Beyond Deceitful Narratives

    Unfortunately, in this current world of media misinformation and/or disinformation, oftentimes it's very difficult to eliminate untruthful, deceitful narratives spewed by elitist social groups, or myopic organizations; specifically on the safety of patient care provided by The Physician Associate/Assistant community compared to other types of healthcare providers. As much as they try to obfuscate or veil the truth, most studies and collected data on PA-led patient care reveal a very different reality from the one usually presented about our inferior, unsafe care to the patient community.

Let's go beyond the quick glance & see what literature truly says about their false talking point:

1. Studies have shown that PAs perform at a level comparable to physicians in areas like diagnostic accuracy, patient satisfaction, and adherence to clinical guidelines. (Sources: JAMA 2009, Journal of General Internal Medicine, 2011)

2. Studies have shown no significant difference in patient safety outcomes between PA-led and physician-led primary care visits. (Source: Annals of Family Medicine 2014)

3. Healthcare System Integration:
The presence of PAs in healthcare systems is associated with increased access to care, particularly in underserved communities and rural areas. Several studies have highlighted the positive impact of PAs on healthcare costs, with their services often resulting in lower overall costs compared to physician-only care. (Sources: Health Affairs 2017, The Journal of Rural Health 2018)

4. Patient Satisfaction:
Numerous studies have demonstrated high patient satisfaction with the care provided by PAs, often emphasizing their communication skills, approachability, and patient-centered approach. (Sources: Journal of the American Academy of Physician Assistants 2012, Journal of Family Medicine 2015)

    The past and even current medical malpractice literature have consistently shown objective data positively showcasing PA practices' safe patient care outcomes. Case in point: a 2019 study published in the Annals of Family Medicine found no significant difference in malpractice claim rates between PAs and physicians in primary care.

    Based on these ( only a handful included) industry reports, PAs' patient-centered care approach makes them valuable members of the healthcare team, contributing significantly to improved access, affordability, and quality of care for patients across all socio-economic strata.

    I hope this information is helpful to you and gives you a comprehensive picture of the role of PAs in healthcare safety and quality. Invite others to go beyond the deceitful narratives.

On Becoming a PA Advocate--Just do it!

 Was PA advocacy on your radar in PA School?

No...not even close. But I believe this might place it in context for you: I come from a lineage of hard-working European relatives from both sides of the family. So it is in my DNA. Despite their/our humble beginnings, it seemed like there was always a sense of commitment and collective effort toward ensuring that every family member had an opportunity to succeed. In my case, to get an education as the 1st born American generation. This emphasis learned at an early age on working together and becoming a “person of value” rather than “success” has contributed to a deep sense of responsibility towards myself and my shared community fellow members. That would be the simple explanation I can think of for that query.

While I came late to the idea of a career in medicine at a young age, my inspiration and motivation for pursuing a career as a PA is steeped in a sense of purpose that extends beyond personal and professional aspirations, but more like "paving the way" to the next generation by repaying a profession that has been very good to me.

Truthfully, I am a self-proclaimed lifelong PA advocate. I have always looked at advocacy as an investment in my own professional advancement and personal growth as an individual. Again, I want to inspire the next generation of talented PAs and PA educators who align with the idea of giving back and enhancing our role in the healthcare industry.

Why did you decide to become a PA activist or advocate as some would say?

Initially in my career, I was viewed as a long-standing “spectator” member and inactive participant in our professional affairs for more than a decade when a friend suggested I should become a “participant” so my voice could be heard given that I was so critical and opinionated about our state chapter organization track record handling our legislative destinies. I accepted the challenge and this career move proved to be not only a pivotal but a foundational incident to my development as an engaged vested professional. Looking back, I would say that made me a better person than I was then. I must say it was a one-of-a-kind learning and a fabulous eye-opening experience. Akin to the old metaphor of "learning how the sausage is made".

Certainly, I am most proud and honored to have served in various roles as a previous member of The Michigan Academy of Physician Associates/Assistants on their Board of Directors. It was an exciting time of growth, development, and innovation that we all benefited by creating a more PA state-friendly practice through our partnering strategic efforts with various stakeholders. I feel humbled and honored to have been a small part of passing PA Act 379 as well as to have worked alongside a great group of selfless talented peers by benefiting from their respective expertise and talents. Having this window of opportunity to observe their dedication and leadership inspired me to think about ways to continue to contribute to the PA family even to the day I retire.

What have been or are some of your interests as a proactive PA advocate? Any advocacy activities that you’re excited to pursue?

First, I want to acknowledge that our role as board members is to be devoted fiduciaries to our constituent peers. We simply are in the room to be their voices and represent our members to the best of our abilities in nonpartisan ways. To me, and others alike this is an extremely important responsibility and one that I take seriously to this day and not lightly at all. 

Building on those past experiences, I remain committed to continuing to tackle other issues that impede the PA profession's progress throughout the healthcare industry. As of today, I think PAs face a significant challenge in removing PA practice barriers and archaic restrictions in Puerto Rico. With this ongoing challenge to our community, I am excited about working with other incredibly talented nationwide fellow PAs seeking to advance our mission of excellence in bringing access to 3.5 million disenfranchised Puerto Rican patients. Sadly,  due to their ineffective island healthcare infrastructure. Have been following this unresolved conundrum, and I vow to assist in moving the needle forward in creating a favorable “practice climate” for ourselves in Puerto Rico through the continuum of my career.

Is there anything you learned from previous Board leadership and servant advocacy that you think will help you in your efforts?

Throughout my career, I have learned many lessons, from team-based co-leadership, co-creating, and the idea that diverse teams produce better outcomes. We have tremendously talented and accomplished leaders in our community, and I look forward to these enriching collaborating experiences.

What do you see as the greatest challenges in the profession? Where are the greatest threats or opportunities?

The accepting embracement by the medical establishment of our brand has always been a source of contention in many respects over the past 5 decades. Albeit somewhat lesser today. And yet one of the greatest opportunities to continue to educate others. Our ability to be fully recognized and embraced is just a matter of time. Also, despite our past progress and ongoing efforts in dispelling misinformation, we must be cognizant that health disparities and inequities will remain an ongoing challenge. Patient-provider concordance and the availability of culturally competent care have proven to lead to better health outcomes. Championing our talented workforce diversity has the potential and has shown to play a critical role in helping our profession meet the evolving healthcare needs of our nation and around the globe too.

Many would like to give back to the profession. As someone who is starting out or is a busy practicing clinician, What advice do you have for those who want to get involved?

There are many compelling reasons to consider volunteering your time either at the state or national level. One of the greatest rewards and most impactful benefits associated with serving your profession is working alongside thought leaders and visionary peers leading to forging long-lasting friendships. There are various ways to get involved that don’t necessarily require a significant time commitment as many mistakenly believe (I know because I was one of them). Consider the profound difference you can make by dedicating even a tiny fraction of your time to the betterment of your professional family. Very few career experiences will compare to this--I know. I have lived it.

 

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