conservative outlets were more likely to highlight potential vaccine side effects and promote natural immunity, while liberal media emphasized vaccine safety and efficacy (Hart, Chinn, & Soroka, 2020). This polarization exacerbated public mistrust and confusion given the conflicting narrative exposures that the American medical care consumer had to juggle.

    The profit-driven nature of media also contributed to the problem. Sensationalism and selective reporting, aimed at increasing viewership, further fueled misinformation and public skepticism towards both vaccines and public health recommendations of the so-called public health "gurus".(Villarreal, 2020).

The Debate: Natural vs. Vaccine-Induced Immunity

    The debate between achieving herd immunity through natural infection versus vaccination was not as complex as they spun it. Proponents of natural herd immunity suggested allowing the virus to spread among low-risk populations, potentially reducing the need for widespread vaccination (Kulldorff, Gupta, & Bhattacharya, 2020). However, the high transmissibility and potential severity of COVID-19, coupled with the risk of overwhelming healthcare systems, made this approach highly controversial. The Vaccine supporters pedaled the notion that this stance offered a more controlled and ensured path to societal immunity, mitigating the risks of severe illness and death (Polack et al., 2020).  

Yet vaccine-induced Myocarditis in the male teenage population was essentially "brushed under the rug".

Conclusion

    So what did we learn from all of this confusing time? Among the many things, that The COVID-19 pandemic exposed the challenges of balancing public health priorities with political and economic interests. Perceived inconsistencies from public health institutions and the influence of profit motives eroded public trust--beyond repair(at least in the mind of this author.) Media politicization further complicated public understanding and acceptance of health measures.

    While vaccines proved effective in mitigating the pandemic, a more comprehensive approach considering both vaccine-induced and natural immunity could have improved mortality outcomes & possible future pandemic responses. 

    Transparent communication and accountability minimizing political and financial influences on public health decisions are always crucial for maintaining public trust in effectively and ethically managing national future health emergencies. Whatever happened to the "to do no harm" medical principle?

Is it not Time For Implementing Health Courts?

    Is the US tort system, particularly in medical malpractice cases, driven by economic considerations or ethical principles? The system is always plagued by inconsistent verdicts, leading to questions of judicial parity and fairness. Some would argue and believe the system is "rigged," meaning the odds are stacked against certain parties, and outcomes are predetermined due to this failed morality.

    One key factor influencing these outcomes is economics. Plaintiff attorneys in medical malpractice cases often prioritize cases with the potential for large financial awards ("big-ticket items"), sometimes exceeding $60,000. This focus on profitability can lead to the neglect of valid malpractice claims with smaller potential payouts ("penny cases"), denying some patients the justice they so clearly deserve.

    This economic imbalance raises concerns about the impartiality of the system, despite assurances from organizations like the American Bar Association (ABA) and the Trial Lawyers Association (ATLA). While these organizations acknowledge imperfections, they maintain the system's fundamental soundness is just...or so they tell us

    In response to these concerns, various tort reforms have been proposed, including malpractice award caps, etc. However, these measures have not proven to be a long-term solution. Another less favored proposed solution is the implementation of health courts and specialized tribunals for medical malpractice cases. While a majority of Americans support this concept, organizations like the ATLA and ABA oppose it, potentially due to concerns about their own influence. They often dismiss health courts as flawed and even harmful, sometimes associating them with "socialistic views," without providing substantial evidence of these views or unilateral assertions.

    The core issue at stake is the conflict between economic incentives and ethical considerations in the pursuit of justice. Obviously, economics are a driving force, so is no surprise our current system is perceived as favoring cases with high financial stakes, potentially denying justice to those with less lucrative claims. This author advocates for health courts as a viable solution & alternative in our judicial system to create a more equitable system, prioritizing fairness and impartiality regardless of economic or social background. The ultimate goal is to eliminate the current system's perceived contempt, unpredictability, and unfairness. Thus, health courts offer a path toward restoring integrity in our flawed and dysfunctional judicial system.

The Haunted Waters of our Healthcare: Our System's Flying Dutchman--a Captainless Ship

    

    The legend of the Flying Dutchman, a captainless & spectral ship doomed to endlessly sail the seas, has haunted maritime folklore for centuries. But this ghostly tale finds an eerie echo in a far more tangible realm: our healthcare system. Like the Dutchman, our healthcare system often feels like a fragmented, perilous voyage, fraught with hidden dangers and elusive destinations.

A Ship Without a Port

    The Flying Dutchman is cursed to never find port, forever adrift. Similarly, many patients find themselves lost in the labyrinth of healthcare, unable to find a clear path to effective, affordable care. They are tossed about by a sea of specialists, referrals, and insurance complexities, never reaching the safe harbor of true well-being.

Hidden Reefs and Treacherous Currents

    The Dutchman's journey is fraught with peril, sudden storms, and unseen obstacles. Our healthcare system, too, is full of hidden reefs: unexpected costs, bureaucratic hurdles, and gaps in coverage. Patients must navigate treacherous currents of confusing policies and procedures, often facing financial ruin or inadequate care.

A Desperate Crew

    The crew of the Flying Dutchman is often depicted as ghostly figures, trapped in their endless voyage. In our healthcare system, patients can feel equally isolated and desperate. They may face chronic illness, debilitating conditions, or the crushing weight of medical debt, feeling abandoned and adrift in a system that should be their lifeline.  

The Illusion of Control

    The Dutchman's captain, according to some legends, is driven by a desperate desire to overcome the odds, even at the cost of his soul. Our healthcare system often presents a similar illusion of control. We are told that with the right insurance and the right doctors, we can conquer any health challenge. But the reality is often far different, with patients feeling powerless against the vast and complex machinery of the system.

A Call for Change

    The tale of the Flying Dutchman serves as a warning, a reminder of the dangers of hubris and the power of fate. Our healthcare system, too, needs a course correction. We must strive to create a system that is not a source of fear and frustration, but a true beacon of hope and healing. Like a ship in need of a safe harbor, our healthcare system requires reform, compassion, and a commitment to serving the needs of all those who navigate its waters. Only then can we avoid the fate of the Dutchman and create a healthcare system that truly delivers on its promise of health and well-being.