Will I ever get over The Impostor Syndrome?

        As a PA, as you mature and grow professionally you will eventually come to a point where you stop seeking professional validation from your colleagues or supervising physician(s). Moreover, many mid-career or senior PAs can’t recall exactly when this occurred in their career, but suffice it to say that level of clinical comfort comes to fruition around your 3rd or even 5th year of clinical practice--maybe a little sooner or a little bit later. Everyone learns and assimilates differently. Just ask your peers.

        You may still feel like a fraud ( aka The Impostor Syndrome ) even with many years of experience under your belt. In fact, even despite the years of CMEs, conferences, and practice skillset refinement & continual enhancement of your knowledge base, it is not uncommon to still feel that you don't measure up in the eyes of others including yourself.

        But rest assured,  as you grow and continue your professional development in your career journey, you will find out you no longer feel like you're a clinical fraud and know nothing at all! In fact, it will all come together and those insecure professional emotions and self-felt insecurities will vanish away. I have precepted numerous PA students during their second-year rotations over the years. All of my students have gone on and done well and I am proud to call them colleagues. While working with these students for 8-week rotations, I have made great friendships. Many have shared their concerns and uncertainty in their readiness to practice. I have also seen their triumphs and watched many grow in their skills and become great PAs. I have also heard their fears. 

        Eventually, you will realize that little nervousness and apprehension you felt and experienced almost daily immediately post-PA school during your early career while going it "alone” or without any mentoring will come to pass too. This is not to say you will never have your fair share of trying times, or difficult patients, nor toxic colleagues/workplaces,  or changing employers several times early on, etc.

        Remember, as the old saying goes: pace yourself; is not a sprint! I now find myself approaching my retirement after 35 years as a surgical PA. Naturally, I feel more comfortable in many areas of medicine than I ever did before; but truth be told, I still feel like I don’t know enough at times. Why? Because medicine is always evolving at a dizzying pace--we all know that. And among the PAs or physicians who have practiced longer than myself, I am sure they would attest to that or feel the same way.

        So, will you ever get over the Impostor Syndrome? Yes, and no. You might not feel any longer nervous or apprehensive about your knowledge base or skill set; rather, more self-aware of what you need to continue learning, and know that learning is a life-long endeavor. Yet, we must recognize and accept many of us in practice tend to see other experienced providers as “experts” in their careers. And in my view that’s okay! Again, Medicine is too vast to be an expert in everything. A PA wanting to be successful (and sane) knows when to ask for help or where to look for the answers.

      Reflecting back at my career thus far, I have concluded that we never really get over The Impostor Syndrome,  but instead, we slowly can become better providers by self-validating our clinical selves knowing that your “training” to be a PA did not end at graduation. The first several years in practice and thereafter will help mold you into the PA you will become thus giving you your very own and unique PA identity. 

 

The Dark Side of Medicine: Profits... their Bottomline

            In recent years, a new phenomenon known as assembly-line medicine seems to have spread throughout an entire industry in a very short time. But more significantly (IMHO), from what I’ve seen, heard, and/or read this new practice mindset can be one of the biggest root causes leading to the demise of Primary care as a specialty. The complaints, frustrations, and/or disappointments of primary care providers seem to have reached an all-time new-level highs given the massive exodus of healthcare givers into medical/surgical specialties.

            The old nice, relaxed pace of practicing the medicine of years gone by are now just a distant memory for many. Back then student graduates were guided and nurtured. They were transitioned easily into their roles by more senior peers or employing supervising physicians. Today  & sadly, that’s not the case nor the reality of this business; everyone is now required to see a higher number of patients regardless of the acuity listed for that encounter visit.

            The pressure to see increased patient numbers (i.e., 10-minute time slots for patient encounters) has not only strained working relationships but also compromised patient care in so many instances. Moreover, is no surprise why many veteran providers retire early, others simply burn out, and others move on to other specialties and/or careers as well. This new practice mindset is not what many students expected nor were they prepared for during their training. Similarly, this very same situation raises another ugly question: are we sacrificing guided professional development with this fast-paced reality? (a topic of discussion for another time)

            Sure, I realize we live & practice in a different economic world order where “lean” operational practices supposedly enhance work productivity & safeguard the (financial) bottom line. I for one, have nothing against this reasoning or belief, yet what I truly oppose is the element of dehumanization this industry philosophy brings to the patient-provider delicate relationship: a mixed message at its core… if not a conflicting one. Isn’t somewhat hypocritical when we try to come across as a very patient-centric industry but all we truly worry/care is about the “numbers” we can keep up, or dare I say it… profits?  

PAs a new breed of Executive Healthcare Administrators -- Why not?

            Today’s executive healthcare positions require & in many cases demands more than a business background or the ability to speak “financial-ese”. This new industry paradigm requires a well-rounded leader; one who is conversant with both the business and the clinical side of medicine. It’s no longer sufficient to be an accountant or a trustee to provide fiduciary oversight to the executive management team. Above and beyond that, these leaders need to be familiar with the latest trends in the industry, not to mention the sometimes unforeseeable marketplace changes in this day and age. Let’s not forget the perennial mandate of cost containment so critical for any business enterprise's sustainability and survivability as well.

           When it comes to Executive Healthcare Administrators by and large they all seem to have the same calling card—a business background. Yet when chosen, PAs are seldom at the top of the list of candidate consideration. Instead, oftentimes, they [we] are bypassed for other PA-kindred professional members (e.g., MDs/DOs, RNs/RPhs, etc). Not until recently, Healthcare Organizations began diversifying their boardroom makeup. And for all the progress that has been made recently, PAs inclusion into this mix has been nil for the most par

            This new executive leader—a Physician Assistant---would possess a unique different skill-set compared to the traditional ones, he or she would have the right experiential mix combination of business knowledge, inside healthcare experience, and technical managerial or administrative expertise. If recognized and groomed properly, these clinicians could significantly eliminate the day-to-day operational deficiencies of HCOs and leadership myopia.

            Unlike traditional business executives or board members, a few forward-thinking  HCOs realize they can do well and even better with PAs due to their prudent stewardship of limited or scarce healthcare resources. While PAs can be good and excel with detailed minutiae responsibilities, almost all are just as good at seeing the big picture too, since they bring a myriad of intangible benefits to the table. Hopefully, others too will start seeing that maintaining these myopic views only perpetuates the untoward effect of unintended professional shortsightedness that is very real encountered in the C-suite

          After all, we [PAs] know first-hand experience about patient-centered care teams & what it takes to catapult the success of an enterprise as a whole. So why not Physician  Assistants as Executive Healthcare Administrators?

The "Awoke" AMA: Are they Tone Death?

        We are in the midst of a global social reset. Many countries including the US are trying to become more trans-culturally transparent by attempting to discard institutionalized biases & racism from all fronts of the socioeconomic spectrum. Also, along the same vein, corporations and profit and nonprofit companies & 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 on crucial conversations facilitating change with elevated empathy, sensitivity, and awareness of past poor systemic inequalities perpetuated by our so-called/racist systemic myopic biases infringing on minority &/or marginalized groups (i.e. BIPOC/LGTBQ+).

        Inexcusably, multicultural health disparities & access to care have been long overdue. Naturally, removing these stereotyped attitudinal beliefs and offensive cultural behaviors will require a huge concerted effort from all healthcare industry stakeholders. Therefore, putting into practice this fresh perspective will require the AMA to go beyond their lip service to the patient community & us--the PA community as well.

        If they want to be viewed by an industry and society as an honestly vested leading humble organization as alluded to in their newly embraced & revised organizational diversity policies, then they must openly recognize two current fundamental needs of the PA profession/community as a whole; namely:

1. Recognize OTP (Optimum Team Practice )

2. Recognize our new professional designation–Physician Associate

        Anything short of valuing interprofessional differences or seeking ways to grow and embrace their understanding & support of the PA profession would be hypocritical. Thus, failing to collaborate in building an industry culture where nonphysician 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 non-inclusive. And worse yet, an openly exclusionary industry stance if not a flagrant discriminatory practice in the eyes of many non-woke physicians/APPs. 

        Utter hypocrisy at its best...how deaf tone can they really be? 

Troubleshooting Pain Management in Patients

        Do you remember when Pain became the "6th vital sign" according to JCAHO? Chances are if you don't, then you have not been practicing medicine long enough. Conversely, if you have been around the block then you know that poorly controlled op & non-op chronic pain can be ascribed or attributed to too many reasons; among them, listed herein are some of the most commonly seen or encountered underlying causes seen in clinical practice:

1. Provider's pain assessments are incorrectly based when only normal VS are presented to them by the nursing staff.

2. During rounds or office encounter patient is non-distressed & is calm-appearing on presentations or exams.

3. Assuming a sleeping or a patient taking a nap is not ever in pain.

4. Assuming the patient is drug-seeking given their PMHx of  "doctor/provider shopping"

5. Assuming the patient is a closet drug user or pusher.

6. Assuming/believing ( “knowing”) procedure or treatment is relatively painless.

7. Assuming the patient is being "manic" given their charted PMHx of Bipolar disorder. 

        Due to the inherent subjectivity of pain being experienced by the patient @ any given time, many providers (including residents) may undertreat the condition due to personal unconscious or implicit biases. It is best to provide an immediate empathetic response such as: "I sympathize with your experienced discomfort and am sorry to hear that you're experiencing pain. Please allow me to look into your pain regimen more closely and make some readjustments, allow me a day or two to see if these changes were helpful. Don't hesitate to let the nurse or me know if there's anything else I/we can do to assist you in finding relief and making you feel more comfortable.

        This frank verbal acknowledgment will ease the patient's fear of being dismissed and underrated as they may have experienced in previous medical encounters. Also assured them, everybody's pain-handling issues are different as you will come to see due to expectations, cultural identity, or even socioeconomic status. Better yet, explain and educate the patient that for his/her benefit you may consider implementing a multimodal pain management approach, or if your interventions are not easing or/ helping mitigate the pain you then may consider ordering or referring the patient to a Pain Management Specialist in order to achieve pain control. Do not forget to add other adjunctive agents such as muscle relaxants, NSAIDs, SSIs, etc. So when we, healthcare professionals (HCPs) use bedside shared-decision making with our patients, then patient satisfaction increases, thus ultimately improving patient trust as a final byproduct.