Ban these awful PA nicknames

[HLReed]

From the latest JAAPA Musings blog:

 

Remember that awful nickname your older brother gave you? Or the one mean kids shouted at recess? It made your skin prickle, fists clench, and eyes glow crimson. Now, imagine your boss walks into your office tomorrow and calls you that very name.

 

If the scenario sounds silly, you may not have paid attention to recent national chatter about the physician assistant (PA) profession. The issue of professional title and terminology has embroiled our ranks and—for the second straight year—dominated conversation at national conferences. But the often-discussed idea of changing the profession’s official title has wrestled focus away from another, and perhaps more disturbing, issue: the slew of unofficial nicknames heaped on PAs by outsiders and, far too often, adopted by our own.

 

You have read them in job postings and news articles, each more inaccurate and uninventive than the last: “advanced practice provider,” “non-physician,” “midlevel,” “physician extender.” I’m willing to bet you don’t use them on your resume or to introduce yourself to patients. Nonetheless, these terms have persisted, and even gained acceptance, through sheer repetition.

 

One in particular seems to roll off the tongue of PAs and NPs more than the others. “Midlevel” has become the frontrunner of accepted substitutes. Never mind that it takes more letters to spell than “PA or NP.” This often-used term is also one of the most demeaning.

 

The single word expresses several false implications. The first is that there is a strict tiered hierarchy in healthcare and PAs and NPs occupy the (imaginary) middle rung. I’m not sure who the “low level” providers are, but I bet whoever coined the term “midlevel” imagined registered nurses on that bronze podium. I pity the first human resources representative with the guts to slap “low-level provider” on an RN job list.

 

The term’s ambiguity adds more danger. Does “midlevel” refer to the provider’s training, skill set, or performance? If physicians provide a high level of medical care, then surely a “midlevel” label implies a product of lesser quality. To the contrary, mounting evidence suggests PAs’ patient outcomes and satisfaction are on par with physicians.

 

Major healthcare organizations have noticed the problem with these substitute names. In February, the Society of Hospital Medicine vowed to abolish the use of such terms and instead refer to professions by their official titles. “Admittedly there may be times when using terms like ‘allied health’ are more expedient,” the Society of Hospital Medicine’s official blog stated, “but the potential for alienating members of the hospitalist family outweighs the need for convenience.”

 

Users of these shortcut names rarely have malicious intent. Often, the words come from a perceived convenience and ignorance of the potential for insult. Large organizations in particular, however, should understand the attitudes they unintentionally project toward the very people they hope to attract. Employers send subtle but strong messages through the diction of their websites and recruitment materials.

 

The PA profession has a responsibility to protect its brand. While debate rages about the accuracy and relevance of the term “physician assistant,” it should not distract from—or worse, condone—the generic labels that threaten to dilute our identity. Regardless of the mixed feelings toward our professional name, it is a title we own. Let’s not have it usurped by one that we don’t.

 

 

You can comment here:

http://journals.lww.com/jaapa/blog/musings/Pages/default.aspx

[Whitcc1]

As a hopeful future PA, this discourse was very enlightening! Thanks and couldn't agree more!

 

 

Sent from my iPhone using Tapatalk

[Boatswain2PA]

"More than a nurse, but not a Doctor.". Dr. Eugene Stead.

 

Sounds like a "mid-level provider" to me.

 

Some of us need to get thicker skin....

[PACdan]

^^^ Eh, times change. PAs seeing all comers in their practice can't really be "midlevels".

 

Regardless, the word doesn't help perception, pt. care, and probably your bottom dollar. Why support it?

[EMEDPA]

the issue mostly arises when describing groups of folks who are not doctors together( PAs and NPs).

I'm ok with "advanced practice clinicians" but hate NPP, midlevel, allied health, and physician extender. My CV only says PA on it. Assistant is nowhere on there. I don't assist anyone. I either work alone(2 of 3 jobs) or side by side with a single doc alternating charts from the same rack regardless of acuity. My state does not require chart review.

I attended a "School of PA studies", worked as a" Lead EM PA", etc.

[PACdan]

^^^ I've seen 'clinical provider' also used as a grouping term. I can't think of a fault with that one.

 

But one thing this forum has really instilled in me is just use ' PA ', everywhere, every time. That's my plan.

[EMEDPA]

one place I worked PAs and NPs were affiliated clinicians, at another we are associate clinicians( interestingly enough, md residents are as well there, it just implies someone who requires cosignature on their chart).

[Guest Paula]

It starts with AAPA putting out a piece on the terminology.  AANP has a really nice position statement, full page.  AAPA has two sentences.  Plus, as a PA it is up to us to correct those around who use the term.  

 

Harrison: Have you contacted your employer to stop using the term in their recruitment and advertised positions for PAs?  They use mid-level. You could ask the PA Service at CC to publish it on your website. 

[Guest Paula]

^^^^ To clarify:  Publish your blog on the PA services at Cleveland Clinic's website.  

[HLReed]

 

 

Harrison: Have you contacted your employer to stop using the term in their recruitment and advertised positions for PAs?  They use mid-level. You could ask the PA Service at CC to publish it on your website. 

 

Paula,

My Director of PA Services is a very strong, vocal advocate for the profession on the local, state and national levels. We have done a good job of tackling some of these things as they come up, but at my (very large) institution, the job postings are written by individual department managers and/or individual HR and recruiting employees. They pop up for a month or two and are taken down. It's a little like playing whack-a-mole.

 

But she reads JAAPA. I'll make sure she sees the article.

 

Everyone,

I hear all of your alternative terms, but I keep asking: why do you replace official titles (or their abbreviations) with longer, less uniform, more ambiguous terms? We are grouping two professions; each has a two letter abbreviation. Do we really have such a weak grasp of our own language?

[JohnnyM2]

"More than a nurse, but not a Doctor.". Dr. Eugene Stead.

 

Sounds like a "mid-level provider" to me.

 

Some of us need to get thicker skin....

The one does not imply the other. Mid-level suggests there are levels of clinical medicine practice. You may feel that you provide a lower quality of care than a "real" doctor, but are you really unable to understand that most PAs feel that they provide the exact same care, within their license restrictions, as an md? Another way to look at it is if a medical assistant is a one and a doctor a ten, the middle is 5. Do you consider yourself to be a 5? But here is the real problem, and I'm not sure you are even willing to admit it, but, if mid-level is the way PAs are perceived, then it becomes easy for legislatures to restrict their licenses and autonomy, and patients will have less respect for the profession. Not too long ago, the Texas state legislature passed a bill restricting the ability of PAs to own a practice. Some ownership is still allowed but a single PA or a group of PAs cannot be majority owners in a practice. These kinds of things happen when PAs accept being relegated to mid-level. IMO you are wrong on the semantics and naive about the politics.

 

Sent from my Kindle Fire HDX using Tapatalk 2

 

 

[cinntsp]

"More than a nurse, but not a Doctor.". Dr. Eugene Stead.

 

Sounds like a "mid-level provider" to me.

 

Some of us need to get thicker skin....

 

1966 called and wants its clever phrase back.  We'll have to give up that term soon anyways now that there are assistant physicians.  I guess we can be sub-mid-level providers.

[Guest Paula]

"More than a nurse, but not a Doctor.". Dr. Eugene Stead.

 

Sounds like a "mid-level provider" to me.

 

Some of us need to get thicker skin....

That is the quote from Dr. Stead that ticked off the nurses and started the war.

[Boatswain2PA]

You may feel that you provide a lower quality of care than a "real" doctor, but are you really unable to understand that most PAs feel that they provide the exact same care, within their license restrictions, as an md? Another way to look at it is if a medical assistant is a one and a doctor a ten, the middle is 5. Do you consider yourself to be a 5? But here is the real problem, and I'm not sure you are even willing to admit it, but, if mid-level is the way PAs are perceived, then it becomes easy for legislatures to restrict their licenses and autonomy, and patients will have less respect for the profession. Not too long ago, the Texas state legislature passed a bill restricting the ability of PAs to own a practice. Some ownership is still allowed but a single PA or a group of PAs cannot be majority owners in a practice. These kinds of things happen when PAs accept being relegated to mid-level. IMO you are wrong on the semantics and naive about the politics.

 

Not a lower "quality" of care, but most PAs provide a different "level" of care than physicians.  Do you really think a cardiovascular PA provides the same level of care (ie provides the "exact same care") as the cardiovascular surgeon?  How about the orthopedic PA and the orthopedic surgeon?  The neurosurgical PA and the neurosurgeon?  Pick your specialty (other than family practice) and you will likely see a wide difference in what the PA does and the physician does.  Most of my PA friends don't come anywhere CLOSE to performing at the same level as their physician supervisors.  They ASSIST their physicians, helping them practice better and more efficiently.

 

The same can be said of most emergency medicine PAs.  Most do fast track, or are relegated to seeing mostly green/yellow triaged patients, leaving the higher acuity patients for the physician.

 

There are a few EM PAs, and quite a few family practice PAs, who likely are held to the same standard, and therefore provide the "exact same care" as their physician supervisors.  This is more common in the rural (or very rural) areas.  However to say that "most PAs feel that they provide the 'exact same care'...as an md" is inaccurate.

 

 

[Boatswain2PA]

That is the quote from Dr. Stead that ticked off the nurses and started the war.

 

Nope, that started earlier than that quote.  Dr. Stead wanted to use experienced nurses and his initial approval from Duke was using them.  The nursing mafia (the ANA) however told him he couldn't use nurses for the PA program.  That is when he went to plan B and started with the military medics.

 

When the ANA realized that he was going to do it anyway (with medics), they quickly pushed through the first NP program in Colorado. 

 

The "war" between nursing and medicine dates back to long before Dr. Stead.

[problem child]

"More than a nurse, but not a Doctor.". Dr. Eugene Stead.

 

Sounds like a "mid-level provider" to me.

 

Some of us need to get thicker skin....

 

I love this, botswain ;)

 

I'm fine with being called a mid-level. I identify myself as a mid-level, (I add PA, if I notice the question on their faces) to other providers (nurses, docs, admin). it's simple, and they then know who I am and what I do.

 

(my patients call me doctor. I correct them and they say, "oh, I know, I don't care, you're a doctor to me"). :)

 

I always thought the term "physician assistant" was confusing, and more demeaning. I'm not an "assistant" I'm an licensed medical professional! I'd much rather be called a midlevel. fewer letters, cuts to the chase, move on, do the job.

 

I am soooo sick of this topic. get over yourselves already! there is a hierarchy in medicine, in case you haven't noticed, and we are what we are! so quit whining and do what we do!

[PACdan]

I'm fine with being called a mid-level. I identify myself as a mid-level, (I add PA, if I notice the question on their faces)...

 

I am soooo sick of this topic. get over yourselves already! there is a hierarchy in medicine, in case you haven't noticed, and we are what we are! so quit whining and do what we do!

 

I don't think it's "whining" as much as it's many people intelligently objecting to a label they feel inappropriately describes their work and subsequently harms their profession.

 

[Guest Paula]

Surgical PAs are assistants. 

 

I'm not an assistant in my rural FP position and have one year less training than my GP collaborator who completed a one year internship and said "screw the residency".  

 

So for me I am not mid-level. 

[cinntsp]

 

I am soooo sick of this topic. get over yourselves already! there is a hierarchy in medicine, in case you haven't noticed, and we are what we are! so quit whining and do what we do!

 

It's ok.  You just sit back and enjoy the ride.  We'll get this profession where it needs to be. :)

[ventana]

BOAT - PLEASE use the multiquote button instead of 3 separate quotes....

 

 

 

 

Not a lower "quality" of care, but most PAs provide a different "level" of care than physicians.  Do you really think a cardiovascular PA provides the same level of care (ie provides the "exact same care") as the cardiovascular surgeon?  How about the orthopedic PA and the orthopedic surgeon?  The neurosurgical PA and the neurosurgeon?  Pick your specialty (other than family practice) and you will likely see a wide difference in what the PA does and the physician does.  Most of my PA friends don't come anywhere CLOSE to performing at the same level as their physician supervisors.  They ASSIST their physicians, helping them practice better and more efficiently.

The same can be said of most emergency medicine PAs.  Most do fast track, or are relegated to seeing mostly green/yellow triaged patients, leaving the higher acuity patients for the physician.

 

There are a few EM PAs, and quite a few family practice PAs, who likely are held to the same standard, and therefore provide the "exact same care" as their physician supervisors.  This is more common in the rural (or very rural) areas.  However to say that "most PAs feel that they provide the 'exact same care'...as an md" is inaccurate.

 

 

 

I have to disagree with you 100% here

 

in a trial there is no separate standard for PAs and in many states the standard to be adhered to is that of a specialist

 

Rather it be Ortho, neuro or FP we do indeed practice at the same level for our scope of practice, hence surgeons need to do the surgery by the pre-post op management can be done by PA.  I actually see a trend where PAs have MORE knowledge of the basics of medicine then the life long orthopod.  They might be 'gasp' better at the job they do then the ortho - for no other reason then they do it a lot....  ask an orthopod how to manage a Na of 121 and you likely get a blank stare, ask a hospital based PA working in ortho with out OR privileges the same question, and likely they have an answer.  

 

In PCP world we do the exact same thing - midlevel is an insult and hurts us all

 

 

You are in the minority and it is too bad that you can not see the big picture and realize that titles and names make a big difference (why do companies spend litterally BILLIOINS of dollars a year to advertise and make words and names mean something?  cause it works! and they do carry meaning with the public.)  In my mind it is very shallow, closed minded, unrealistic thinking to say that we have "mid-levels" and practice at a mid-level with in our scope or practice.

 

 

Sorry but I think you are 100% wrong.

[problem child]

I don't think it's "whining" as much as it's many people intelligently objecting to a label they feel inappropriately describes their work and subsequently harms their profession.

 

I don't think "physician assistant" describes the work I do. as I said before, I think it's confusing and it is a title that often demeans us in the eyes of patients bc it is often interpreted by them as "medical assistant" (like, "when am I going to see the doctor..?"). they don't know that I can do what a doctor does; they look apprehensive, I hate reciting the whole "what a PA is" bullshit....I just want to do my job and get on with my day.

 

ps I'm not saying I introduce myself to patients as a midlevel. I introduce myself as a PA (not "physician assistant" for the above reasons) and get down to business. it is when I am working with attendings, nurses, other midlevels and residents that I will say, "I'm a mid-level, a PA" and then we get to work. if one of them (resident, attending, etc) introduces me as an NP, however...(smile)...I correct them because I'm proud of my knowledge and training and know very well it is distinct from NPs.

 

hope that helps. 

[cinntsp]

I don't think "physician assistant" describes the work I do. as I said before, I think it's confusing and it is a title that often demeans us in the eyes of patients bc it is often interpreted by them as "medical assistant" (like, "when am I going to see the doctor..?"). they don't know that I can do what a doctor does; they look apprehensive, I hate reciting the whole "what a PA is" bullshit....I just want to do my job and get on with my day.

 

ps I'm not saying I introduce myself to patients as a midlevel. I introduce myself as a PA (not "physician assistant" for the above reasons) and get down to business. it is when I am working with attendings, nurses, other midlevels and residents that I will say, "I'm a mid-level, a PA" and then we get to work. if one of them (resident, attending, etc) introduces me as an NP, however...(smile)...I correct them because I'm proud of my knowledge and training and know very well it is distinct from NPs.

 

hope that helps.

 

Why would you need to use the term midlevel as if these other healthcare folks don't know what a PA is? I spent a lot of time in hospitals over the past year and never had to tell anyone I'm a midlevel to make them understand.

 

Sent from my Nexus 5 using Tapatalk

 

[KMD16]

Mid-level. Very distasteful. An assistant, can't stand it anymore. To be often time group under allied health, is so insulting to say the least. I just introduce myself as a PA.

[PACdan]

 

 

I don't think "physician assistant" describes the work I do. as I said before, I think it's confusing and it is a title that often demeans us in the eyes of patients bc it is often interpreted by them as "medical assistant" (like, "when am I going to see the doctor..?"). they don't know that I can do what a doctor does; they look apprehensive, I hate reciting the whole "what a PA is" bullshit....I just want to do my job and get on with my day.

 

ps I'm not saying I introduce myself to patients as a midlevel. I introduce myself as a PA (not "physician assistant" for the above reasons) and get down to business. it is when I am working with attendings, nurses, other midlevels and residents that I will say, "I'm a mid-level, a PA" and then we get to work. if one of them (resident, attending, etc) introduces me as an NP, however...(smile)...I correct them because I'm proud of my knowledge and training and know very well it is distinct from NPs.

 

hope that helps.

I agree with you that the "assistant" part of PA needs a change just as much or more than discontinuing the use of midlevel, but it's not a one or the other scenario, both can be accomplished.

 

As others have said, the physicians, nurses, etc. should really know what a PA is and does, without you having to introduce yourself with "I'm a midlevel". If they don't, I worry about their exposure to medicine.

 

It's awesome you're proud of your knowledge and training as a PA that makes you distinct from an NP. But using "midlevel" strips away that distinctiveness and lumps you back together, especially to the lay public. I know alternate terms don't fix that aspect of it, but that's why I think the best suggestion I see is to use PA every time.

[Boatswain2PA]

It's ok.  You just sit back and enjoy the ride.  We'll get this profession where it needs to be. :)

 

You might want to wait until you are done with school before you force many of us to the back of the bus and you single-handedly save the profession.

 

Of course, when you get done with school and you are finally responsible for practicing medicine on your own you might just realize how much you haven't learned yet. 

 

BOAT - PLEASE use the multiquote button instead of 3 separate quotes....

 

 

 

 

I have to disagree with you 100% here

 

in a trial there is no separate standard for PAs and in many states the standard to be adhered to is that of a specialist

 

Rather it be Ortho, neuro or FP we do indeed practice at the same level for our scope of practice, hence surgeons need to do the surgery by the pre-post op management can be done by PA.  I actually see a trend where PAs have MORE knowledge of the basics of medicine then the life long orthopod.  They might be 'gasp' better at the job they do then the ortho - for no other reason then they do it a lot....  ask an orthopod how to manage a Na of 121 and you likely get a blank stare, ask a hospital based PA working in ortho with out OR privileges the same question, and likely they have an answer.  

 

In PCP world we do the exact same thing - midlevel is an insult and hurts us all

 

 

You are in the minority and it is too bad that you can not see the big picture and realize that titles and names make a big difference (why do companies spend litterally BILLIOINS of dollars a year to advertise and make words and names mean something?  cause it works! and they do carry meaning with the public.)  In my mind it is very shallow, closed minded, unrealistic thinking to say that we have "mid-levels" and practice at a mid-level with in our scope or practice.

 

 

Sorry but I think you are 100% wrong.

 

I tried using multi-quote while removing extraneous portions of the quote, but wound up deleting the header and goofing up the whole thing :-)

 

For malpractice trials there certainly IS a different standard of care for a PA versus generalist versus a specialist.  While this varies state to state, the differences can be things like who is allowed to testify as an expert witness for and against you (many states require equal education/certification and licensure within the state). For example - I practice rural EM.  If I were sued for malpractice, a board certified emergency medicine physician would not be allowed to testify against me as an expert witness because I am not a board certified emergency physician, and neither are any of my supervising physicians.  This makes sense because we practice different "levels" of medicine.  For example - if an exanguinating chest trauma comes in.  The BC EM doc can crack the chest and cross clamp the aorta, whereas I can't. 

 

I agree with you that we provide the same level of care in accordance with our scope of practice....but we have a different scope of practice!

 

Don't be so sure that I am in the majority.  Just like any political movement, it is the often the vocal minority who stir up the most emotion.  Just because there are some vocal people on these boards who denigrate those of us who use the term mid-level, and some who think they are just as educated and proficient as a physician, doesn't mean that the majority of our profession feels the same way. 

 

And lastly, can we stop calling each other derogatory names?  I am a "big picture" kind of thinker, and I am certainly not a "shallow, closed minded, unrealistic thinker". 

 

We just disagree on whether the term mid-level is derogatory.

 

But then again, I don't think the Washington Redskins is a derogatory name either....maybe I need some thinner skin!