Attendings see every patient

[ventana]

 

I guess my point is, while I fully support PA's practicing as autonomously as they feel comfortable with/are qualified for, in some settings NO ONE is actually autonomous. Not even the attending.

 

This is the very crux of medicine today. NO ONE IS INDEPENDENT as far a practicing medicine - medicine is a TEAM sport, but we need to be responsible for our own profession. Obviously FPA does not mean we are going to be doing surgery and managing dialysis patients..... That is for each speciality. What it does mean is that we are a full fledged member of the team, and the very same logic the doc's use to patrol and regulate themselves we should insist for our own profession. We need to be totally responsible for our own actions and education.

 

But stupid, antiquated rules about what a PA can't sign, or can't do, are merely obstructing to what we do every day..... (I am speaking in the PCP world her, not surgery or sub specialities)

[Guest JMPA]

Monte,

Your signature indicates you're a student, so I'm not sure where you are in your career and if you have any experience working in a hospital or hospital medicine.

Trust me, as a PA working within a huge hospital conglomerate, I wasn't "creating" any environment in the hospital - I was operating within it. For how I thrived/operated in my day-to-day work, I chose to employ an attitude of service which I won't reiterate in this post.

 

Our hospital policy  environment was that docs saw every patient (again, for billing purposes). Most of the time, the doc was mostly acting as what I (jokingly) liked to call "the mayor", going in, bs-ing with the patients, reviewing my notes, signing off and moving on to the next patient. If that's how the hospital wants to do business, fine. If I didn't like it, I could pick up another job somewhere else. HOWEVER, I liked the setup because if there was a complicated patient that I was concerned about, our group tried to employed a team approach where an effort was made to see the patient together. I never felt undermined or made to feel like I was a student by the doc, I felt supported and part of a team. It was a similar vibe as if I had called in a consult. I've never met a PA, NP, or doc in hospital medicine who felt totally comfortable with every patient -even the ones with "lots" of experience.

 

Our patient surveys did not indicate that patients felt like the PAs were incompetent or that they just wanted to skip a step and see the doc while they were laying in their hospital beds staring at the ceiling. NPs and PAs were often praised for spending more time with patients, remembering personal details, etc. Not a surprise there.

patient surveys work best for wiping ones behind. I dont practice mcdonalds medicine and i hope the majority of PAs dont either.

[charlottew]

But stupid, antiquated rules about what a PA can't sign, or can't do, are merely obstructing to what we do every day..... (I am speaking in the PCP world her, not surgery or sub specialities)

 

By the way this is off topic, but ventana did you see that the commonwealth of MA recently passed a bill allowing PA's to sign death certificates? It may take a little while to trickle down to actual policies at individual institutions, but it is now MA law. :)

 

(I received an email from MAPA about this, cannot find it on the ma.gov site! or on MAPA home page for that matter)

[KMD16]

I accepted a new position in hospital medicine and am surprised that the attendings see every patient after the PAs/NPs every day. I don't mind this model now because I'm relatively new, but don't think I'd want to do this forever and it seems rather inefficient. Is this a common model?

 

Be careful here. As a new grad. You've got to humble yourself and use this as an opportunity to learn from these doc. If you saw a patient and the doc went in and see the patient and write own note on pt. If I were you, I would go back and review the doc note and take note. The key point here is you've got to learn as much as you can. Be respectful. You're a new grad and have a lot to learn. 

 

On the other hand. Each hospital system are different. Bylaw varies from hospital to hospital. Reimbursement another huge factor. 

[ventana]

By the way this is off topic, but ventana did you see that the commonwealth of MA recently passed a bill allowing PA's to sign death certificates? It may take a little while to trickle down to actual policies at individual institutions, but it is now MA law. :)

 

(I received an email from MAPA about this, cannot find it on the ma.gov site! or on MAPA home page for that matter)

 

I have not heard that and was just talking to Boston the other day

 

Unfortunately I don't think this is the case - there is some misinformation out there stating that we can, and even Boston was confused initially when I called them, but to my knowledge DPH still mandates a DOC signature.....   PAs can do the declaration of death, but no the Cert

 

 

Please tell me how this has anything to do with care, quality or anything else?  The patient is dead, it is a form..... obviously we should be able to fill it out......

 

 

 

 

 

This is the law

A registered physician assistant, after the death of a person who was a patient under the care of such physician assistant, may declare such person dead; provided, however, that said physician assistant first makes a reasonable effort to contact the attending physician or medical examiner before making such determination or pronouncement; provided, further, that such determination or pronouncement be made in writing on a form approved by the commissioner of public health and subscribed under pains and penalties of perjury; and, provided further, that the medical examiner be notified forthwith of the exact location to which the decedent has been removed.

[charlottew]

As I said I cannot find corroboration of this on the ma.gov or MAPA websites, but this is the email I received on July 20th from MAPA (MA Association of PA's):

 

The MAPA Board is pleased to announce that the language introduced as an outside section to the FY17 state budget allowing PAs to sign a death certificate was maintained as part of the budget signed last Friday by Governor Baker.

 

We want to take this opportunity to thank everyone who took the time to e-mail or call the governor's office to voice your support of this outside section. We had support all the way through this process from Senators and Representatives (particularly from our legislative champions on this, Representative Pat Haddad and Senate Majority Leader Harriette Chandler).  However, in the end the language still could have been vetoed by the Governor. It is clear that the efforts made by the Board and membership made a difference. Thank you.

 

We also could not have accomplished any of this without our lobbyists, Charles Glick and Kate Saville Worrall. They have tirelessly advocated on our behalf and guided us in the tactics to get this through. The best thing about Charles and Kate is that they really get PAs and what we do and are capable of doing. 

 

Please consider a donation to the MAPA Political Action Committee that also allows us to get the work done.

 

Here is the language that has been adopted:

 

399 SECTION 48. The fourth paragraph of section 9 of chapter 46 of the General Laws, as appearing 400 in the 2014 Official Edition, is hereby amended by adding the following sentence:- A physician assistant may take all action required under this section to furnish a standard certificate of death 402 for registration.

 

This language is now law.  It will take time to get this updated in the regulations and we will update you with the next steps on how this gets promulgated and when PAs can start signing the death certificates. We will work with DPH on this. 

 

Thank you again and thank you for your membership and support that allows us to accomplish such goals.

 

Regards, 

 

Sarah Christie, PA-C

MAPA President

[Boatswain2PA]

I may be overly opinionated, but you're no better for calling an adult kid with disrespect as intent. I made a valid point comparing the method with medical assistants, sorry you disagree.

 

Goodluck to you, Stat. If the format makes you happy.. then so be it!

You came out guns blazing, and you're still a student.  What did you expect?  Stat's reply to your demeaning post was nicer than the one that went through my head.

 

as a new grad it's ok. with time, the doc and PA should both get comfortable with the PA taking over more of the pt load and only going to the doc with occasional questions or consults as needed. if they see every pt, that's not about pt care, that's about reimbursement..

We have to be careful not to generalize.  While your quote is for FP and EM, but may not work so good with subspecialisties.  The surgeons hands should see the belly, and the CT surgeon should probably see the pt and look at the CT scan. Good PAs in subspecialties often have limited autonomy but they allow that subspecialist to see more patients.

 

 

patient surveys work best for wiping ones behind. I dont practice mcdonalds medicine and i hope the majority of PAs dont either.

I think you can get some good information from surveys....just gotta add appropriate amount of salt to them.  Unfortunately administrative suits don't know how to glean such information.

 

Has nothing to do with practicing McDonald's medicine, just valuing the opinion of (some of) my patients.

[Reality Check 2]

I do not like the money making aspect of a doc seeing every patient. Waste of time, waste of energy and fully demeaning.

 

As a new grad - I was ok with that. 

 

See one, do one, teach one...... Wean me off my training wheels and make sure I know what the hell I am doing and I don't hurt people.

 

If my doc wanted to do that now - 25 yrs in - in a busy Family Practice - I would call BS and walk. Money making scheme or complete control freak - pick one.

 

I have worked with and taught PAs who NEVER want their umbilical cord severed - they don't want the responsibility or liability as they see it. 

 

I do not care for their perspective and think they diminish those of us who live up to our teaching and knowledge base. 

 

PAs cross all spectrums of medicine in all specialties and each world is a little different. We need to communicate what is happening in our own worlds and make sure we keep some sort of basic set of principles for how we are treated and utilized in our service to the medical community - ie. don't be a scribe, don't be an MA, don't be a peon.

 

Just my old 2 cents........

[Statko]

patient surveys work best for wiping ones behind. I dont practice mcdonalds medicine and i hope the majority of PAs dont either.

 

Again, this is about playing the game and operating in the environment you're in. You might not like patient satisfaction surveys, but guess what... your department head, the CEO, and the board of the hospital do nothing except pour over patient satisfaction data in their meetings to benchmark your institution against everyone else. Admins don't care what individual PAs, or for that matter, what individual docs think. They care about money and perception.

 

So, if you want to substantiate why you deserve a raise, prove a colleague isn't pulling their weight, your department's outcomes are better than any of your competitors - patient satisfaction scores come in very handy.

 

It's not like PAs, docs, or anyone else has a choice whether or not Press Ganeys get sent out to patients. That's the reality of working in hospital medicine. To be mad about it doesn't really do anything, might as well figure out how to leverage it to your advantage.

[ventana]

 

As I said I cannot find corroboration of this on the ma.gov or MAPA websites, but this is the email I received on July 20th from MAPA (MA Association of PA's):

 

The MAPA Board is pleased to announce that the language introduced as an outside section to the FY17 state budget allowing PAs to sign a death certificate was maintained as part of the budget signed last Friday by Governor Baker.

 

We want to take this opportunity to thank everyone who took the time to e-mail or call the governor's office to voice your support of this outside section. We had support all the way through this process from Senators and Representatives (particularly from our legislative champions on this, Representative Pat Haddad and Senate Majority Leader Harriette Chandler).  However, in the end the language still could have been vetoed by the Governor. It is clear that the efforts made by the Board and membership made a difference. Thank you.

 

We also could not have accomplished any of this without our lobbyists, Charles Glick and Kate Saville Worrall. They have tirelessly advocated on our behalf and guided us in the tactics to get this through. The best thing about Charles and Kate is that they really get PAs and what we do and are capable of doing. 

 

Please consider a donation to the MAPA Political Action Committee that also allows us to get the work done.

 

Here is the language that has been adopted:

 

399 SECTION 48. The fourth paragraph of section 9 of chapter 46 of the General Laws, as appearing 400 in the 2014 Official Edition, is hereby amended by adding the following sentence:- A physician assistant may take all action required under this section to furnish a standard certificate of death 402 for registration.

 

This language is now law.  It will take time to get this updated in the regulations and we will update you with the next steps on how this gets promulgated and when PAs can start signing the death certificates. We will work with DPH on this. 

 

Thank you again and thank you for your membership and support that allows us to accomplish such goals.

 

Regards, 

 

Sarah Christie, PA-C

MAPA President

 

 

 

Appears you are one step ahead of me!

 

I have searched and searched and not been able to find anything, as well, I never got the email.... grumble grumble grumble

 

 

But all that aside is great news!

[kayakr]

Be careful here. As a new grad. You've got to humble yourself and use this as an opportunity to learn from these doc. If you saw a patient and the doc went in and see the patient and write own note on pt. If I were you, I would go back and review the doc note and take note. The key point here is you've got to learn as much as you can. Be respectful. You're a new grad and have a lot to learn.

 

On the other hand. Each hospital system are different. Bylaw varies from hospital to hospital. Reimbursement another huge factor.

[kayakr]

New to inpatient, not a new grad. I do appreciate the learning opportunities and I am learning a ton. but it can get frustrating depending on the attending. For example, some attendings let me do what's appropriate then sign off the note. I discuss ahead of time if I am uncertain. Other attendings make it clear that they literally don't even want me to adjust a BP med or levothyroxine without discussing it first. Causes unnecessary delays and is not an efficient use of my time or abilities.

[Boatswain2PA]

New to inpatient, not a new grad. I do appreciate the learning opportunities and I am learning a ton. but it can get frustrating depending on the attending. For example, some attendings let me do what's appropriate then sign off the note. I discuss ahead of time if I am uncertain. Other attendings make it clear that they literally don't even want me to adjust a BP med or levothyroxine without discussing it first. Causes unnecessary delays and is not an efficient use of my time or abilities.

Sounds like this is a systemic problem between the doc's then.  I would talk to the chief of staff (or whoever's in "charge" of the docs) and ask for some clarity on what the role of the PA is.  Are you supposed to practice medicine (adjusting meds), or simply be a scribe.  If it's the former, then the COS could level things out with the docs.  If it's the latter, then, well...now you know!

[KMD16]

Just a quick note here.

 

There are doc who are so full of it and doesn't think there should such thing called PA and they would rather be the only one in charge or who calls the shot.

 

On the other hands, there are some that would jump at the opportunity that a PA is on their team. You must learn how to play the game. Keep a smiling face.

 

If a particular doc wants to see every patient and wants you run everyone by them, then, do it. I'm sure not all the doc in your group or on your service want you to run every pt by them. Maybe this particular doc had bad experience working with a PA or maybe s/he is new fresh out of residency or had very exposure working with PA.

 

There's politics in medicine. Learn how to play the game. Reporting this particular doc won't be the wise thing to do. Just saying

[KMD16]

New to inpatient, not a new grad. I do appreciate the learning opportunities and I am learning a ton. but it can get frustrating depending on the attending. For example, some attendings let me do what's appropriate then sign off the note. I discuss ahead of time if I am uncertain. Other attendings make it clear that they literally don't even want me to adjust a BP med or levothyroxine without discussing it first. Causes unnecessary delays and is not an efficient use of my time or abilities.

I tell you this is very typical in Inpt medicine.

 

Get us to it. Re-adjust else you'll find yourself moving shop.

 

You'll learn that each doc approaches to pt mgmt differs.

 

Grab a pen and note pad n start writing note. OK Doctor potato head does it this way and Doctor A-hole does it this way. When you're caring for a pt of Doctor A-hole simply do it his way. Find him immediately, tell him hey Doctor A-hole, I saw your pt and I adjusted his BP meds the way you would. You'll end up developing a good relationship and Doctor A-hole will stop micro managing you or having you run every pt by him. You got the idea.

[GetMeOuttaThisMess]

Gotta tell ya folks, having started out in this scenario decades ago because it was the only model available per law, it wasn't that big of a deal and if one likes the idea of less liability hanging over their head as a result of the physician wanting to see them all then more power to them.  It's THEIR setting, as well as the physician(s).  To each his own.  That being said, I've interacted with some PAs in settings where I don't mention my background and frankly I wish they'd consult their doc because of their lack of proper Q&A and assessment skills as were demonstrated (specifically new, or somewhat new grads in a specialty setting w/o SP interaction on complicated/not clear cut cases).  In THESE situations, I/we DID come to see the doc.  Same goes for some physicians I've interacted with either for myself or family.  Frankly, some of the things I observe scare the hell out of me.

[kayakr]

I tell you this is very typical in Inpt medicine.

 

Get us to it. Re-adjust else you'll find yourself moving shop.

 

You'll learn that each doc approaches to pt mgmt differs.

 

Grab a pen and note pad n start writing note. OK Doctor potato head does it this way and Doctor A-hole does it this way. When you're caring for a pt of Doctor A-hole simply do it his way. Find him immediately, tell him hey Doctor A-hole, I saw your pt and I adjusted his BP meds the way you would. You'll end up developing a good relationship and Doctor A-hole will stop micro managing you or having you run every pt by him. You got the idea.

 

 

Exactly - this is what I've been doing.  I feel like I'm developing multiple personalities, but sometimes you just have to do what works.  I know that attending "A" likes drug "Y" for said condition and attending "B" likes drug "Z", etc,.  Just gets frustrating at times depending on who I'm working with.  Control freak attending days make me feel invisible, but other days I feel accomplished and appreciated with other attendings.  At least I get to work with a variety of people and am not "stuck" with a single attending for long.  I like it all-in-all, but the model is so different than outpatient, it is an adjustment for sure.  

[ventana]

Massachusetts PA can now sign death certs!

 

Physician Assistant Authority to Issue Certificate of Death

SECTION 48.   The fourth paragraph of section 9 of chapter 46 of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by adding the following sentence:- A physician assistant may take all action required under this section to furnish a standard certificate of death for registration.
 

 

http://www.mass.gov/bb/gaa/fy2017/os_17/houtexp.htm

 

strong work MAPA!!!!