Collaboration vs Supervision

[Jim Anderson]

I just wrote this on the Huffington Post blog, based in part on my mostly productive and positive conversations here with PAs recently about what AAPA needs to do. I am running for the AAPA Board Secretary-Treasurer position in the April 1 election, and I hope you will take a look.  

http://www.huffingtonpost.com/jim-anderson/physician-assistants_b_5013750.html

Jim Anderson, PA-C, MPAS, ATC, DFAAPA

(AAPA election page:  http://www.aapa.org/about_aapa/leaders/resources/item.aspx?id=7390)

[PACdan]

Nice entry. The term "collaboration" is a much more appropriate descriptor. And will help improve lay perceptions when one describes their relationship with physicans. I hope the legalese has moved away from "supervision" by the time I'm in practice.

 

 

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[EMEDPA]

Nice job Jim. Strong work!

[whoRyou]

Well done!

[CorpsmanUP]

A well written and thought out article.

 

One grammatical mistake -Fourth paragraph fourth line, you started a sentence with but which is generally not considered acceptable in formal writing.  

 

...in collaboration with a physician. But the quirkiness of the title "physician assistant" still leads on occasion to some of the same questions...

 

it could be rewritten ...in collaboration with a physician; however, the quirkiness of the title "physician assistant" still leads on occasion to some of the same questions... is grammatically correct and implies a direct connection between the two thoughts expressed.

[Guest Paula]

I will be the devil's advocate...but later...or I will be late to work. 

[wjm7]

This article is excellent.  Very rarely do I feel that we are so well represented in the media.  You crafted a really nice piece.  Congratulations, and thanks.

[ventana]

Pretty good!

 

Now if we can get AAPA to continue to realize that the PA in the trenches are VERY different from the "what we thought" PAs were......

[Guest Paula]

I believe the word "independent" is misunderstood.  As far as NPs are concerned independent means they are not required or forced to have a link to a physician AND that they are able to provide services within their scope of practice and within their nursing board rules.  Most NPs, even if they are "independent" continue to  collaborate with other health care professionals and refer to specialists and consult with others as needed in the interest of the patients. 

 

"No prover should be an island, functioning completely independent of other providers, not NPs, not MDs and not PAs".   If this is really true then all of us, including physicians must sign a collaboration agreement with other providers or health care professionals.  MDs cannot obtain an "independent" license unless they tether their license to another MD, DO, NP, PA, CNM, CRNA.   None of us should be allowed to practice alone. If the MD's collaborating partners die then the MD is by law out of a job until (s)he writes up another collaboration agreement.  This scenario will harm patients while the MD who works on a reservation (for example) searches for another MD, DO, NP, or PA to sign an agreement so (s)he can work.  Patients will suffer because they have now lost their medical provider. The MD has lost his livelihood because no one was available to agree to work with him.  

 

I, as a PA, want, yes want an independent PA license that is NOT tethered to a physician or any other health care professional.  Do I practice "independently"?  No, in reality I do not.  I collaborate with the MD and NP in our practice. I consult and refer for the benefit of the patient.  Do I practice with autonomy?  Absolutely.  I want to practice autonomously with an independent PA license.  I want to see PAs develop their own PA boards and practice medicine as autonomous, collaborative providers who will not lose their job when the MD dies, leaves a practice, etc.  I enjoy a collegial, collaborative relationship with the providers I work with.  That is good patient care to not work in an island, but PAs need independent licensure.

 

As far as the title....assistant is the wrong nomenclature for the profession.  PA initials are ok for  now but as long as  CMS, insurance companies, employers, pharmaceutical companies, PA education programs, AAPA and others believe we are assistants then we will not gain much independence and will not achieve the CMS designation of LIP.  PAs need to be LIPs. I believe the emotions for the title debate are not based solely on being misunderstood.  It is much deeper than that and involves a culture of the profession who does not believe we are capable of being independently licensed and have brainwashed our students and MDs.

 

Title: Licensed Medical Practitioner. After 50 years we have proven our competence.  No sense in being kept in the dependent and supervised status. 

[LT_Oneal_PAC]

I believe the word "independent" is misunderstood. As far as NPs are concerned independent means they are not required or forced to have a link to a physician AND that they are able to provide services within their scope of practice and within their nursing board rules. Most NPs, even if they are "independent" continue to collaborate with other health care professionals and refer to specialists and consult with others as needed in the interest of the patients.

 

"No prover should be an island, functioning completely independent of other providers, not NPs, not MDs and not PAs". If this is really true then all of us, including physicians must sign a collaboration agreement with other providers or health care professionals. MDs cannot obtain an "independent" license unless they tether their license to another MD, DO, NP, PA, CNM, CRNA. None of us should be allowed to practice alone. If the MD's collaborating partners die then the MD is by law out of a job until (s)he writes up another collaboration agreement. This scenario will harm patients while the MD who works on a reservation (for example) searches for another MD, DO, NP, or PA to sign an agreement so (s)he can work. Patients will suffer because they have now lost their medical provider. The MD has lost his livelihood because no one was available to agree to work with him.

 

I, as a PA, want, yes want an independent PA license that is NOT tethered to a physician or any other health care professional. Do I practice "independently"? No, in reality I do not. I collaborate with the MD and NP in our practice. I consult and refer for the benefit of the patient. Do I practice with autonomy? Absolutely. I want to practice autonomously with an independent PA license. I want to see PAs develop their own PA boards and practice medicine as autonomous, collaborative providers who will not lose their job when the MD dies, leaves a practice, etc. I enjoy a collegial, collaborative relationship with the providers I work with. That is good patient care to not work in an island, but PAs need independent licensure.

 

As far as the title....assistant is the wrong nomenclature for the profession. PA initials are ok for now but as long as CMS, insurance companies, employers, pharmaceutical companies, PA education programs, AAPA and others believe we are assistants then we will not gain much independence and will not achieve the CMS designation of LIP. PAs need to be LIPs. I believe the emotions for the title debate are not based solely on being misunderstood. It is much deeper than that and involves a culture of the profession who does not believe we are capable of being independently licensed and have brainwashed our students and MDs.

 

Title: Licensed Medical Practitioner. After 50 years we have proven our competence. No sense in being kept in the dependent and supervised status.

Awesome post. 100% agree.

[delco714]

A well written and thought out article.

 

One grammatical mistake -Fourth paragraph fourth line, you started a sentence with but which is generally not considered acceptable in formal writing.

 

...in collaboration with a physician. But the quirkiness of the title "physician assistant" still leads on occasion to some of the same questions...

 

it could be rewritten ...in collaboration with a physician; however, the quirkiness of the title "physician assistant" still leads on occasion to some of the same questions... is grammatically correct and implies a direct connection between the two thoughts expressed.

Seriously? That's all you got out of that?

 

Any who, fantastic job Jim!!

[CorpsmanUP]

No, that is not the only thing I got from the article.  As was stated I believe it was well written and thought out and conveys a very important message concerning the shifting reality of the PA profession.  I also accept that perceptions matter.   I offered constructive feedback that would allow the article to become slightly more polished.  One of the issues PAs face is that many physicians consider the profession a shortcut or end run around med school; more specifically that a lot of PAs are not good enough for med school and that they “don’t know what they don’t know.”  On the other hand we have NPs clamoring for recognition of their DNPs as equivalent to the MD and offer the remaining certificate and BS programs as proof that PA education is less rigorous than advanced nursing practice irrespective that PA programs are three times more credit intensive than theirs.  Normally I could care less about grammar on the internet (just look at CNN’s copy editing sometime, it is atrocious.)  In this instance it was a public document being presented by an individual aiming to be a public voice for the profession.  I think it is to the benefit of the profession as a whole for that voice to be as refined as possible.  While it may not be an accurate gauge, proper grammar and syntax is deemed by many individuals as a sign of intelligence.   PAs cannot be seen as simply equal to other APPs, they need to be seen as better.  We need to shift public perception to PAs becoming the obvious and preferred choice of providers and part of that is done by leaving absolutely no question of our professionalism in any arena. 

[wjm7]

For the record, it's actually OK to start a sentence with "but."  People are often taught otherwise, but it's actually fine, in both formal and informal writing.  Given the misconceptions, though, it might be best to avoid beginning a sentence with a conjunction when representing the profession.

 

BUT again, it's fine, and Jim's article was top notch.  Polished and informative.  Exactly what was needed.

[CorpsmanUP]

I never said it can’t be done; there are few hard and fast rules in English grammar that are absolute.   I said, “…is generally not considered acceptable in formal writing.”  Having done copy editing for a top ten newspaper in the past, I have seen many the letter critiquing the grammar and structure of the writing.  While some of it was warranted and some was not, what came from that experience was acknowledgment of how serious it was to some people.  Ultimately in communication perception is the reality you have to deal with.  If many of your readers “perceive” that you made a mistake, then you did.  That perception is an unnecessary hurdle for you to overcome in communication if you can avoid it by following “generally” accepted rules.  That was my point.

[wjm7]

Completely agree.  Good point.

[BruceBanner]

I believe the word "independent" is misunderstood.  As far as NPs are concerned independent means they are not required or forced to have a link to a physician AND that they are able to provide services within their scope of practice and within their nursing board rules.  Most NPs, even if they are "independent" continue to  collaborate with other health care professionals and refer to specialists and consult with others as needed in the interest of the patients. 

 

"No prover should be an island, functioning completely independent of other providers, not NPs, not MDs and not PAs".   If this is really true then all of us, including physicians must sign a collaboration agreement with other providers or health care professionals.  MDs cannot obtain an "independent" license unless they tether their license to another MD, DO, NP, PA, CNM, CRNA.   None of us should be allowed to practice alone. If the MD's collaborating partners die then the MD is by law out of a job until (s)he writes up another collaboration agreement.  This scenario will harm patients while the MD who works on a reservation (for example) searches for another MD, DO, NP, or PA to sign an agreement so (s)he can work.  Patients will suffer because they have now lost their medical provider. The MD has lost his livelihood because no one was available to agree to work with him.  

 

I, as a PA, want, yes want an independent PA license that is NOT tethered to a physician or any other health care professional.  Do I practice "independently"?  No, in reality I do not.  I collaborate with the MD and NP in our practice. I consult and refer for the benefit of the patient.  Do I practice with autonomy?  Absolutely.  I want to practice autonomously with an independent PA license.  I want to see PAs develop their own PA boards and practice medicine as autonomous, collaborative providers who will not lose their job when the MD dies, leaves a practice, etc.  I enjoy a collegial, collaborative relationship with the providers I work with.  That is good patient care to not work in an island, but PAs need independent licensure.

 

As far as the title....assistant is the wrong nomenclature for the profession.  PA initials are ok for  now but as long as  CMS, insurance companies, employers, pharmaceutical companies, PA education programs, AAPA and others believe we are assistants then we will not gain much independence and will not achieve the CMS designation of LIP.  PAs need to be LIPs. I believe the emotions for the title debate are not based solely on being misunderstood.  It is much deeper than that and involves a culture of the profession who does not believe we are capable of being independently licensed and have brainwashed our students and MDs.

 

Title: Licensed Medical Practitioner. After 50 years we have proven our competence.  No sense in being kept in the dependent and supervised status. 

 

I also agree. Good post.

 

I think the "assistant" part of our title is a misnomer given our present scope. There are a lot of alternatives that would make sense, but I think a complete name change (i.e. General Practice Provider, or Licensed Medical Practitioner) would take away some of the public confusion and re-establish PA's as trained, credentialed, unrestricted general practice providers.

 

There are some things I think that only physicians should do independently, such as all surgery, radiology, etc. We have to draw the line somewhere. But as far as general practice areas like IM, FM, UC, Peds, ED; there is no reason we could not be "autonomous" in the legal sense.

 

HOWEVER---I do NOT think we should be releasing new grads into the wild with independent practice rights. They should have to practice under an SP for 2-4 years...kind of like working residency. I don't know about you guys but I'm just now starting to feel like I am competent enough to handle most general med problems at 2 years out.

[PACdan]

I think the "assistant" part of our title is a misnomer given our present scope. There are a lot of alternatives that would make sense, but I think a complete name change (i.e. General Practice Provider, or Licensed Medical Practitioner) would take away some of the public confusion and re-establish PA's as trained, credentialed, unrestricted general practice providers.

I agree that General Practice Provider or Medical Practitioner are more fitting & descriptive titles for PAs. Yet one is still left holding the bag, having to explain your "GPP" or "MP" title to the lay person or patient. The problem is that there are few monikers as simple and well recognized in the medical professions as "doctor" & "nurse". Their roles are ubiquitous in many languages.

 

With 50 years of PA coming up, I feel that a dramatic name shift now could set back what seems to be a snowballing understanding of the PA title/role. Most all of my friends (mid-to-late 20's) knew what a PA was or had seen one before I was even applying. It's a matter of erosion and dinosaurs, it just takes time.

 

If *anything*, I say Physician Associate (hot debate, I know), if only to avoid changing all those name plaques. :)

 

 

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[BruceBanner]

^ There is no way around that. PAs have been around almost 50 years and we are STILL explaining ourselves. No matter what the change, we'll be 'splaining until the day we retire.

[Guest Paula]

Just like RIcky said to Lucy  "Luuccyyy .....you've got some 'splaining to do".

[Guest Paula]

^^^^^^^^ That dated me!