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About HLReed

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  1. Paula, My Director of PA Services is a very strong, vocal advocate for the profession on the local, state and national levels. We have done a good job of tackling some of these things as they come up, but at my (very large) institution, the job postings are written by individual department managers and/or individual HR and recruiting employees. They pop up for a month or two and are taken down. It's a little like playing whack-a-mole. But she reads JAAPA. I'll make sure she sees the article. Everyone, I hear all of your alternative terms, but I keep asking: why do you replace official titles (or their abbreviations) with longer, less uniform, more ambiguous terms? We are grouping two professions; each has a two letter abbreviation. Do we really have such a weak grasp of our own language?
  2. From the latest JAAPA Musings blog: Remember that awful nickname your older brother gave you? Or the one mean kids shouted at recess? It made your skin prickle, fists clench, and eyes glow crimson. Now, imagine your boss walks into your office tomorrow and calls you that very name. If the scenario sounds silly, you may not have paid attention to recent national chatter about the physician assistant (PA) profession. The issue of professional title and terminology has embroiled our ranks and—for the second straight year—dominated conversation at national conferences. But the often-discussed idea of changing the profession’s official title has wrestled focus away from another, and perhaps more disturbing, issue: the slew of unofficial nicknames heaped on PAs by outsiders and, far too often, adopted by our own. You have read them in job postings and news articles, each more inaccurate and uninventive than the last: “advanced practice provider,” “non-physician,” “midlevel,” “physician extender.” I’m willing to bet you don’t use them on your resume or to introduce yourself to patients. Nonetheless, these terms have persisted, and even gained acceptance, through sheer repetition. One in particular seems to roll off the tongue of PAs and NPs more than the others. “Midlevel” has become the frontrunner of accepted substitutes. Never mind that it takes more letters to spell than “PA or NP.” This often-used term is also one of the most demeaning. The single word expresses several false implications. The first is that there is a strict tiered hierarchy in healthcare and PAs and NPs occupy the (imaginary) middle rung. I’m not sure who the “low level” providers are, but I bet whoever coined the term “midlevel” imagined registered nurses on that bronze podium. I pity the first human resources representative with the guts to slap “low-level provider” on an RN job list. The term’s ambiguity adds more danger. Does “midlevel” refer to the provider’s training, skill set, or performance? If physicians provide a high level of medical care, then surely a “midlevel” label implies a product of lesser quality. To the contrary, mounting evidence suggests PAs’ patient outcomes and satisfaction are on par with physicians. Major healthcare organizations have noticed the problem with these substitute names. In February, the Society of Hospital Medicine vowed to abolish the use of such terms and instead refer to professions by their official titles. “Admittedly there may be times when using terms like ‘allied health’ are more expedient,” the Society of Hospital Medicine’s official blog stated, “but the potential for alienating members of the hospitalist family outweighs the need for convenience.” Users of these shortcut names rarely have malicious intent. Often, the words come from a perceived convenience and ignorance of the potential for insult. Large organizations in particular, however, should understand the attitudes they unintentionally project toward the very people they hope to attract. Employers send subtle but strong messages through the diction of their websites and recruitment materials. The PA profession has a responsibility to protect its brand. While debate rages about the accuracy and relevance of the term “physician assistant,” it should not distract from—or worse, condone—the generic labels that threaten to dilute our identity. Regardless of the mixed feelings toward our professional name, it is a title we own. Let’s not have it usurped by one that we don’t. You can comment here: http://journals.lww.com/jaapa/blog/musings/Pages/default.aspx
  3. Like any representative democracy, the AAPA can only represent those who are actively involved in the process (the silent, by definition, are not heard). The point of the HOD is that anyone who wants to be involved in the process has a forum to present ideas and oppose said ideas. This IS the time for feedback. If you aren't an HOD delegate, you can contact the delegate that represents you and voice your concerns.
  4. Ultrafiltration (UF) is just the rate of fluid removal during renal replacement therapy. It can be performed with or without solute removal to achieve net negative fluid balance. If patients can't hemodynamically tolerate the large fluid shifts of intermittent hemodialysis, but still need fluid removal and are anuric, they can have CVVHD with a slow rate of UF for fluid removal. We do it all the time in the ICU for patients that are fluid overloaded but otherwise don't need dialysis. The dialysis access and equipment would be exactly the same, settings differ.
  5. The Yale reference is often used incorrectly over and over again. The Yale PA Program was originally called "Associate" and stayed that way because, in part, Yale as a university is obsessed with tradition. The degree does not have the word "Associate" in it anywhere. It is a Master's of Medical Science awarded by the Yale School of Medicine. PAs in Connecticut are legally referred to as physician assistants, even for those of us that graduated from a Physician Associate Program. What PA's are called in the workplace is a matter of state law and bucking that can lead to a revoked license and a short career. Be careful.
  6. Starting with Critical Care (Medical ICU) taught me a broad array of medicine. From silly inpatient problems to emergency situations (codes, unstable arrhythmias, MIs, hemorrhage, perforated bowels) to really, really sick and complicated patients on death's door. But it was not easy right out of school. Grueling.
  7. Early in my first job I felt guilty for being done with my work and leaving early, even though my fellow employees and supervisors encouraged me to do so. Now I see they were right. Since then, I have stayed late far more days than I have left early. That guilt has retroactively vanished. Salaried employees have to take it both ways and hope it balances out. But keep in mind that early on the work load might be lighter or expectations might be less. However, using the extra time for personal/professional development is also a wise investment. Those extra hours in the afternoon are well spent on CME or personal interest projects that build your resume. It's a win-win for you and your employer.
  8. Right. My orders are followed just like any other licensed clinician in the hospital setting. Luckily, I work for a hospital that has its practice-level policies well laid-out and very strong PA leadership system-wide (some names you'd recognize ;-) ). I've never had any problems with this law, but state-wide it's another thing that someone could point to and say "Hey look, why deal with all this BS when you can just hire NPs instead of PAs?" Selfish politics at the higher levels creating roadblocks to patient care.
  9. Yes and I'm curious if they still oppose. Still, great news. Thanks for everyone who contributed. More work to be done for next week.
  10. Here is my JAAPA editorial blog detailing the issue a little more in the bigger picture. If you don't mind sharing this through your blogs and social media outlets, it may help elevate the issue and put pressure on the parties at the table. Thanks! http://journals.lww.com/jaapa/blog/musings/pages/post.aspx?PostID=47
  11. No, I want to clarify that I was simply saying that this issue very directly affects the practice of PAs in Ohio and your help would send a big message to those of us practicing here. Thank you for giving this your attention. It may make life a lot easier for OH PAs and our patients. H
  12. I don't know what insults you are referring to. That was an invitation regarding the current issue of this thread. If I unintentionally struck a nerve, I apologize. Thank you for your efforts.
  13. Paula, it's 2014. Communication is instantaneous. Send the "letters." And addressing the ONA is fine, but communication would be better sent to legislators and third-parties like bloggers and media outlets explaining, in simple terms, the impact this type of behavior has on patients. I've individually contacted every member of the Health and Aging Committee in the Ohio House as well as the health and medicine reporters and editors of the major media outlets in the three largest metropolitan areas in OH. My blog regarding this issue should post to JAAPA soon. If you want my talking points to these various parties now, PM me and I can provide them. Now would be a good time for PAFT to show that they get behind issues that actually affect PA practice. OH is home to one of the largest private employers of PAs in the country, the Cleveland Clinic. If you want people to join your organization, show them something.
  14. I'm trying. Alas, I am but one man. Anyone here have any legislative or media contacts in Ohio?
  15. Underwhelming response from a normally chippy crowd... Anyone setting up road blocks to patient care for selfish gain should be embarrassed. And have a spotlight shone on them. There's opportunity here.
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