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PAs answering MDs inboxes


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I work in a singe specialty practice with 4 MDs, 3 PAs and relatively high patient load. We recently started having the PAs cover all of the inboxes (telephone encounters and patient emails). The way this works is I have one day without patients and spend the whole day covering the entire clinic's inboxes. The other two PAs do this for the rest of the week where they have 1/2 day scheduled to see patients and 1/2 of the day to respond to all of the messages. 

 

Ostensibly this was to open up more time for the MDs to see new consults. So far it seems that the MDs and office manager love this system and we (the PAs) hate it. My main issues with it are that it is unsatisfying work to answer somebody else's emails/phone calls and that the patient's get upset that the responses come from a different person depending on what day of the week the call/email come in and often from a provider they have never met. The patient satisfaction issue was brought up to the department head as a reason to stop doing this but it seems like they are persistent with continuing with this model. My questions are as follows:

 

1) Anyone else work like this?

2) Is this demeaning to our profession or am I overreacting?

3) We are going to have a provider meeting to discuss this. Any tips or advice?

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You are NOT overreaching here and I think this is insulting to our profession. This is their job!! An MA can easily screen messages and emails and present them to the MD at the beginning or end of the day. He/She can simply tell the provider what the message is about, and the provider gives an answer. This is a job that can (and should) be handled between an MA and MD, not be delegated to PAs.

 

I hate this stuff. It may just be the confirmation bias of the forums, but it seems like our scope is continuing to slide downhill. We are becoming over-qualified MAs with a prescription pad.

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Let's see. The MDs don't like the admin work of handling their own messages so they delegate that work to an assistant. That would be perfectly reasonable if you were an assistant. You need to decide if that's what you are. Just realize that if you all refuse to do the admin work they might decide to hire an MA and get rid of one of the PAs. That would be OK with me, but perhaps not with you.

Look, every job has some scut work but for the MDs to delegate all of it seems a bit excessive. I guess this is one of those career defining moments.

 

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I've done inbox covereage for MDs, but it was everyone's job, not limited to PAs, and we had an LPN reading and screening all the messages first so all the routine junk (referral status, etc.) that didn't need a provider reviewing it was never seen by the provider.  When I was out, the MDs would cover my inbox. I had no problem with a mutual load sharing situation like that.

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I'm going to disagree... a little. In specialty care particularly we are there to see patients but, in my opinion, also to help the specialist spend their time doing things only he/she can do. While an MA can screen messages they can't make medical decisions or prescribe. I have done some of this and it doesn't hurt my feelings...and no I am not new. I have been practicing for 27 years. My only caviat when I was asked to help with messages, lab reports, refill requests was I am going to do it as I see fit and if you want to bitch about it do it yourself. I'm not your little clone and trying to guess how you (physician) would manage an issue is the road to madness.

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I've done inbox covereage for MDs, but it was everyone's job, not limited to PAs, and we had an LPN reading and screening all the messages first so all the routine junk (referral status, etc.) that didn't need a provider reviewing it was never seen by the provider.  When I was out, the MDs would cover my inbox. I had no problem with a mutual load sharing situation like that.

 

This is how it works here. I'm in a large referral hospital covering several surgical services. We answer inbox messages that have been filtered through a nurse to screen out the junk.

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Back before email it was called returning all the phone calls and refilling meds, though we didn't have legal prescriptive authorization to be doing so (this even predates prescriptive only Children's Motrin). A feather in your cap was when your doc commented that you could assess a particular specialty problem as good as a FP, though it didn't seem to matter that it was YOUR specialty.

 

 

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It is demeaning and a complete waste of PA skills and treatment capacity.

An LPN or RN should man things like that and triage and filter to each provider.

 

MD does NOT stand for Medical Deity and no provider is above dealing with his/her OWN patients.

 

Unfortunately you are already roped in and shown them they don't have to deal with it.

This will be tough to get out of but needs to stop NOW before they decide you work during THEIR lunch of pick up their dry cleaning or whatever.

 

Be a PA, not a phone assistant!!

 

My very old 2 cents.............

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nope

now way

no how

 

every provider can answer their own calls

 

 

The medical home is trying to answer this issue as well   RNs are expensive, but guess what they can do EVERYTHING a PA can do on the phone - with the exception that they will have to contact a provider to review......    (no they can't prescribe, but they can ask the provider for a script after talking to a patient)

 

 

I would STRONGLY argue against this and use any of the supporting articles that we all need to be practicing at the top of our licenses,    That means RN's do this work.......

if you have 3 PA's doing this, and average income is 120k, for three days a week - that is 75k it is costing the practice to have this "service" and to top it off the practice LOOSES that much money (or likely many times that) because the PA was not generating revenue (Which they should be doing) 

 

Point  out the numbers to admin, heck they can get a FULL TIME nurse for that $$$$

 

 

 

politely decline to do it as a group (if only one declines you might be looking for a job.....)

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nope

now way

no how

 

every provider can answer their own calls

 

 

The medical home is trying to answer this issue as well RNs are expensive, but guess what they can do EVERYTHING a PA can do on the phone - with the exception that they will have to contact a provider to review...... (no they can't prescribe, but they can ask the provider for a script after talking to a patient)

 

 

I would STRONGLY argue against this and use any of the supporting articles that we all need to be practicing at the top of our licenses, That means RN's do this work.......

if you have 3 PA's doing this, and average income is 120k, for three days a week - that is 75k it is costing the practice to have this "service" and to top it off the practice LOOSES that much money (or likely many times that) because the PA was not generating revenue (Which they should be doing)

 

Point out the numbers to admin, heck they can get a FULL TIME nurse for that $$$$

 

 

 

politely decline to do it as a group (if only one declines you might be looking for a job.....)

I agree, except I see the current trend in many specialty offices being---> hire multiple entry level MA's for pennies on the dollar and cut the RNs to save money. That leaves almost all of the patient consultation work up to the providers. Does this save them money in the long term? I don't know, but it is a trend in my area...

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Thank you for the responses. I think that I need to be more firm when discussing this with the department head at our upcoming meeting. Right now I do feel insulted by the situation. To make it worse, if the PA who was covering the inboxes for the day calls out or has time off scheduled the remaining PAs have to see a full schedule of patients and handle all of the inboxes rather than the MDs answer their own messages for that day. I feel like they must have already figured that financial cost of using PAs this way so my only argument against it is the personal level of dissatisfaction with the situation.

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I agree, except I see the current trend in many specialty offices being---> hire multiple entry level MA's for pennies on the dollar and cut the RNs to save money. That leaves almost all of the patient consultation work up to the providers. Does this save them money in the long term? I don't know, but it is a trend in my area...

 

this is not true in PCP fields

 

they want us seeing and managing our own patients

 

have a tough time thinking this makes sense in the speciality field either

Surgery is what makes $$ - yet is only a small number of patients - but if the PAs are seeing office, and feeding the doc more surgeries everyone is happy, and no provider is doing busy phone work

 

 

 

As for firing RN's - that is why they came up with the medical home as RNs can be HIGHLY effective

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I do quite a bit of this in my full time job. As a provider I can read, respond, prescribe and close out the encounter quickly. Half the time the RNs or admin staff don't know what to look up or collect correct information. It is faster to just do it myself.

 

I limit my time in the pt message box to my first hour a day in the office before patients. If it comes in after that I get to it the next day. Urgent issues are handled by phone or same day clinic appointments.

 

Since my salary is not linked to RVUs here I am more than happy to spend limited time responding for the physicians at this point I my life. We have actually seen improved patient satisfaction by having providers do this rather than RNs.

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In the situation you describes this sounds like total crap. It is one thing if everyone is doing it equally. Just to dump that on the PAs is not right.

 

The thought process "it frees up time for your specialist" is insulting to you as a person and PAs as a profession. You answer your patient emails and the doctors answer their patient emails. It is one thing to help out. What they are doing is dumping most or all of the work on you. I would not be happy about this whatsoever.

 

To spend an entire day answering emails as a PA so the doctors don't have to is a total waste of your knowledge, skill set and unless it is something you want, I think it is incredibly unfair they sprang this guys on you.

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So it seems answering messages for MDs is not always a bad thing, as I originally thought. I know a surgical PA, very experienced, who worked with one very busy orthopod who did a lot of spinal fusions. The PA assists in surgery and, after the first or second follow up, done by the physician, typically handles all additional routine follow ups. He also handles all messages. He seemed very satisfied with this arrangement and was great to work with. In this situation, the PA is collaborating with his SP in a very efficient team approach and I wouldn't view that as demeaning. He certainly did not. It seems different for a group of PAs to handle all MD messages but I guess I wouldn't now condemn the practice out of hand. I suppose it depends on whether it bothers you because it is assigned as scut work.

 

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