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My Friend Dave Mittman asked me to post his blog here from clinician1:

 

The AAPA Embraces A New Reality; Will You?

Yes, it’s that title thing again. The title change continues to come up time and time again because the title describes an antiquated identity that isn’t an accurate reflection of our level of education, the PA’s expertise, our quality or our position in healthcare. At the simplest level, it’s not what we do. But this time we have good news. The AAPA has come out with a “PA Communication Guide” that clearly articulates a centrist position regarding our title and more. These are smart, wise and needed guidelines. Here they are, take a good read: http://www.aapa.org//WorkArea/DownloadAsset.aspx?id=2147484763&utm_source=co%5Fleaders&utm_medium=email&utm_campaign=comm%5Fguide
Kudos to the AAPA for recognizing, listening, and acting on this problem. This will hopefully solve the title issue, but there is a huge “IF” involved. The “if” is only if you/we act on these guidelines. Seriously. If not, the profession will really have a hard time moving forward.
When people read the title physician(s) assistant, they take the “A” word as the truth. If you called yourself a mechanic’s assistant and I went to the repair shop, I would question you running the shop. If you called yourself a pilot’s assistant, I would NOT take my family in an airplane if you had no pilot on board?
We don’t assist, we DO. The first time you say you are an “assistant” and there is no one around for you to assist, do you actually think it inspires confidence? I think people have questions about that. Saying assistant and then writing a prescription might just increase your liability? It would with me if I was not a PA. Yes, once they get to know us, people love us. But that should not mean we have to live with a yoke around our necks because of an antiquated title. The AAPAs Guidelines recognize this.
I have also heard people ask, “What shall I say when people ask, “What does PA mean?” I think an answer to those that ask (which will decrease as the same percentage who ask what RN or MD means) is simple; “ We used to be (or are) called physicians assistants or associates but we found that the title did not/does not adequately reflect the scope and ability we have today”. We decided to go by the initials “PA” as we were already known by them”.  “How can I help you today?”
And while you are at it, please say you “collaborate” with different healthcare professionals to bring the patient the best medical care possible. Not that you are “supervised” twenty-five years after you started practicing. Lastly, please stop using “dependent” or “mid-level”. Dependent means you could possibly need psychological help and mid-level means even worse. If you live in a state where you must say assistant on a name tag, say it and in a few years let’s put up a bill to change. PA is our name. Medicine is what we practice. Period.
So I am asking you if you are a PA to change your Facebook, Linked-In and practice information. Explain the situation to the front desk and to our MD, RN colleagues. Most importantly let your colleagues and your PA program know they need to do the same. It’s time.
Let’s leave the “A” word where it belongs; somewhere in history’s attic.

 

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I'm glad to see this shift. Short of a name change, avoidance may be the best strategy. The title is so grammatically challenged, it will be a struggle until it is changed. As a writer, and before learning about PAs, I was that person who so desperately wanted to make physician possessive. Because if it's not, it's two nouns stuck together. Even without the genitive 's, grammatically, the first noun is forced to act as a modifier, such as "the car door." It doesn't feel like compound noun -- "air bag" or "coffee pot" -- because the nouns are so different heirarchically and it's not a common phrase, except to us. Enough musing for Sunday morning... 

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That's great, but it still feels incredibly lukewarm to me. Using the initials "PA" and at the same time trying to distance ourselves from the words those initials stand for gives me an eye twitch. It also kind of flies in the face of the simple fact that "so what does PA stand for?" is a completely reasonable and logical question, and we're being asked to give a hopelessly inside-baseball kind of answer.

 

It's a good step, but it's actually only half a step.

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Agree it's half a step, but at least it's a step forward.  I think Dave had a slip though in one of the sentences where he wrote..we used to be called physicians assistants or associates.  Shouldn't he have written  physician assistant or associate?

 

I am grammatically challenged.  I may be wrong. 

 

Regardless I don't use the assistant term unless forced to.  I will be starting a new job is a few months and will have the conversation with the department who makes up my name tag.  I will ask for only my name and PA-C on it, or if they insist I will have them put MS, PA-C on it!  LOL!

 

Sure hope I don't get sidelined on that.  I noticed the NPs badge only had initials, APNP on it and not nurse spelled out.  

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 I like it. 

 

No matter what the regulations say, we need to change the conversation and this is a step in the direction of doing exactly that. Yeah, it's not a wholesale change in policy, but I'd rather have the near term focus on changing practice regulations and then working towards a name change sometime in the future.

 

Furthermore, if we can get people to call us a PA, no one will really care when we come to the table and ask for the A to go from assistant to associate. Right now, few know what we do or what we are, so there's no time for the conversation about a name change to really happen. 

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I am grammatically challenged. I may be wrong.

 

The whole thing is grammatically challenged; that's been the problem all along.

 

In English, the adjective precedes the noun--not the other way around:

Medical Doctor

Nurse Practitioner

Physical Therapist

Automotive Mechanic

Registered Dietician

Green Apple

Blue Bird

Merry Christmas

 

How ridiculous and confusing would it be if MDs were called Doctor Medicals? Or if this kind of poor writing were present in our foundational legal documents? "Physician Assistant" is just bad English, and it makes for a lot of misunderstanding. We've probably benefited from its ambiguous nature since MDs can't really figure out the English any more than we can. Plus "PA" is already a longstanding abbreviation in the west for "Personal Assistant"--non-threatening, to say the least. This is the root cause of our ultimate identity crisis, and GRAMMAR seems to be among the best motives for name change, in and of itself. Either add the apostrophe-s to the P (to make it possessive), or swap the letters around. But as it is, PA doesn't make any intuitive sense to the native speaker of English--a challenge since the PA profession's strongest foothold is among the world's largest English speaking population. No wonder PAs are so often called Physician's Assistants or, less often, Assistant Physicians; people's brains are just trying to refer to us in proper English!

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The whole thing is grammatically challenged; that's been the problem all along. 

 

In English, the adjective precedes the noun--not the other way around: 

Medical Doctor

Nurse Practitioner

Physical Therapist

Automotive Mechanic

Registered Dietician...

 

How ridiculous and confusing would it be if MDs were called Doctor Medicals?  Or if this kind of poor writing were present in our foundational legal documents?  "Physician Assistant" is just bad English, and it makes for a lot of misunderstanding.  We've probably benefited from its ambiguous nature since MDs can't really figure out the English any more than we can.  Plus "PA" is already a longstanding abbreviation in the west for "Personal Assistant"--non-threatening, to say the least.  This is the root cause of our ultimate identity crisis, and GRAMMAR seems to be among the best motives for name change, in and of itself.  Either add the apostrophe-s to the P (to make it possessive), or swap the letters around.  But as it is, PA doesn't make any intuitive sense to the native speaker of English--a challenge since the PA profession's strongest foothold is among the world's largest English speaking population.  

 

Not to mention putting the "C" at the very end!  (What the hell do we tack a C on there for anyway?  Are MDs and NPs not certified???)  

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Some states and insurance companies require the C for reimbursement.  NPs have numerous titles.  One of them is FNP-C (meaning certified).  I want C on my badge. 

 

zoopeda:  What is your grammatically correct title for a PA?

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See above. Without changing any words, there are two options:
Physician's Assistant and Assistant Phyician. (I actually like Associate Physician, but that involves a word change and I leave that decision up to PAs with much more experience in the profession than I.). As for the C, the system can be set up for insurance billing without it. There is no such thing as an MD-C in my state, so there's no reason to do it just because NPs do. That said, if we must keep the c, again, put it in English order (instead of jibberish): "certified so-and-so". C goes at the front. (Of course accountants have a pretty strong hold on the letters CPA...)  Could you imagine a world where we spoke everything backwards? "I'm a doctor medical certified." Or "I'm an apple red worm-eaten." It's no wonder everyone's confused!

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Outdated Lexicon/Myths/Misperceptions 

 

“PAs are mid-level providers, physician extenders, non-physician providers or advanced practice providers.”

 

"With regard to PA education and experience, these terms are often misunderstood by consumers and do not accurately portray or describe how PAs practice medicine to other providers or patients. Nor do they reflect their license or legal title. If PAs need to be referenced as part of a larger group, use healthcare provider” or “healthcare practitioner,” but the preferred reference would include simply the name of each profession."

 

 

Boom. No more "mid-level" term defense.

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Another way the grammatical ordering of the terms "physician assistant" undermines our professional goals...

 

In the rare instances where a title actually does order the subject (noun) before the modifier (usually adjective), there is an implied "of" in between the terms:

ie DO = Doctor of Osteopathy, DC = Doctor of Chiropractics

 

"Of" is analogous to apostrophe-s in English.  Hence one more reason the English speaking brain naturally jumps from "PA" to "Physician's Assistant."  

 

It's just a bad name for so many apolitical reasons. 

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I am definitely enjoying the discussion of the English grammar reasons why our title is a challenge, and I agree that it probably explains why the apostrophe-S makes intuitive sense (and therefore probably won't ever die).

 

I had another thought about why the switch to "PA" isn't very satisfying: it's exactly the same thing KFC did, when they changed the name of their company from "Kentucky Fried Chicken" to just "KFC." Pretending it's not an abbreviation* is, at best, kind of a silly way to make the best of a bad situation. Changing it outright is probably more helpful and appropriate by an order of magnitude.

 

That being said, I understand that we take what we can get, when we can get it, and baby steps forward - or even sideways - are better than steps backward. I'm just itching for more substantive change... and I'm not convinced this is really going to make that change any easier.

 

 

 

* initialism, actually, if we're being language nerds, but whatever.

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Yeah the Docs would just love that! Lol

 

I base this off the Chinese model of medical school and physician status.

 

 

China has a three-tier 3-5-7 healthcare system composed of Assistant Doctors who train for 3 years, Doctors who train for 5 years and Medical scientists who train for 7 years at the university.

https://en.wikipedia.org/wiki/Assistant_Doctor

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I base this off the Chinese model of medical school and physician status.

 

https://en.wikipedia.org/wiki/Assistant_Doctor

 

Much smarter system.  It's also cool to note the entry level title (Assistant Doctor) is an undergraduate (5-year) degree.  Dr is "Masters" (3 more), and "PhD" is 2-3 more on top of that.  Interns live in dorms within the hospital and sometimes see 80 patients a day.  Cool. 

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