Patient Safety Outcome Metrics Disputed: Where is the outrage of the Physician Assistant Community?

     

        The problem with half-truths, or media disinformation is that oftentimes they are actually believed if continually repeated or perpetuated. Unfortunately these incorrect spins can become deeply ingrained in the collective mind of people; especially when grossly out of context or worse yet, not corrected contemporaneously by the reporting entities. Sadly, and  painfully, a very well known reality to all PAs who have experienced this stigmatization first-hand in their respective careers by the misinformed patient, practice manager or even dept. head administrators. Even more troubling to this author is the apathetic indifference of many of our own peers who remain complicit with our detractors or opponents in this regard.

        Primarily the objective data ( patient safety outcome care metrics) reflect very similar clinical care outcomes between our physician counterparts and us-- the non-physician providers as some like to refer to us when compared by others.

As I am sure, you have noticed our profession has been maligned for several years now. Whether it is overtly or not, we have yet to surmount a credible vigorous rebuttal campaign with political muscle in Washington, D.C. PAs for Tomorrow, a recently created Specialty interest group, splintered from the AAPA given their indifference or anemic stance when creating and developing the PA brand. While they may have been proactive in educating many in advancing our interests, at the end of the day they are somewhat limited since they rely mostly on donations and membership dues. Sadly, to this day, The AAPA has not advanced our brand aggressively nor launched a major national advertising campaign aimed @ focusing on our most pressing initiatives in the marketplace today. For example, nationwide OTP acceptance @ once...not 10 years from today, loss of employment parity due to the strong alignment of the AANP (nursing profession) with  strong lobbying supporters. These organizations openly support & fund generously the nursing profession, thus creating friendly Congressional lobbying allies. Unlike our community which we lag behind because we have not learned “the Art of the Deal” by being timid in advocating our own cause, so we remain marginalized...so where's the outrage from the PA community? Obviously, yet to be heard.

But, if we continue being passive, uninvolved in our own affairs, the outcome of our professional destiny then will be fated. 

I hope that this incorrect patient safety narrative spewed by some physician groups through various informational outlets would be the catalyst in becoming the driving force to fundamentally change & awaken us from our collective passivity. 

It is my hope that we can all see that without this outrage, we cannot protect and preserve our significant professional advancement that our predecessors secured in our progressive professional evolution.

Stand up and oppose  professional misinformation or disinformation or even more mischaracterization of a great profession that has served you & all of us well. Please, donate, speak and or write to debunk this flagrant lie. You must assert the truth when clarifying or inform others about our magnificent profession.

The Opioid Crisis: Who is really to Blame?

        Finger-pointing for this debacle and health crisis has been widespread, albeit skewed and unjustly zeroed on the medical community. In my opinion, much of it is unfair since I have yet to come across any reading that has taken a more objective in-depth look at the causative factor and asked unbiasedly why it happened in the first place. In other words, place the problem in its proper context by examining the genesis of this debated conundrum and ask ourselves– who is really to blame?.

        Critics have mostly blamed Big Pharma for their greed and the federal government & states for their poorly slow response to this devastating societal tragedy. But one would be remiss if the blame would go non apportioned accordingly, meaning forgetting to recognize or at the very least attribute other entities directly or indirectly responsible for this public health nightmare; to basically go one step further, right?.

So who else should be held responsible? Well, for starters how about JCAHO? The Joint Commission Accreditation Hospital Organization, the quasi-governmental bureaucratic agency that led the well intended campaign named “Pain the 6th vital sign”  back in the late nineties. Based on their researched studies, they spearheaded this idea/project & placed the healthcare industry in a very untenable position since the medical community had failed to address the undertreatment of pain for decades, thus pressuring medical providers to correct this deficiency in the management of chronic pain. Obviously this industrial guilt trip became deeply rooted leading to over prescribing.

By their views, we were told to step-it-up and so we did, because they told us so. Sadly and mistakenly, we failed to pause and reflect on the foreseeable consequences of this moral dilemma. Yes, we must and have accepted to shoulder this imperative responsibility in our clinical practices/careers. Unfortunately, this self-created malady is a classical example of “The Law of Unintended Consequences” – an undeniably painful reality to this day. 

The medical community has strived and will continue to do so when it comes to addressing & dealing with this complex clinical phenomena by becoming more educated & becoming more prudent prescribers. A work in progress to this day, but improving.

           As all stakeholders have become aware of this difficult problem, we should avoid this past pressurized demand. Furthermore, avoid singling out a particular group & stop pointing vilifying fingers. But more importantly, recognize & accept the fact we all played the “over prescribing role” in this disgraceful national opioid epidemic. Simply, we must do it.

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The Hateful Trifecta

 

In 2021 & 2022, one thing was & is becoming clear: the anti-PA rhetoric is becoming louder & louder by the minute as seen by the American Medical Association (AMA) back in November 2020, entitled “ #stop scope creep... because patient safety isn’t a game”. Also, ACEP ( The American College of Emergency Physicians), and AFPPA ( The American Family Practice Physicians Association are the last physician communities to go public with this agenda. These Physician groups are morally bankrupt since their campaigns essentially seek to stall or halt the evolutionary progression of the scope of practice of Advanced Practice Providers ( APPs), mainly Nurse Practitioners, Physician Assistants, Nurse Midwives and CRNAs.

Healthcare is evolving, not to mention nowadays is 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 be a true physician extender. 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 & physicians too.

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 health professionals. In fact, rest assured The Advanced Practice Providers Community do not disagree nor dispute with this premise.

However, what this author/we object and disagree with is their hypocritical & disingenuous fear-mongering media campaign of misinformation to the American Healthcare consumer. They basically seek to build & present their skewed argument on untruthful statements about the safety of the health care services provided by us.  

This fomented inter-professional divisions of curtailing the modernization of PA practice at the legislative level should be viewed and considered a significant barrier to the increasing and facilitation of healthcare access to our fellow Americans in an already fragmented healthcare industry. But make no mistake, right now is a critical time to put these turf battles to rest. Now is the time  to place inter-professional political ideologies or differences aside  for the common good & betterment of a siloed industry.  As a group of healthcare professionals, we should & need to stop demonizing, disenfranchising or canceling other Healthcare Kindred professions.

It's time for them to stop seeking to score political points with partisan constituents by marketing disinformation to the general public. Quite frankly in my view, this hypocritical industry practice model is very short-sighted, professionally divisive,if not completely unconscionably unsustainable.  

Is it time to consider becoming a Union member?

    You drive to work everyday, and oftentimes you feel dejected or simply demoralized given that your workplace needs go unmet or your employer has become less PA supportive. In fact, you have started to feel more of an assembler in an assembly line than actually a highly regarded and respected professional clinician. And this is all due to your employer’s current workplace culture. One that’s purely profit-driven even though they claim & pretend to be a patient-centered working environment. Yet, clearly no regard for you wellbeing or work-life balance for that matter.

    But before too long, you feel that you have been placing yourself at risk more and more just to keep the assembly line alive, however, deep down you  feel disrespected and devalued since your employer’s work expectations are simply unrealistic, always adding to the daily workload.

    You have tried to re-negotiate your contract, to find a satisfactory resolution to the dilemma at hand. But your efforts continuously fall short. Your efforts and attempts are dismissed and any hopeful potential dialogue to remediate the flagrant indifference goes to the wayside. Much to your chagrin & dismay any expected concessions are trumped, always due to some budget issues excuses,yet they keep raking in the money…at your expense, naturally.

    You ask yourself, “what do I do now?” In a split second you consider resigning  and dusting off the old resume to embark in an unpredictable job hunt.But,then you realize you have vested time and effort in your unpalatable working conditions.

    However the question you should be asking yourself is this one: should I rally my colleagues to unionize? Followed by “why not?” and “what I/we got to lose”?  I know because I have been there and done that! Don’t allow Paralysis Analysis to interfere with leveling your playing field or your possible negative views of unions hold you back. After all, it might be your only recourse if you have no voice or representation at the table. Ask yourself this, is it time for unionizing?

To facilitate your decision consider the following steps:

1.Research, research and research all your options.

2.examine your past & current employer-employee working relations history

3.suspend  or set aside your preliminary union biases you may have.

4.follow your heart/instincts..

 

The "Awoke" AMA: Are they for real?

    We are in the midst of a global social reset. Many countries including the US are trying to become more transculturally transparent by attempting to discard institutionalized biases & racist transgressions committed in their transactional roles with all traditionally disenfranchised ethnic groups. Also, along the same vein, corporations. profit and nonprofit organizations have begun to effectively address workplace inequalities while the healthcare industry is trying to eradicate past healthcare inequities as well.

    So given that premise, we’re all embarking in crucial conversations facilitating change with elevated empathy, sensitivity and awareness of past poor systemic inequalities. Mostly if not all perpetuated by our so-called/racist systemic myopic biases infringing on minority or marginalized groups. 

    Multicultural health disparities corrections & access to care has been long overdue. Naturally, removing these stereotyped attitudinal beliefs and offensive cultural behaviors will require a huge concerted effort from all healthcare industry stakeholders. But putting into practice this fresh embraced perspective will require the AMA to go beyond lip service to their partnering stakeholders such as the patient community & us as well.

    If they want to be viewed credibly by society and other various industry stakeholders as a vested enlightened & unbiased organization as alluded in their newly revised/embraced diversity policies, then they must openly recognize two fundamental needs of the PA profession/community; namely:

1. Recognize OTP (Optimum Team Practice )

2. Recognize our new professional designation–Physician Associate       

    Anything short of valuing inter-professional differences or seeking ways to grow and embrace their understanding & support of the PA profession would be hypocritical. Thus failing to truly collaborate in building an industry culture where non-physician providers are not empowered to bring their full, authentic selves to the table, nor increase access to healthcare to vulnerable patient communities is not only disrespectful, but downright morally hollow. And worse yet, such a move could be viewed as nothing more than an insincere case of organizational moral self-exculpation in the eyes of many in any transactional role they would attempt to engage in. Especially with prior oppressed social groups.

    For PAs diversity, equity & inclusivity have always been more than ideas, they have been part of our professional DNA and calling when providing care to our patients for the past 5 decades.

   So will the AMA abide by their own modernized organizational policies and revamped organizational image? Perhaps…only time will tell if they are as passionate in rebuilding and maintaining an honest transparent cultural philosophy that is representative of this new paradigm were intolerance of any form of discrimination is openly rejected & ultimately condemned in the name of social justice. 

    In sum, as George Bernard Shaw said it best: "Progress is impossible without change, and those who can not change their minds can not change anything".