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.

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.