The Physician & Advanced Practice Providers Communities: A Problematic Unresolved Quagmire

Tension between The AAPA and the AMA as well as many other physician groups can be expected to escalate in the coming years. Over the past several years the physician community and the PA/NP Communities have been jousting with each other & at odds over the Scope of Practice advancement sought by AAPs throughout the country. Clearly, both groups are opposed to each other’s agenda. This entrenched philosophical quagmire is deeply rooted in misunderstandings, misconceptions, and even mischaracterizations that continue to this day. 

Many physicians' views of nonphysician providers are not very flattering ones. In fact, and currently, they are seeking to discredit this class of highly trained healthcare professionals by portraying them as unruly, deceitful unsubordinates seeking to replace physicians with inferiorly trained clinicians. Thus, claiming this places patients at medical risk given the short & inadequate training in their oftentimes misinformed views of APPs training.

Conversely, APPs see their counterparts as pompous and/or abusive team leaders. They rapidly claim and point out that physicians’ disdain for APPs is palpable if not visible in many circumstances. Thus, creating difficult interprofessional dynamics between both groups. Sometimes it is not uncommon to see animosity or acrimonious interactions between the two groups erupt on various social media platforms. 

Much to their chagrin, APPs are not only continuing to evolve but also assume greater bedside clinical responsibilities. Traditionally part of the physician’s patriarchal domain in the marketplace has been decreasing. Therefore this is seen by them as the ultimate professional encroachment & displacement. This threat is unfathomable in their minds. The fact, that PAs/NPs/CRNAs don't feel the need to be subservient practitioners to the past once-revered physician, this stance has not only exacerbated the relationship, but it also has contributed significantly to their interprofessional strain on many fronts. 

So, given the unresolved strained relations between both groups, the question becomes this: can advanced practice providers and physicians come to terms with working collaboratively side by side with such differing interprofessional practice perspectives?  But more importantly, can it be salvaged? restored?

For physicians, the bottom line is they see themselves “as the perennial captain of the ship”. For many of them, is untenable to accept nonphysician providers as associates as shown & evidenced in the many nonsupportive expressed opinions or official stances declared by their many specialty organizations through the years in various media or social platforms. 

Likewise, nonphysician providers feel unless the physician/medical community comes to terms with acknowledging their growing presence and role (raised professional status) in the healthcare landscape, it will remain an impasse.

 One thing is certain– if both groups fail to move beyond & come to terms, then the practice of medicine is going to be a miserable one for all involved stakeholders…including patients since neither group wants to concede acknowledgment to the other. 

We can only hope this quagmire doesn’t remain in perpetuity. But, only time will tell…

 

Shortsighted Power Struggle Dynamics

 

Tension between The AAPA and the AMA/AOA as well as many physician groups can be expected to escalate in the coming years. Over the past several years the physician community and the PA/NP Communities have been at odds over the Scope of Practice advancement sought by AAPs throughout the country. Both groups are opposed to each other’s agenda. Physicians favor restriction, and APPs favor expansion.

Many physicians' views of nonphysician providers are not very flattering ones. In fact, and currently, they seek to discredit this class of highly trained healthcare professionals by portraying them as unruly unsubordinates seeking to replace physicians with inferior care. Thus, believing this, they feel it places patients at medical risk given the short & inadequate training in their oftentimes misinformed views.

Conversely, APPs see their counterparts as entrenched myopic abusive team leaders. They rapidly claim and point out that physicians’ disdain for APPs is palpable if not visible in many circumstances. Thus, creating difficult interprofessional dynamics between both groups. Sometimes it is not uncommon to see animosity or acrimonious interactions between the two groups erupt overtly or subtly. 

Plus, APPs are not only continuing to evolve but also assume greater bedside clinical responsibilities. Traditionally part of the physician’s domain in the recent past, therefore being seen as a professional encroachment threat that has been usurped by lesser trained caregivers in their views. The fact, that PAs/NPs/CRNAs don't feel the need to be subservient practitioners to the past once-revered physician, has certainly contributed to this growing huge interprofessional strain on many fronts. 

So, given the strained relations between both groups, the question becomes this: Can physicians come to terms with nonphysician providers working alongside & collaboratively with each other?  

For physicians, the bottom line is they see themselves “as the perennial captain of the ship”. For them, is untenable to accept nonphysician providers as associates as seen & evidenced in many expressed opinions or official stances declared by their medical specialty organizations in various media or social platforms.

Likewise, nonphysician providers feel unless the physician/medical community comes to terms with acknowledging their growing presence and role (raised professional status) in the healthcare landscape, it will remain an impasse or a moot point too for them.

 If both groups fail to move beyond & come to terms, then the practice of medicine is going to be a miserable one for all stakeholders involved...including patients since neither group wants to concede to the other. 

Early Career Rough Patches.

 

I have a secret to share with any new PA grad or any newcomer to the profession who feels stressed or is/has been struggling to find a “right fit” employer post-PA school. Or even uncertain about their career choice if things have not gone as planned or envisioned before joining the PA world.

            I know, you feel like throwing the towel. Initially in my career, I struggled to get my bearings. In fact, I almost quit medicine altogether in my first year 3 years of practice. After spending 6 years in college & thousands of dollars in debt (school loans). Looking back, I must confess, I was overwhelmed, stressed, & tough it was all a huge mistake that I had made. Moreover, I even thought I made the wrong career choice.

            

            It didn't take me long to figure out that I needed to become strong and resilient if I was going to survive and push through the “workplace dark clouds”. This means that the quickly unsupportive employers, the toxic office politics, and the uncaring coworkers or even tone-death group practice managers were all very suffocating to me—the newbie & uninitiated PA. After all, PA school never prepared me for these battlefields & turbulent rollercoaster rides. At times I couldn't see past it nor endure these early difficult times. 

          But don't worry, it will come to pass once you realize it is not all your fault and you have value. I have seen this with countless others, sadly medicine sometimes can eat its own. I have seen it in medicine, nursing, etc. Fortunately, much of that has lessened to a more tolerable point. Once you start developing your clinical skills, and personal confidence the ride becomes less turbulent and easier.

          You must be in tune with yourself and have the support of your family and friends. And realize what mistakes you made along the way. For me, I was naïve and too trusting, but more importantly I didn’t do my diligent research on prospective employers during my job search. Sometimes I wished I would have had the internet at my fingertips, it would have made things a little bit easier.      

          Also, I wished I had known about de-stressing techniques earlier in my career or developed a Hobby. An advice that I pass on to my students to this day since I can spare them some of the trials and tribulations when I got started 35 years ago.

        As negative or uneasy as these experiences or circumstances can be, frame your mind to see these unforeseen situations as opportunities instead of setbacks which is very easy to default to when things are not going your way. Remember with a little help from your friends, and family and having faith or a "thick skin" as they say you can overcome these hurdles.

        So don’t throw the towel in quite yet if you’re going through a rough patch early in your career. ..think about the quote instead:

"Pain nourishes courage. You can't be brave if you have only had wonderful things happen to you"

Mary Tyler Moore

PA Pride

        What is PA week? Each year from October 6-12, we celebrate National PA Week, which recognizes the PA profession and its contributions to the nation’s health and wellbeing interventions.

        During that week, the PA community establishes this time as an opportunity to raise awareness and visibility of the profession nationwide. Before it was a weeklong event, National PA Day was first celebrated on October 6, 1987, in honor of the 20th anniversary of the first graduating class of PAs from the Duke University PA program. October 6 is also the birthday of the profession’s founder, Eugene A. Stead, Jr., MD. Now the profession is 56 years strong! Our numbers and acceptance continue to rise even though we might not be a household name...yet

      Since 1967, PAs have been improving patient outcomes and moving healthcare forward. Always innovative. Always flexible. Always ready for what’s next. As we celebrate the profession’s next 50 years, we should collectively view challenges as opportunities. Better yet, unforeseen industry circumstances as possibilities. Because PAs have always achieved the extraordinary and gone beyond.

The PA Community in partnership with all other dedicated healthcare professionals is constantly striving to increase awareness of how to make our healthcare system safer, more efficient, and accessible while providing increased quality to patients and value to the patient community.

PAs regardless of the medical specialty they practice in, they truly embody and every day humbly exemplify their "clinical excellence and service to people" in their diverse clinical roles & caregiving activities to the American healthcare consumer.

To my fellow colleague PAs, embrace your PA legacy with pride and distinction not only during PA week but also every day! Living that call honorably, intentionally, and measurably for the betterment of your fellow brother and fellow sister. 

         We have been trusted for over 50 Years...let's make it ready for 50 more!

                

A Thought on Physician Fragility.

    Isn't medicine about serving & caring for the less fortunate-- our ill /sick fellow society members? So why is it that modern healthcare seems more entrenched in partisan politics than the so-called politicians in Washington? Our patient community needs healthcare access and expert medical advocacy when it comes to medical policy-making...not legislative barriers, inter-professional intolerance (aka turf battles) flexibility. The lack of cooperation, inclusivity, and tolerance is obviously absent when physician groups' behavior departs from Team-based practices.

    How so? (you ask). Well, there are quite a few examples if one looks closely throughout the country. For example, many Medical Boards and Medical state chapter societies are seeking to label non-physician providers as unsafe clinicians. This new position not only seeks to discredit our industry value but rejects both, the mature flexibility and cooperation all physicians should embrace when working with PAs to best serve patients together.

    Is difficult to see the Physician community be so threatened by APPs. This "Physician Fragility" mindset should not be a problem. Physicians and PAs work together in teams and with other healthcare providers every day. Evidence has shown that when PAs have the flexibility to practice at the highest levels of their education and experience, patients benefit most as a result. Unfortunately, many seek to foment division and regression by proposing Scope of Practice restrictions. These partisan legislative moves only seek to reinforce archaic PA practices/regulations. These proposals already decrease access to care in many socio-economically disadvantaged communities or rural ones too. Also, situations like these consequently increase the physician's clinical burden by having to spend more time caring for an older sicker patient population. Hence another factor leading to burnout and/or early retirement.

    One doesn't have to be a "Rocket Scientist"  to see the results of myopic restrictive regulations do not serve patients well. In addition, there is no evidence these kinds of regulations improve patient care or that they are even necessary. The point is, that these proposed regulations are a screen for a disguised restriction of trade. Basically, in search of a problem where there's none.

    Even more disappointing, is the refusal to acknowledge our professional evolution and growth from mere assistants. Their denial seeks to seriously undermine skill  & desire to be professionally respected along with our request to promulgate & support PA-friendly policy regulations that make sense for PAs We know firsthand and understand the challenges and needs facing our profession better than anyone.  Therefore, if they are as patient-centric as they say they are, then, all Physician groups should stand to eliminate any additional layers of bureaucracy that limit healthcare access to patients.

    In the end, Physicians and PAs are all members of the same team when it comes to providing the  American patient with high-quality healthcare. There is no reason why PAs and physicians can mutually resolve/settle this important issue by reaching across the aisle and putting these attitudinal views to rest.