Tired of fighting the good fight....

[sas5814]

Today I am a little sad both personally and for the profession. I have a friend and colleague who has been a strong advocate for the profession working both inside and outside of established PA organizations, for more than 25 years. It is hard to count his contributions for the greater good but they range from being a key player in securing scheduled drug privileges for PAs in Texas many years ago to organizing and helping fund the legal battle that finally achieved practice ownership for PAs in Texas after our state organization gave it away while touting their work as the greatest thing that ever happened. It is a long list but you get the idea.

Recently as a leader in a national PA organization he offered to arrange a meeting during the upcoming AAPA conference in San Antonio with the Governor and Lt Governor and leadership of AAPA, TAPA, and AFPPA to discuss the merits of increased PA autonomy. Not only did he receive no response from the key players at all there was back channel discussion both inside and outside his organization of doing what had to be done to make sure such a meeting didn't take place. Now these folks didn't realize their conference call had a recorded summary and just because the “official” conference call had ended the recording didn't stop.

I have long known our state and national leadership was politically weak. I could opine as to why this has been going on so long and why we can't seem to create any real political will but it would be conjecture. I don't think any of these people are evil or nefarious. People are people and we all do things for our own reasons consciously and unconsciously. I think there are folks who enjoy the power and authority of a leadership position and resent anyone outside the organization who tries something on their own. I think some people are collecting titles and ticket punches and just marking time. Many get into positions where they have to make decisions about groups of PAs and types of practices they know nothing about. I believe they all sincerely believe they are trying to do some good. I know trying to change the long time corporate mentality of an organization is a time consuming chore that often fails.

Today I'm just tired of trying. I have beat my head against this wall for more than 20 years and, as near as I can tell, nothing much has changed. In the broadest sense of the word our leadership makes decisions based more on who we will upset than anything else. We remain polite and kind in a political world where we are the only ones who do. The physicians and nurses kick us around and we take it quietly and passively making compromise deals that gives away our most precious things. Today I'm tired of trying when more of my energy is taken up trying to make my own “representatives” do what they should be doing than anything else.

I know many of the responses I'll get because I have heard them for 25 years. You don't know the big picture.....you are too aggressive.... the doctors are going to get mad at us...the nurses are going to get mad at us.... I have heard them all. It isn't just simple disagreements about style. It is fundamental core beliefs about how we need to market and represent ourselves and capturing opportunities. With respect to my brethren in specialty care we are poised to be the future of primary care for the foreseeable future and we continue to miss opportunities, even when they are served up to us, out of fear and ignorance and inexperience. Today I retire from the fight to look after myself.

Rant concluded. (mic drop)

[Reality Check 2]

I completely respect your weariness and experience it frequently.

Our national organizations have not helped us to the point of furthering our profession in a positive manner.

We are too polite and submissive and agreeable when it is not in the best interests of medicine in general, patient care and the state of our nation's broken and failing medical systems.

 

We CAN make a difference and we do. We could do more.

 

By and large, I would say that those of us old folks in primary care do NOT want our own shingle per se or a million dollars (not to be found) and we don't want to wear crowns or carry scepters - We want to practice the way we need to with few barriers and take care of people who desperately need it. 

 

I am originally from Texas and there is extra weariness there in the Bible Belt of Good Ole Boys and backroom meetings that torpedoes the best intentions of most any profession. I truly hated that part of the state.

 

Take deep breaths, know that there are those of us who are right there with you and hold your head high knowing you have done right by your patients.

 

Bless You

[Guest Paula]

Hang in there, sas5814.  I find your post extremely sad and frustrating.  Is there any place  for an FTC ruling or restraint of trade case that you and your colleague could present to help with getting autonomy in primary care?

 

Something has to change.  We need to take it to the mattresses. I do not know how to approach this either, but something has to change.

 

We need to take control of our own profession.

 

How do we convince the masses of PAs who are apathetic and disengaged and beat into subservience?

[jmj11]

sas,

 

I feel your pain and know exactly what you are saying. It is frustrating. I've shared before (long time ago) when I tried to take on a very important issue in the state of MN. Then I got an e-mail from the state president (and very active in the AAPA for years). He knew me personally as we worked for the same institution. First, rather than saying thanks for taking on this important project for PAs, he said, that I had no right to do this, because he had not delegated me that responsibility. Next he said that "you better be careful Mike, I have the position to ruin your career."  I was dumbfounded. I was simply trying to fix state language in their FMLA interpretation that said that PAs could only sign it if they were working under the direct supervision of an MD, DO or ARNP. He didn't see a problem with that language. Next time I saw him, in the gym of all places, he asked, "does that issue still bother you?"

 

Then, in Washington state I go involved with a committee in trying to improve the laws for PAs. Then, during the first meeting a malpractice attorney turned on me and wrote a law to band all PA-owned practices. Suddenly, rather than helping our laws, I was fighting for my life and the PA establishment didn't seem to get it.

 

I could tell many more stories like this. It is discouraging. I too have given up the fight and will only focus on my own patients and finding the time to enjoy my life outside of work. I hope the younger PAs can change the system.

[GetMeOuttaThisMess]

I have seen it here in Texas since 1980 and had interactions with the "founding fathers" in state as well. I have not been a fan of the recent leadership so I'm stopping leaving my phone number on the nightstand and expecting a follow up phone call for another date. There have been some important changes made over the years though just not as many, or timely, as I would have expected. Five plus years and counting down. It's all about a paycheck and retirement now.

[Boatswain2PA]

Can you shed any light on WHY these organizations didn't want to meet with the Gov/Lt Gov?  

 

I have my own guess as to why they wouldn't, but I'm curious if I'm right.

[jmj11]

Can you shed any light on WHY these organizations didn't want to meet with the Gov/Lt Gov?  

 

I have my own guess as to why they wouldn't, but I'm curious if I'm right.

While we are waiting on the real answer from sas, I will give my guess:  1) It wasn't their idea and 2) might offend some doctor somewhere and for goodness sake we can't do that.

[Reality Check 2]

I do not think the medical establishment at a whole is anywhere ready to admit that we aren't a healthy society and that primary care isn't a valiant profession and, most importantly, that no one wants to become a primary care provider from the physician standpoint.

 

If the powers that be cannot admit the system is broken, then all attempts to point out any sort of solution aren't desired and would actually force the situation to be addressed outside of endless committees and years of doing nothing but looking busy.

 

Let's not forget the lobbyists paid for by the for profit commercial insurance companies who discourage any legislation that would further medical care.

 

The whole issue of Affordable Care and the general attitude of hatred and partisanship among politicians further slows any progress in actually providing care to patients in need.

 

So, we, the knowledgeable and willing who want to provide improved services to help the matter - are ignored or shunned because the problem doesn't really exist yet to these folks and they don't have to worry about it personally - the politicians probably have a concierge provider and have zero clue what they pay for insurance - they just get what they need.

 

It is sad and insulting and the only folks who suffer endlessly are the patients.

 

Today is a particularly hard day for me in practice and this thread nails it home. Some days the fight is more painful than others.

[Boatswain2PA]

While we are waiting on the real answer from sas, I will give my guess:  1) It wasn't their idea and 2) might offend some doctor somewhere and for goodness sake we can't do that.

You think these are the reasons the AAPA wouldn't meet with the Governor/Lt Governor of the state that is hosting the annual AAPA conference?

 

Even if the AAPA didn't want to talk about expanding the scope of PA practice, they could at least meet with the Gov/Lt Gov to highlight the importance of PAs in healthcare.

 

I think it had more to do with who the Governor/Lt Governor of Texas are.  SAS....who's right?

[True Anomaly]

You think these are the reasons the AAPA wouldn't meet with the Governor/Lt Governor of the state that is hosting the annual AAPA conference?

 

Even if the AAPA didn't want to talk about expanding the scope of PA practice, they could at least meet with the Gov/Lt Gov to highlight the importance of PAs in healthcare.

 

I think it had more to do with who the Governor/Lt Governor of Texas are.  SAS....who's right?

 

His post did not suggest that the Governor and Lt Governor were asking to meet with the AAPA- his post said that "a leader in a national PA organization he offered to arrange a meeting during the upcoming AAPA conference in San Antonio with the Governor and Lt Governor and leadership of AAPA, TAPA, and AFPPA to discuss the merits of increased PA autonomy."- meaning that, said person (or is it you, SAS?) had offered to single-handidly arrange a meeting between all five of the listed parties, but also was a part of "a national PA organization" which apparently isn't AFPPA or the AAPA, and I doubt it's PAFT because someone else would've mentioned something here.  

 

The idea that the Governor and the Lt. Governor, who don't exactly see eye-to-eye on many things, would pair up to meet with the AAPA on the subject of PA autonomy given that the legislature isn't even in session currently is, to be frank, kinda silly.  It wouldn't happen.  They can't even agree on basic issues within their own party, let alone something like PA autonomy

[Boatswain2PA]

His post did not suggest that the Governor and Lt Governor were asking to meet with the AAPA- his post said that "a leader in a national PA organization he offered to arrange a meeting during the upcoming AAPA conference in San Antonio with the Governor and Lt Governor and leadership of AAPA, TAPA, and AFPPA to discuss the merits of increased PA autonomy."- meaning that, said person (or is it you, SAS?) had offered to single-handidly arrange a meeting between all five of the listed parties, but also was a part of "a national PA organization" which apparently isn't AFPPA or the AAPA, and I doubt it's PAFT because someone else would've mentioned something here.  

 

The idea that the Governor and the Lt. Governor, who don't exactly see eye-to-eye on many things, would pair up to meet with the AAPA on the subject of PA autonomy given that the legislature isn't even in session currently is, to be frank, kinda silly.  It wouldn't happen.  They can't even agree on basic issues within their own party, let alone something like PA autonomy

I didn't suggest the Gov and Lt Gov were asking to meet.  But, from below, I inferred that SAS's friend was trying to GET a meeting between these players, and the AAPA representatives shot it down.

 

Recently as a leader in a national PA organization he offered to arrange a meeting during the upcoming AAPA conference in San Antonio with the Governor and Lt Governor and leadership of AAPA, TAPA, and AFPPA to discuss the merits of increased PA autonomy. Not only did he receive no response from the key players at all there was back channel discussion both inside and outside his organization of doing what had to be done to make sure such a meeting didn't take place. Now these folks didn't realize their conference call had a recorded summary and just because the “official” conference call had ended the recording didn't stop.

[Reality Check 2]

Where is SAS? Did he literally walk away?

Go fishing?

 

You ok, dude?

[Maverick87]

Today I am a little sad both personally and for the profession. I have a friend and colleague who has been a strong advocate for the profession working both inside and outside of established PA organizations, for more than 25 years. It is hard to count his contributions for the greater good but they range from being a key player in securing scheduled drug privileges for PAs in Texas many years ago to organizing and helping fund the legal battle that finally achieved practice ownership for PAs in Texas after our state organization gave it away while touting their work as the greatest thing that ever happened. It is a long list but you get the idea.

Recently as a leader in a national PA organization he offered to arrange a meeting during the upcoming AAPA conference in San Antonio with the Governor and Lt Governor and leadership of AAPA, TAPA, and AFPPA to discuss the merits of increased PA autonomy. Not only did he receive no response from the key players at all there was back channel discussion both inside and outside his organization of doing what had to be done to make sure such a meeting didn't take place. Now these folks didn't realize their conference call had a recorded summary and just because the “official” conference call had ended the recording didn't stop.

I have long known our state and national leadership was politically weak. I could opine as to why this has been going on so long and why we can't seem to create any real political will but it would be conjecture. I don't think any of these people are evil or nefarious. People are people and we all do things for our own reasons consciously and unconsciously. I think there are folks who enjoy the power and authority of a leadership position and resent anyone outside the organization who tries something on their own. I think some people are collecting titles and ticket punches and just marking time. Many get into positions where they have to make decisions about groups of PAs and types of practices they know nothing about. I believe they all sincerely believe they are trying to do some good. I know trying to change the long time corporate mentality of an organization is a time consuming chore that often fails.

Today I'm just tired of trying. I have beat my head against this wall for more than 20 years and, as near as I can tell, nothing much has changed. In the broadest sense of the word our leadership makes decisions based more on who we will upset than anything else. We remain polite and kind in a political world where we are the only ones who do. The physicians and nurses kick us around and we take it quietly and passively making compromise deals that gives away our most precious things. Today I'm tired of trying when more of my energy is taken up trying to make my own “representatives” do what they should be doing than anything else.

I know many of the responses I'll get because I have heard them for 25 years. You don't know the big picture.....you are too aggressive.... the doctors are going to get mad at us...the nurses are going to get mad at us.... I have heard them all. It isn't just simple disagreements about style. It is fundamental core beliefs about how we need to market and represent ourselves and capturing opportunities. With respect to my brethren in specialty care we are poised to be the future of primary care for the foreseeable future and we continue to miss opportunities, even when they are served up to us, out of fear and ignorance and inexperience. Today I retire from the fight to look after myself.

Rant concluded. (mic drop)

 

Like you said, a lot of it has to do with the combination of a hunger for power, incompetence, and inefficient bureaucracies.

 

I first noticed these kinds of things in the military (which is one big reason why I got out). Then, I realized that it's rampant in all major organizations. It's a real headache to people that truly want to change things and get things done.

[kargiver]

Wars require wartime generals, and having been in the trenches politically at the highest levels (as several of the mods can confirm), and ruffling many a feather as I really don't give a hoot what people think if I hurt their feelings if I tell them like it is - understand this - the PA profession is one of subservient attitude towards docs and anything and EVERYTHING is done to keep that in place - by both groups.

 

I work alone in the middle of nowhere, just flew out a GI bleed secondary to active varices, no GI services - surgeon here is useless, so the patient was flown to a tertiary center an hour past the closest one because they are full from everything else we have already sent them.  I have a doc that signs my charts as required by license but I keep my group up to date on ID trends, some EMS stuff (although two of the other PAs oversee local EMS), and advise on all aspects of critical care and immunology/microbiology.  A few years back now, when giving a talk at a national meeting, the s*** I got from the "good ole boy" network" when I stated "Rural EM PAs do the same exact job as EM docs," to medical products sellers... you'd think the world ended.  All of the "MD advocates" for PAs in EM at the meeting told me to "tone it down," "I don't know what I am talking about," etc... my response was less than politically correct.

 

Wars call for wartime generals.  We have very few.

 

Sadly, many in the PA world don't want the responsibility it takes to do what MDs do, they actually want the backup, want their hand held, and actually buy into the message the AAPA sold (and still sells) for all these years.  EM is on the cutting edge of societal evolution in medicine, and its no different in the MD world or the PA world, but there are distinctly 3 different type of EM PAs.  The OVERWHELMING majority are more than happy being "assistant," "dependent," "physican-led," and any other crap that shows we want no responsibility.  In essence, most want a white collar job with a blue collar mentality, and for the few who have fought the fight to raise the bar, they have learned that not only do the docs not want us there, our own people don't want us there.  In a few systems this is not the case.  They are the exception - not the rule.

 

So for those who want to be on the edge, doing what you can at the limit of your license, seek out those opportunities that allow you to do so, go for it, and forget your "colleagues."  For they are ultimately against you too.  They will tell you "you should have gone to med school" when in reality, no, you or I shouldn't have.  I already do what docs do.  I didn't need to waste another 6 yrs of my life to get to that point.  At some point, when the dollar wins out over politics at the national level, then it won't matter, until then, pick your battles carefully or don't give a crap what people think and show them they have it wrong.  Can't argue results.  Otherwise,  at the end of recorded conversations where you hope to expand PA autonomy, keep expecting to hear the same old crap... they are just PAs.

 

G
 

[ventana]

^^^^^^^^^^^^^^^^^

 

 well said

[BruceBanner]

On a social level I think the majority of PAs are ok with a dependent role. This is probably the key reason why we aren't advancing in our autonomy. We certainly do have weak and overly-diplomatic "leadership" in the AAPA, but this isn't news. They are just there to collect some dollars and keep the peace. This small forum has a selection bias for those who have a crusade or an axe to grind against various administrations. And that's not to be insulting, it's just the truth.

 

I think when we start toeing the line on autonomy issues, physicians get territorial and feel it is inappropriate. I can understand that. It's not so much about losing "turf", I just think they feel the buck should always stop with them. If I was a doc I'd probably feel the same way---e.g. I've earned this position, you cant just come in through the backdoor and eat my pie.

 

It really boils down to our foundations---individual PAs. Like I said and kargiver above, the vast majority of PAs are okay with our dependent role---as long as we dont go backwards. Major HCOs have an interest in keeping us a viable yet non-potent part of the workforce from a leadership standpoint. The AAPA is visible and established but doesn't really give a hoot about anything other than collecting our $$ and not rocking boats. Other orgs like PAFT are valiant but under-powered. State governments vary---my thought is they all have bigger fish to fry than pesky issues like PA autonomy. Add to all that the much larger and louder nursing profession sarging forward with their own autonomy, and we are effectively a non-issue in lawmaker's eyes.

 

People get into the PA profession because they want to practice medicine without the time investment and level of responsibility a physician has. It doesn't matter if we get "wartime" generals in our leadership, because we don't collectively care enough. Look at our demographics---80% of the PAs I know are young moms with families. They just want to take care of patients without too much interference and go home on time. This wont change, and until it does, our role will stay the same.

[Guest JMPA]

time to bring the issue to Trump

[Reality Check 2]

time to bring the issue to Trump

 

 

 

Not funny. 

He would probably dismember our profession altogether or try to deport us.......................

[Guest JMPA]

Not funny. 

He would probably dismember our profession altogether or try to deport us.......................

what has obuma done for the PA profession?

[overthehorizen]

Today I am a little sad both personally and for the profession. I have a friend and colleague who has been a strong advocate for the profession working both inside and outside of established PA organizations, for more than 25 years. It is hard to count his contributions for the greater good but they range from being a key player in securing scheduled drug privileges for PAs in Texas many years ago to organizing and helping fund the legal battle that finally achieved practice ownership for PAs in Texas after our state organization gave it away while touting their work as the greatest thing that ever happened. It is a long list but you get the idea.

Recently as a leader in a national PA organization he offered to arrange a meeting during the upcoming AAPA conference in San Antonio with the Governor and Lt Governor and leadership of AAPA, TAPA, and AFPPA to discuss the merits of increased PA autonomy. Not only did he receive no response from the key players at all there was back channel discussion both inside and outside his organization of doing what had to be done to make sure such a meeting didn't take place. Now these folks didn't realize their conference call had a recorded summary and just because the “official” conference call had ended the recording didn't stop.

I have long known our state and national leadership was politically weak. I could opine as to why this has been going on so long and why we can't seem to create any real political will but it would be conjecture. I don't think any of these people are evil or nefarious. People are people and we all do things for our own reasons consciously and unconsciously. I think there are folks who enjoy the power and authority of a leadership position and resent anyone outside the organization who tries something on their own. I think some people are collecting titles and ticket punches and just marking time. Many get into positions where they have to make decisions about groups of PAs and types of practices they know nothing about. I believe they all sincerely believe they are trying to do some good. I know trying to change the long time corporate mentality of an organization is a time consuming chore that often fails.

Today I'm just tired of trying. I have beat my head against this wall for more than 20 years and, as near as I can tell, nothing much has changed. In the broadest sense of the word our leadership makes decisions based more on who we will upset than anything else. We remain polite and kind in a political world where we are the only ones who do. The physicians and nurses kick us around and we take it quietly and passively making compromise deals that gives away our most precious things. Today I'm tired of trying when more of my energy is taken up trying to make my own “representatives” do what they should be doing than anything else.

I know many of the responses I'll get because I have heard them for 25 years. You don't know the big picture.....you are too aggressive.... the doctors are going to get mad at us...the nurses are going to get mad at us.... I have heard them all. It isn't just simple disagreements about style. It is fundamental core beliefs about how we need to market and represent ourselves and capturing opportunities. With respect to my brethren in specialty care we are poised to be the future of primary care for the foreseeable future and we continue to miss opportunities, even when they are served up to us, out of fear and ignorance and inexperience. Today I retire from the fight to look after myself.

Rant concluded. (mic drop)

Unless and until the AAPA makes independent practice a primary goal of the organization and formulates a plan to achieve this goal, PAs must withdraw their support financially from the organization. The AAPA is an enemy of the PA . The AAPA is anathema to the future professional growth of our profession. I don't know how to get my fellow PAs out there to STOP SENDING MEMBERSHIP DUES to the APPA. Why would a 19th century slave send his wages to his slave master to "watch out for him?" The AAPA wants to keep PAs down and out. They want to keep our practice from advancing. The "leaders" are self serving apparatchiks who will destroy this profession.

[CAdamsPAC]

Wars require wartime generals, and having been in the trenches politically at the highest levels (as several of the mods can confirm), and ruffling many a feather as I really don't give a hoot what people think if I hurt their feelings if I tell them like it is - understand this - the PA profession is one of subservient attitude towards docs and anything and EVERYTHING is done to keep that in place - by both groups.

 

I work alone in the middle of nowhere, just flew out a GI bleed secondary to active varices, no GI services - surgeon here is useless, so the patient was flown to a tertiary center an hour past the closest one because they are full from everything else we have already sent them.  I have a doc that signs my charts as required by license but I keep my group up to date on ID trends, some EMS stuff (although two of the other PAs oversee local EMS), and advise on all aspects of critical care and immunology/microbiology.  A few years back now, when giving a talk at a national meeting, the s*** I got from the "good ole boy" network" when I stated "Rural EM PAs do the same exact job as EM docs," to medical products sellers... you'd think the world ended.  All of the "MD advocates" for PAs in EM at the meeting told me to "tone it down," "I don't know what I am talking about," etc... my response was less than politically correct.

 

Wars call for wartime generals.  We have very few.

 

Sadly, many in the PA world don't want the responsibility it takes to do what MDs do, they actually want the backup, want their hand held, and actually buy into the message the AAPA sold (and still sells) for all these years.  EM is on the cutting edge of societal evolution in medicine, and its no different in the MD world or the PA world, but there are distinctly 3 different type of EM PAs.  The OVERWHELMING majority are more than happy being "assistant," "dependent," "physican-led," and any other crap that shows we want no responsibility.  In essence, most want a white collar job with a blue collar mentality, and for the few who have fought the fight to raise the bar, they have learned that not only do the docs not want us there, our own people don't want us there.  In a few systems this is not the case.  They are the exception - not the rule.

 

So for those who want to be on the edge, doing what you can at the limit of your license, seek out those opportunities that allow you to do so, go for it, and forget your "colleagues."  For they are ultimately against you too.  They will tell you "you should have gone to med school" when in reality, no, you or I shouldn't have.  I already do what docs do.  I didn't need to waste another 6 yrs of my life to get to that point.  At some point, when the dollar wins out over politics at the national level, then it won't matter, until then, pick your battles carefully or don't give a crap what people think and show them they have it wrong.  Can't argue results.  Otherwise,  at the end of recorded conversations where you hope to expand PA autonomy, keep expecting to hear the same old crap... they are just PAs.

 

G

 

True so very true. From the ends of the Aleutians to the North Slope of Alaska , I've seen the remains of those who needed to be "assistants" who were sent to slaughter by the Peacetime PC Generals of the PA Army..............Having survived 30 years or covering my flanks or being surrounded by other "Warrior Class PAs" I'm approaching  the stack arms point in my career but I'll keep  a CCW until I burn my NCCPA Card and various PA Licences! You are not alone my friend..................