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Pimping by an attending


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Wonder if anyone had this and can share the thought on dealing with this crap.

I work in ED, community hospital. no fast track, we all work from the same pile of charts with docs attending to the most acute cases. No residents in ED. 

I have one doc who thinks PAs are residents and it is OK to ask them to finish her procedures like lacs and I&Ds. What's more annoying is that whenever I have a question or need to her to clear the x-rays, there is never a straight answer but rather a pimping session in front of RNs and such. It is usually done in a patronizing and condescending tone and I guess the feeling is like "I bestow my wisdom upon thee" and it is ok for this doc to say - "hey, go read this and that and you will tell me later". This game could be fun but more often than not, when we are knee deep in it, it is NOT.

I am all about learning as I was an educator before PA also, but this crap gets old quick.

I talked to that doc once saying I would appreciate a team and collaborative approach rather than  being a "resident" to which the answer was "sure, but I NEED to know what you know and what you don't and PAs are in essence are glorified residents and basically it is sucks to be you, because we have 6 attending and all of them have different styles and you have to do what they want/like".

 

I wanted to ask how this doc would like if cards or neuro consults would pimp her/him every time we place a call just to KNOW what they know, but I did not in order not to escalate further.

 

What would you do? Am I overreacting?

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well...I have been doing this for a long time and I insist on being treated like a professional. When a doc talks to me in any way other I stop it cold. Finish my procedure? No sorry I have my own patients to attend to. tell me what you see? Nope I am asking your opinion. I am not a glorified resident and if you can't treat me with professional courtesy then we simply won't speak. 

I had one doc who wanted me to suture the top of a deep puncture from a dog bite and I said no. He said "I'm telling you to do it." I replied 'and I am saying no. My supervising physician can stop me from doing anything but nobody can make me do something I think is wrong. Further I don't work for or answer to everyone with MD behind their name."

Your mileage may vary but generally I find stopping their bullying BS cold works best.

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Agree with MT2PA. I'm all for ongoing education but it should be done in a tactful manner. The SDN forum is chock full of EM physicians who get "tired" of PAs consulting their SP despite the fact that the very definition of the SP/PA relationship is based on the ability to bounce treatment plans and diagnoses off of someone with more training and knowledge of the subject manner. Ridiculing a PA for running something past them, or even worse, following hospital policy by having the Doc sign off on imaging, is absurd.

 

Sounds like you've approached it with her once without resolution. I'd try to bring it up to a Doc with some seniority just so they're not blindsided when you depart. You can also try to not get scheduled with her, but working a shift work gig has a lot of moving pieces and you're likely going to a) make life more difficult for the scheduler or b) make life more difficult for yourself if the Doc who likes to degrade you publicly catches wind you're avoiding shifts with her.

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I think some docs (and PAs, etc) need to remember that we are all in this together. Two heads can be better than one and it doesn't matter if the title of those two heads is different.

 

I love working with docs, PAs and NPs who bounce things off each other no matter what. Sometimes you have to talk stuff out if it is complex. I consult with specialist friends and colleagues on a daily basis. 

 

One of my favorite docs who loved working with PAs always said "don't walk in the swamp alone". 

 

This doc likely cannot be changed and it shouldn't cost you a job if the other docs are all pretty collaborative and easier to work with. Trying to remedy the problem and making sure those in positions of power KNOW what is happening is about the only thing that might change the situation in the future.

 

Another vote for staged independence in practice rights............................

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first step

 

NEVER do them a favor or finish one of their procedures - and if he/she ties to force you get them to "owe you a favor"  nail them hard on this, they are not your brain, and you are a stand alone employee

 

second step - start pimping them.... learn some esoteric stuff and pimp them for all it is worth - find their weaknesses and then use it to your advantage.... yeah sounds a little weird, but by showing them that you know more in certain areas they might lighten up on it - or it will backfire and they will hate you

 

third step - lodge a complaint with HR and point out that you are a revenue generating employee - unlike a resident, and you are expecting to practice at the top of your license.  Make sure you state you are very welcoming to constructive criticism but hold firm

 

 

four - look for a new job..... was in a similar position in an ER - that honestly stunk, and the day I realized I was not going to succeed there is the day I stopped worrying so much about what the crappy employees thought of me.  I did my job (and did not make up exams, upcode charges, and lie in the medical records like they wanted me to for the sake of productivity)

I heard after I left the medical director almost lost his license, the company that I worked for lost the ER contract(this was their only contract and they had been there for many years) , the PA that they hired to replace me lost a huge court case for d/c a floppy baby....(guess you actually have to do an examine to realize they are floppy...)   I literally ran out of there afraid for my license....

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Guest UVAPAC

Thanks for all the input, I do not think I really want to switch jobs now. Just have to find a way to work it out with this doc. It just makes life much more toxic. This and listening how they are overworked and underpaid.

 

I am just curious, do you find him doing it to all PA-C's and APRN's or just you?

 

Sounds like this attending has napolean compex

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stand up 

be a professional

demand respect

respect the doc as well, but do not do his crap work

involve HR now so they can guide you

be professional

stand up for yourself

refuse to work shifts with him/her - are other PAs in the same boat - if so talk together and bring it to admin together

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stand up 

be a professional

demand respect

respect the doc as well, but do not do his crap work

involve HR now so they can guide you

be professional

stand up for yourself

refuse to work shifts with him/her - are other PAs in the same boat - if so talk together and bring it to admin together

 

The problem is in the lack of knowledge of PA profession by docs. In vast majority of cases I noticed the understanding is that we are there to make docs' life easier, do scut work and routine boring tasks. The language that gets me the most is "I do not expect you to see subtle lucency of hairline fractures or understand the calcification patters of malignant lung nodules"... like you frigging need a brain out-pouching feature to know this. 

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My snarky side came out 

 

If this doc is NOT your primary doc on your license - STAND UP.

 

When she busts you on something - stand tall and say firmly and maybe a bit louder than normal - "I am asking for your collaboration. I am a fully trained and licensed medical provider capable of seeing patients on my own. I value my colleagues and like to work together and gain extra perspectives when available. If you aren't willing to help out with this patient's care by working WITH me then I will move on. I am NOT required to get your approval for anything - I was just being collegial."

 

Of course, gain some allies first in the persons of your actual collaborating licensure physician and after talking with HR. 

 

It isn't fun to be the stand up kid but if it needs to be done - and that is obvious - decide if you want to be that person - a leader. Someone who stands up for the profession and personal integrity. 

 

If this doc IS the doc on your license - get that changed asap. Go to HR or admin in your group and get that crap changed. No sense in staying an indentured servant for no good reason. 

 

Surely someone in your group is the right kind of doc who knows what we do and how well. Don't assume they know nothing - teach them.

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While I am not disagreeing with the advice provided, to do this justice, need more information.

 

How long have you been a PA?

How long have you been an ED PA?

How long have you been at this ED?

Do you have any prior healthcare experience and any training post PA program in EM?

Is there a current training program at your ED for PAs?

Are you a hospital employee or employee of a group?

If an employee of hospital, is the physician also an employee?

If an employee of a group, is the physician a partner?

Are you a full member of the medical staff or courtesy member?

What state do you practice in?

What is your scope of practice?

 

At the start of my career, I worked in a similar situation.

There were times that I bristled under demands and constraints of the physicians I worked with.

Later in my career, I realized I learned some very important things (including how NOT to treat others). 

Perhaps future you will have gained something from this experience 3-5 years from now.

Good luck.

George

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