Ban these awful PA nicknames

[cinntsp]

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.

 

When that happens in 3 weeks I'll let you know if my opinion has changed. Regardless, my comment was made half in jest.

 

Sent from my Nexus 5 using Tapatalk

 

 

[PACdan]

^^^Yeah Chris, how dare you have critical thinking that isn't commiserate with your "status".

 

What does a student know. And even after that you're just a new grad. Sheesh, so later you've got 5 years experience? Call me when it's two complete decades.

 

*30 years later*

 

You're retired now grandpa, that the he11 do you know!

 

;)

[Boatswain2PA]

^^^Yeah Chris, how dare you have critical thinking that isn't commiserate with your "status".

 

What does a student know. And even after that you're just a new grad. Sheesh, so later you've got 5 years experience? Call me when it's two complete decades.

 

*30 years later*

 

You're retired now grandpa, that the he11 do you know!

 

;)

It's not the disagreement Dan, it's the flippant attitude toward those of us who he disagrees with.  "1966 called and wants their clever phrase back", and "You just sit back and enjoy the ride".  There is no substance here, just derogation from someone who still has preceptors responsible for their patient care.

[cinntsp]

It's not the disagreement Dan, it's the flippant attitude toward those of us who he disagrees with. "1966 called and wants their clever phrase back", and "You just sit back and enjoy the ride". There is no substance here, just derogation from someone who still has preceptors responsible for their patient care.

There is substance if you read between the lines. The point was that a 50 year old view may be antiquated and it's time to reassess. For someone with such a thick skin, you're really taking my sarcasm to heart.

 

Let's not get things twisted here. Please don't pretend that having less responsibility is what makes folks disagree with the term midlevel. You've seen plenty of experienced PAs with that sentiment.

 

Sent from my Nexus 5 using Tapatalk

 

[chris.shannon77]

Let's make it one of those words we can use within our group, but make it unacceptable for those outside of our group to use it to describe us.

[Boatswain2PA]

... The point was that a 50 year old view may be antiquated and it's time to reassess. For someone with such a thick skin, you're really taking my sarcasm to heart...

Now you have posted something substantive.

 

It's always good to reassess.  Over the past 50 years PA education has improved (and then again it could be argued that it has declined over past 8-10 years as well), and our scope of practice is vastly improved in every state. 

 

However so has the physician education.  The "gold standard" for medical education is now a residency trained and board certified physician.  We still fall far below that standard, therefore it is appropriate to consider us "mid-level" providers.

 

Sarcasm is often difficult to appropriately express in written form without coming across as disrespect.

[chris.shannon77]

Mine was sarcasm.  I'm pretty sure it didn't get lost is translation.

 

I'm going to develop an emoticon to convey sarcasm, get rich, and retire.

[problem child]

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

 

you need to read my posts more slowly, if you're interested. I explained the whole thing already. it's about teaming up, identifying yourself to your colleagues, and getting the work done. I do locums work, so I am often in new work environments.

[PACdan]

I'll restate here a sentiment that I posted elsewhere. And that is: if you draw a straight line between nurse and doctor, I don't see PAs falling in the middle. Through all their education, training, and practice, that point would be closer to physican and farther from nurse, not equidistant from both.

 

Longer, 100+ credit Master's programs, residences, and CAQs are all things driving up the "gold standard" for PAs as well.

 

I am thankful for the paved road, I hope I can pave it further or at least add a fresh topcoat.

 

[chris.shannon77]

Upper Mid-Level?

 

The lay person understands upper middle-class.

[PACdan]

 

Upper Mid-Level?

 

The lay person understands upper middle-class.

 

 

Yup, fits the technical description better, IMO.

 

It's also akin to low, mid, and high-grade (test) gasoline. There are several classes past mid-grade... (91 octane, 93 octane, etc.)

[chris.shannon77]

Yup, fits the technical description better, IMO.

 

It's also akin to low, mid, and high-grade (test) gasoline. But with 91 octane being the cut-off for Premium fuel and labeled as such, they call 93 octane "Super-premium" and so on in the "high-grade" realm.

 

I'd say most PAs are premium and most docs are super premium. And the public gets octane ratings (hopefully). I wouldn't call PAs "mid-grade" fuel.

 

Great analogy.

 

So do we go with PPA - Premium Physician Assistant, PCP - Premium Clinical Provider, or PA-P - Physician Assistant - Premium?

 

I like Physician Assistant - Premium.  Has some ompf at the end.

[PACdan]

Great analogy.

 

So do we go with PPA - Premium Physician Assistant, PCP - Premium Clinical Provider, or PA-P - Physician Assistant - Premium?

 

I like Physician Assistant - Premium.  Has some ompf at the end.

 

Oh god, I tried to get rid of it because my analogy was getting too complex. haha

 

Simplified: Not mid-grade, but not Ultra-Premium. But always unleaded. ;)

 

I'm just gonna stick with PA, and try to avoid all other labels. When the day comes, I'll vote for Advanced Practice Clinician or Clinical Provider over Midlevel...

[cinntsp]

you need to read my posts more slowly, if you're interested. I explained the whole thing already. it's about teaming up, identifying yourself to your colleagues, and getting the work done. I do locums work, so I am often in new work environments.

Have you really ever said you're a PA and had a resident or nurse be confused only to understand when you say 'you know...a midlevel'?

 

Sent from my Nexus 5 using Tapatalk

 

 

[PACdan]

you need to read my posts more slowly, if you're interested. I explained the whole thing already. it's about teaming up, identifying yourself to your colleagues, and getting the work done. I do locums work, so I am often in new work environments.

 

I think the question is how does stating "midlevel" with other medical personnel accomplish "teaming up, identifying yourself to your colleagues, and getting the work done" any faster than saying: "I'm Problem Child, a PA, nice to meet you, let's get cracking”?

 

I think the answer is: it doesn't. Unless you routinely encounter those in medicine who have no idea what a PA is, but somehow understand the full concept of a "midlevel".

[Boatswain2PA]

I think the question is how does stating "midlevel" with other medical personnel accomplish "teaming up, identifying yourself to your colleagues, and getting the work done" any faster than saying: "I'm Problem Child, a PA, nice to meet you, let's get cracking”?

 

I think the answer is: it doesn't. Unless you routinely encounter those in medicine who have no idea what a PA is, but somehow understand the full concept of a "midlevel".

I'm sure that's not how ProblemChild refers to him/herself.

 

However, when discussing pleuralities, it is easier to say "Doc's see the level 1's, and midlevels can see level 2 & 3's" than "Physicians see the level 1's, and PAs and nurse practitioners can see the level 2 & 3's". 

 

Or, "We are hiring another mid-level" vice "We are hiring another PA or nurse practitioner".

 

It's just an informal term

[ventana]

from out physician counterparts

 

http://www.clinician1.com/posts/article/a_physician_says_stop_calling_nps_mid_level_providers/

 

A Physician Says “Stop Calling NPs Mid-Level Providers”

Posted 13 hours, 25 minutes ago by Dave Mittman  Acute Care/Emergency Medicine, Adult Health, Cardiology,Dermatology, Emergency Medicine, Family Medicine, Geriatrics, Internal Medicine, PA or NP Education, Pediatrics,Psych/Mental Health, Retail Care, Rural Healthcare, Surgery and Women's Health

Stop calling nurse practitioners mid-level providers 
MICHAEL D. PAPPAS, MD | PHYSICIAN | JULY 14, 2014

I really hate it when a nurse practitioner is called a mid-level provider.

“Mid-level provider” isn’t even a legal or academic term. It is slang developed to demean or minimize a health professional, who is not an MD.

The term “mid-level provider” is primarily aimed at nurse practitioners (NPs) as well as physician assistants (PAs) and mid-wives. It is insulting to health professionals as well as to the patients that they serve.

Let’s be logical and think about this. “Mid-level” implies that he or she provides middle of the road or average care, not high-level care. Who then delivers high-level care? It must be the MD, of course. So, who delivers the lowest level of care? Nurses?

Nurses are the foundation of medical care. They tell us (MDs) when they recognize a problem or a need for an intervention. Then, we act. They are not low-level providers. Therefore, if nurses are not low-level care providers, then nurse practitioners cannot be mid-level providers.

What do the patients and families think when they hear this? “Don’t worry Mom and Dad, a low-level and mid-level will take care of your sick child, until the high level arrives.” That just sounds stupid.

It is also insulting to anyone who has decided to pursue higher education and improve oneself that he or she has finally achieved mid-level competence.

Maybe the term “mid-level provider” got started based on the number of years in training. I understand that physicians have more years of school than practitioners. I get that. But, most of us know that we define ourselves after we begin working on our own, and are responsible for our own decisions. The first 3 to 5 years after graduation is when we grow and decide what kind of clinician we will be.

Children and their parents want to receive excellent medical care delivered to them by a kind and gentle clinician. MDs don’t have a market on that one. If, as a clinician, you can provide excellent medical care with humility, then you provide the highest level of care available. I don’t care if the initials after your name are MD, NP, PA, or DOA. Children definitely don’t care. They just want to get better.

So let’s move out of the dark ages, and join the age of enlightenment. Let’s not insult our patients by telling them that we will provide mid-level care to them, and let’s not insult our co-workers by calling them less than what they are.

Instead of “a mid-level will be seeing your child,” how about, “Our clinician will be right with you, and he or she will take excellent care of your child?”

Michael D. Pappas is a pediatrician and can be reached at Children’s Intensive Caring.

http://www.kevinmd.com/blog/2014/07/stop-calling-nurse-practitioners-mid-level-providers.html

[PACdan]

 

 

I'm sure that's not how ProblemChild refers to him/herself.

 

However, when discussing pleuralities, it is easier to say "Doc's see the level 1's, and midlevels can see level 2 & 3's" than "Physicians see the level 1's, and PAs and nurse practitioners can see the level 2 & 3's".

 

Or, "We are hiring another mid-level" vice "We are hiring another PA or nurse practitioner".

 

It's just an informal term

 

I understand it saves a few syllables, but I think "informal terms" can develop formal consequences over time.

 

 

Hence why I will choose to avoid.

[DiggySRNA]

 

from out physician counterparts

 

http://www.clinician1.com/posts/article/a_physician_says_stop_calling_nps_mid_level_providers/

 

A Physician Says “Stop Calling NPs Mid-Level Providers”

Posted 13 hours, 25 minutes ago by Dave Mittman  Acute Care/Emergency Medicine, Adult Health, Cardiology,Dermatology, Emergency Medicine, Family Medicine, Geriatrics, Internal Medicine, PA or NP Education, Pediatrics,Psych/Mental Health, Retail Care, Rural Healthcare, Surgery and Women's Health

Stop calling nurse practitioners mid-level providers 

MICHAEL D. PAPPAS, MD | PHYSICIAN | JULY 14, 2014

I really hate it when a nurse practitioner is called a mid-level provider.

“Mid-level provider” isn’t even a legal or academic term. It is slang developed to demean or minimize a health professional, who is not an MD.

The term “mid-level provider” is primarily aimed at nurse practitioners (NPs) as well as physician assistants (PAs) and mid-wives. It is insulting to health professionals as well as to the patients that they serve.

Let’s be logical and think about this. “Mid-level” implies that he or she provides middle of the road or average care, not high-level care. Who then delivers high-level care? It must be the MD, of course. So, who delivers the lowest level of care? Nurses?

Nurses are the foundation of medical care. They tell us (MDs) when they recognize a problem or a need for an intervention. Then, we act. They are not low-level providers. Therefore, if nurses are not low-level care providers, then nurse practitioners cannot be mid-level providers.

What do the patients and families think when they hear this? “Don’t worry Mom and Dad, a low-level and mid-level will take care of your sick child, until the high level arrives.” That just sounds stupid.

It is also insulting to anyone who has decided to pursue higher education and improve oneself that he or she has finally achieved mid-level competence.

Maybe the term “mid-level provider” got started based on the number of years in training. I understand that physicians have more years of school than practitioners. I get that. But, most of us know that we define ourselves after we begin working on our own, and are responsible for our own decisions. The first 3 to 5 years after graduation is when we grow and decide what kind of clinician we will be.

Children and their parents want to receive excellent medical care delivered to them by a kind and gentle clinician. MDs don’t have a market on that one. If, as a clinician, you can provide excellent medical care with humility, then you provide the highest level of care available. I don’t care if the initials after your name are MD, NP, PA, or DOA. Children definitely don’t care. They just want to get better.

So let’s move out of the dark ages, and join the age of enlightenment. Let’s not insult our patients by telling them that we will provide mid-level care to them, and let’s not insult our co-workers by calling them less than what they are.

Instead of “a mid-level will be seeing your child,” how about, “Our clinician will be right with you, and he or she will take excellent care of your child?”

Michael D. Pappas is a pediatrician and can be reached at Children’s Intensive Caring.

http://www.kevinmd.com/blog/2014/07/stop-calling-nurse-practitioners-mid-level-providers.html

 

Beautifully well put

[JohnnyM2]

I think the question is how does stating "midlevel" with other medical personnel accomplish "teaming up, identifying yourself to your colleagues, and getting the work done" any faster than saying: "I'm Problem Child, a PA, nice to meet you, let's get cracking”?

 

I think the answer is: it doesn't. Unless you routinely encounter those in medicine who have no idea what a PA is, but somehow understand the full concept of a "midlevel".

Score!

 

Sent from my Kindle Fire HDX using Tapatalk 2

 

 

[andersenpa]

"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....

Do you practice mid-level medicine?

[db_pavnp]

Dude said he supports keeping the name "Redskin".  That's just classic, old man racism.  You aren't gonna convince him with a war of words.

[chris.shannon77]

Dude said he supports keeping the name "Redskin".  That's just classic, old man racism.  You aren't gonna convince him with a war of words.

 

What's your stance on the "Redskins" when these other names are trademarked or pending trademark.  Your statement comes off very bandwagon word police liberal. #fakeoutrage

 

Figgas over Niggas: This pending trademark seeks to cover a line of “Apparel for dancers, namely, tee shirts, sweatshirts, pants, leggings, shorts and jackets.” “Niggas,” of course, is a slang version of the word “nigger,” a term considered highly offensive towards black Americans.

Kraut Kap: Another recently-filed trademark, this one for a line of plastic lids. “Kraut” was made famous in World War II as a derogatory term for opposing German soldiers, as well as Germans in general.

Dago Swagg: A label created for a line of clothing. ”Dago” is a corruption of the common name Diego, and is used in English-speaking countries as an offensive term for those of Italian descent, and occasionally people from other Mediterranean countries as well.

Cracka Azz Skateboards: Unsurprisingly, this trademark was taken out for a line of skateboards and longboards, as well as associated clothing such as bandannas. While the USPTO helpfully notes that “The wording ‘cracka azz’ has no meaning in a foreign language,” “cracka” is a slang version of “cracker,” which in this context is a term of derision for whites, used primarily within the black community.

You Can’t Make A Housewife Out Of A Whore: This trademark for T-shirts and hats appears to imply that women involved in prostitution can never transition into the domestic role of a housewife. Such an accusation would certainly “bring them into contempt or disrepute,” the stated reasoning for eliminating the Redskins trademark.

Blanco Basura: A seemingly innocuous phrase, Blanco Basura, rendered into English, is actually the highly offensive slur “white trash.” White trash is a derogatory insult that typically refers to poor, white Americans, who have a penchant for crime and a patent disrespect for authority. Apparently, they thought they could go unnoticed designing a hateful beer.

Home Cookin Biscuit Head: Intentionality, as we well know, is not required in order for something to be highly, highly offensive. They should’ve done their due diligence before designing this logo for the restaurant industry. The term “biscuit head” has its origins in the Korean War, when American GIs picked this unseemly term to describe the shape of Koreans’ heads.

Gypsy Soule Women Who Live By Their Own Rules: This line of makeup containers and tote bags is a double whammy. “Gypsy” is a term for the itinerant Romani people that derives from the erroneous belief they originated from Egypt, rather than India. In addition, the “Live by their own rules” component hearkens to the common stereotype that Romani routinely ignore the law and engage in criminality.

Mammy Jamia’s: A company going by the name of A & S Cairns Limited has decided to attach its good name to an antebellum slur used to refer to an enslaved black woman who was in charge of household affairs, particularly caring for white children. The product? Frozen fruits and vegetables. Was it really worth it, A &S?

Uppity Negro: Intended to be imprinted on mugs and apparel, this trademark references the frequently used adjective “uppity” to describe blacks who agitated for greater respect and civil rights in the Jim Crow-era South.

http://theblacksphere.net/2014/6/racist-trademarks 

[PACdan]

Dude said he supports keeping the name "Redskin".  That's just classic, old man racism.  You aren't gonna convince him with a war of words.

 

That's a bit over the line. While the "Redskins" debate is certainly a healthy one, it's not "old man racism". If anything it's institutionalized racism, with many people growing up with the sports team and never having a racist bone or intent in their body. I'm not saying it doesn't need change, but not supporting its change does not make one an automatic racist.

[andersenpa]

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'm picking this thread up in the middle (no pun intended) but I can addrss this.

 

Each PA provides a level of service- "services typically provided by physicians" is legislative terminology- which would be offered by the SP in their practice. In some fields the overlap is near 100% (FP and EMED's EM practice are good examples). In others the service lines are more discrete.

 

I am in CT surgery and can speak to your post.

 

PAs in CT surg do not provide the entire spectrum of the scope for the specialty, but in a sense, the surgeons don't provide the PA's scope either. In my group, the surgeons operate, offer consultation/clinic services. The PAs co-operate, harvest conduit and manage the ICU. From a practical standpoint we each have our own areas. From a larger view there are more things a surgeon CAN do but DOESN'T than vice versa (eg I won't do a CABG independently). Similarly, our surgeons don't offer endoscopic vein harvesting (the PAs do). There is a gold standard which we each have to meet.

 

When it comes to WHAT I DO (operating and ICU care for the most part) then the level of service and quality of care better damn well be identical to a physician level of care, or I am subjecting the patient to care below the standard. This goes for all PAs, and is most obvious in flelds like FP where a blinded observer probably couldn't tell the difference between a doc, PA or NP.