A Growing Intolerant View of Advance Practice Providers --so why is that?

       All relationships change or evolve over time. And for better or worse, that is a fact of life. Case in point, a good example of that is our very own inter-professional association with our physician colleagues; one which has undergone and continues to undergo some changes even today. Naturally many factors play into this situation.

      Clearly, speaking of factors one can see Advanced Practice Providers SOP ( scope of practice ) has been evolving too in recent years. Therefore, as time has progressed, one can see our interdependent association has lessened during these times. In fact, professionally speaking we are more autonomous these days than we were in the early days as practicing delegated clinicians. Evidence of this advancement can be seen in recently passed legislative updates nationwide. Full Practice Authority with NPs and Optimum Team Practices are the prime examples that come to mind when one sees the evolvement of our scope of practice, for both, NPs and PAs respectively.. 

But, this recognition has come with a price along with an increasing slanderous backlash trend from multiple physician associations and the very own physician community. Particularly the AMA being one of the most vocal & unsupportive organizations of all of them.

  So why is this phenomenon more noticeable these days to the advanced practice providers community?

  Simple, our past paternalistic association with our former paternalistic colleagues mindset has been slowly dismantled and eroded to the point that nowadays patient care is no longer physician-centric as it used to be in the old days. Much to their chagrin, the updated model of team-based medicine has emerged in many respects as more Advanced Practice Providers-friendly if not downright nursing-centric. Obviously, this industry inclusive move has drawn a wedge between physician and non-physician providers. The displacement of their past industry power has shaken the longstanding traditional hierarchical view of the antiquated system. Thus, apparently this subtle status displacement has intensified and fueled their resentment and professional insecurities to the point of openly disparaging and criticizing our quality patient care outcomes very openly. Hence, the daily misledia continues to inaccurately and @ times deceitfully advance biased stories. These half-truths of their irresponsible reporting at times subtlety cloaked in the form or the guise of patient safety concerns are fundamentally wrong when hypocritically shown to the medical consumer.

Sadly, this disturbing painted picture of sub-par care provided by APPs is nothing more than a negative discrediting rhetoric & projected/transferred professional insecurities of their own. 

A MEMO to all Toxic Physicians

 

  TO: to all Toxic Physicians

  FROM: All Non-physician Providers

  SUBJECT: Your Condescending Attitudinal Behavior

  DATES: Continually for the past Five Decades 

       It has been far too long that we have avoided this important discussion. One that's paramount to our working relationship and vital to the survivability of our strained relationship, both in and out of the OR.

       So let's clear the air...shall we. Please, allow me/us the opportunity to bring to your attention the root of the problem as succinctly as I/we possibly can make in a calm and reasoned manner while being free of any patient or work-related stressors. 

        Now that we have your undivided attention in this matter, we would like to point out your difficulty to relate professionally when you are sarcastic, condescending or plain rude when directing patient care activities. This outdated non-trusting paternalistic attitude & transactional behavior not creates tension and fosters animosity between you and the team of healthcare professionals but hospital administrators as well. We do realize the burden of responsibilities that rest on your shoulders are significant. However, pause and reflect for a moment on the fact that your unrecognized incivility will not only turn away your colleagues, & all other ancillary medical staff, but your patient & family as well. 

        So please, consider amending your ways by becoming  a more tolerant and inclusive provider. By graciously dealing and addressing this personality shortcoming  as best as you can you will find yourself more at ease being the "captain of the ship", making it again  a more enjoyable role in your career.

        It's time to discard this antiquated practice model and reap the benefits of inter-professional inclusivity and understanding. Implementing this new paradigm will be less taxing in all your dealings.

Greatly appreciated now and in the future,

The Healthcare team.

 

 

     

My Biggest Professional Fear

 

        This past year ( 2020 ) was quite a year, one of angst for many of us on many fronts given the domestic and worldwide challenges faced during the pandemic. From the political, to the economy, we saw the different repercussions play in our lives during these uncertain times.

        For some it was personal, for others it was professional.  Yet, we the PA Community (as a whole) continued experiencing professional stigmatization @ all levels. And even more so than ever before, based on recent widely seen publicized untruthful assertions by various physician groups about Advanced Practice Providers [APPs] incompetent or subpar medical care outcomes.

 Why are we so Stigmatized?

         As a PA, you well know how nondescript and misleading our professional title can be and it has been for the past five decades. It's very easy to see how we can be a blemished or devalued professional  group when there's a pervasive basic lack of understanding of our Scope of Practice and industry role. The constant repetition of skewed informational inaccuracies to medical consumers and industry stakeholders never ceases to amaze me even in  these days of the "disinformational age" as I like to call it. Plus, we continue being labeled  either overtly or subtlety as "doctors wannabes"   or more derogatorily as "medical school dropouts" in many physician circles/blogs seen nowadays.

        This negative view of our community stigmatizers even emboldens them to foster legislative professional advancement barriers under the guise of patient safety as proposed by the watchdog group called Physician for Patient protection. Obviously [ we ] being depicted as a dangerous, or poorly trained incompetent providers does nothing to engender confidence nor trust in the patient community. This systemic discriminatory labeling tactic creates not only barriers, but also, reduced likelihood of industry collaboration and acceptance of our brand by other non-physician stakeholders by simply planting mistruths; thus allowing them to cement their necessity of power outside their constituents. Easy to see their ultimate goal; stigmatization of an outside group or individual renders them powerless in the competitive marketplace.

Addressing The Industry Stigma--how to mitigate it?

        We as a community ( and individually) can & must create a positive mindful narrative even though we may have less industry support or financial partners advocating for our industry role. Every AAPA. State Chapter Organization, PA Specialty Organizations along with the AAPA should form a marketing coalition to educate all stakeholders and the industry once and for all of the benefits of our unique Brand. Anything short of such a coalition would not restore the perennial myopia when it comes to understanding our position.

        Such a concerted effort can educate influentially many in discarding or reversing their erroneous stereotypical views of us. One that basically would set forth all our contributing benefits to all the stakeholders we interact daily with... including some members of various divisive physician organizations  calling for our professional industry disenfranchisement by continually referring to us as lesser quality providers/care givers.

        The willingness to stand tall and speak up should take center stage when our voice or OTP is threatened. But more importantly we should strive to eradicate all and any anti-stigma efforts by bringing our contributory narrative into the forefront of every single media outlet in the country. 

        By establishing  a perennial continuum of visibility we will raise our stock and overcome their Medical Tribal Stigmatization...anything short of that will lead me to my biggest fear--stigmatization in perpetuity!

                

          

The Hateful Trifecta

 

        As 2021 rolls out, one thing is becoming clear: the anti-PA rhetoric is becoming louder & louder by the minute as seen in the American Medical Association (AMA) public campaign back in November 2020, entitled  “ #stop scope creep... because patient safety isn’t a game”. Shortly after, ACEP ( The American College of Emergency Physicians), and AFPPA ( The American Family Practice Physicians Association sister physician groups are the last two physician communities to go public supporting this hypocritical agenda. These Physician groups positions are morally bankrupt since their campaigns essentially seeks to stall or halt the evolutionary progression of the scope of practice of Advanced Practice Providers, mainly, Nurse Practitioners, Physician Assistants, Nurse Midwives and CRNAs. They have not only benefited from our utilization easing the workload of their members, but also being reimbursed financially in most cases by our care services rendered to the patient population.

        Personally, do no profession owns a monopoly. Moreover, Healthcare nowadays is clearly a team effort, and all members of the team play a vital part in the care of the patient. In my opinion, most advanced practice providers  are not seeking to replace the physician, nor are anti-physicians’ per se, but rather being true physician extenders in increasing access to millions of people every year. And yes, I/we can assure the medical community as well as the patient community we know our role as well as our limitations. Sadly, but surely, there will always be cavalier advanced practice providers out there, but then again they are also seen in many other healthcare professions too including the physician community as well.

        The position of the AMA, Physicians for patient protection and the authors of the book Patients at Risk postulate that patients deserve care led by physicians --- the most highly educated trained and skilled medical healthcare professional. I / we, the advanced practice providers Community do not disagree with this premise nor deny it.

        However, what I/we object and disagree is their disingenuous hypocritical fear-mongering stance & campaign of misinformation to the American Healthcare consumer. They basically seem to build their argument on untruthful statements ( skewed out of context data ) about the safety of the health care services provided by us and other APPs.  

        This fomented inter-professional divisiveness of curtailing the modernization of PA practice at the legislative level should be viewed and considered a significant intrusion into our own affairs, thus limiting healthcare access to our fellow Americans in an already tough fragmented healthcare industry. But make no mistake about this, right now is a critical time which we shall all come together & put these turf battles to rest. Now is the time to openly chastise those who place inter-professional political ideologies or differences above the common good of the American people. 

        As a group of healthcare professionals, we should & need to stop disenfranchising or demonizing Healthcare Kindred professions. It's time for them to stop seeking to score political points with partisan lobbying allies by marketing disinformation to the general public. Quite frankly in my view, this hypocritical industry practice model is very short-sighted, professionally abhorrent if not unconscionably venomous and utterly disingenuous.   

Holding accountable our unprofessional peers.

Could you hold accountable an unprofessional or unethical peer member when providing subpar clinical care? Or fraudulently misrepresenting themselves to the world and industry @ large?

While you might think this is not your primary responsibility to be policing others, it might behoove you to think again. Why? Because, yes, we all have an ethical obligation to address unprofessional/rogue behavior. If whistleblowing makes you uncomfortable then look at the situation from a patient advocacy protective perspective. In other words, as difficult it may be to you in participating in this internal potential reporting activity, look at it from a “beneficence’” point of view.

In life, sometimes coming to terms to act can be difficult and for many of these moral quandaries it sure can lead to instances of ethical paralyses analysis.

And while these situations might be stressful and downright unpleasant or possibly time-consuming experiences, rest assured that you will be doing the right thing if you hold up your duty when time comes along requiring your ethical and moral stewardship.

Moreover, your anticipated stress level can be mitigated knowing that you’re placing the common good of the patient above your own interests as opposed of those culpable transgressing providers that breached  their own Hippocratic oath.

By reporting the wrongdoer to the medical licensing boards or state society you’re weeding out the so called “bad apples” in the community. You will be safeguarding a patient’s life by eliminating the potential harm that a patient would have been placed under the egregious provider. So when dealing or grappling with an unethical or unscrupulous peer provider, be the “Good Samaritan”. Don't coward or turn a blind eye--refuse to be an accomplice of this maladaptive professional behavior. Call it out. Be intolerant of any fraudulent activities...be the vigilant reporter, the vigilant voice your conscience calls you to be.