JohnnyM2 Posted November 11, 2014 Share Posted November 11, 2014 I don't like waiting weeks and weeks for Dr. appointments so I usually ask if they have a PA I can see earlier. Amazing how often they have PAs but didn't bother to inform me.. Today, I went to the dermatologist for a scheduled PA appointment and was asked to sign a form acknowledging that I would be seeing a PA. When I asked what the point of the form was (rhetorical question), I was told that it was a legal requirement (doubtful) for me to agree to see a PA instead of a regular doctor. When I saw the PA, I suggested he and any of his colleagues push back against this type of institutionalized discrimination which, by its very existence, suggests PAs are inferior to MDs. I asked if they would require patients to sign a form acknowledging that they would be seeing a DO or an MD fresh out of residency and he was pretty sure they wouldn't. I know they wouldn't because no practice in its right mind would want to suggest some of its MDs are superior to others, even though we all know its true. The PA thought it was a requirement of some insurance companies but that really didn't make any sense either. Regardless, IMO, this kind of thing institutionalizes the idea that PAs are inferior to MDs. The PA community and its advocacy groups need to push back against these rediculous policies that crop up spontaneously here and there. Its like a game of whack-a-mole but it needs to be played out nevertheless. Link to comment Share on other sites More sharing options...
gbrothers98 Posted November 11, 2014 Share Posted November 11, 2014 I hear this from our nursing staff sometimes. I work in an ED that staffs solely with PAs, we have done this for over 10 years. The patient may not be aware of that (there is a large sign right by the door they enter the ED) , they are told that I will be in to see them and the nurse will ID me as a PA. Pts will hesitate or make remarks, the nurse will buy into this and try some sort of ineffectual explanation. I enter the room, usually after a short introduction and getting down to business, pts intuitize that this is the way things are. On the other hand, I discuss with the staff that when they buy into that patient response, they immediately undercut my relationship with the patient. I remind them that I am the guy that they run all their personal and family health problems by and have actually cared for some of them during illness and injury. Some get it, some dont. I actually had one of my more close PA colleagues ask me when I saw her for a torn meniscus if I wanted to see the orthopedist vs her?! Come on!! You are right, it is an everyday uphill battle. G Brothers PA-C Link to comment Share on other sites More sharing options...
KMD16 Posted November 11, 2014 Share Posted November 11, 2014 The inferiority is here to stay for a very long term. Sad but true. I wouldn't fight it. We're not MD or DO right? Believe me. I'm on your side. Link to comment Share on other sites More sharing options...
SoCal_PA Posted November 11, 2014 Share Posted November 11, 2014 The inferiority is here to stay for a very long term. Sad but true. I wouldn't fight it. We're not MD or DO right? Believe me. I'm on your side. What?? Why not fight it? I'm hoping the new, larger influx of PAs will not settle for being mistreated and rise up against what has become "the norm" Link to comment Share on other sites More sharing options...
PACdan Posted November 11, 2014 Share Posted November 11, 2014 That office must have gotten some looney in there that was all "how dare I not see a doctor/you tricked me/I'll sue", because they saw a PA. And the office's over-reactionary response is to create this waiver form, so no one else can complain/feign ignorance. I feel bad for the PAs who have to work in an office with that albatross around their necks. Link to comment Share on other sites More sharing options...
KMD16 Posted November 11, 2014 Share Posted November 11, 2014 Want to fight inferiority. Good luck. The new larger influx of PAs you mentioned are getting pinched. They called it the new face of PA (young with no life exp or prior HCE by that I meant formal RN, EMT or medic). If pts were to sign a form to see me the PA. It create an opportunity to educate the pt what we do and who we are. There exist an unspoken institutionalized inferiority towards a PA. Most often time you don't see this written on the wall in bold. So do an unspoken inferiority by MD towards a DO. Yes. This are region specific. Link to comment Share on other sites More sharing options...
KMD16 Posted November 11, 2014 Share Posted November 11, 2014 That office must have gotten some looney in there that was all "how dare I not see a doctor/you tricked me/I'll sue", because they saw a PA. And the office's over-reactionary response is to create this waiver form, so no one else can complain/feign ignorance. Very likely. Have seen it happen. Link to comment Share on other sites More sharing options...
JohnnyM2 Posted November 11, 2014 Author Share Posted November 11, 2014 The inferiority is here to stay for a very long term. Sad but true. I wouldn't fight it. We're not MD or DO right? Believe me. I'm on your side. Thanks for 'being on my side' but, sorry, I don't buy it. Of course a PA is not a DO or MD. So what? PAs are also not baseball bats, ice cream cones or monkeys. PAs should be defined by what they are, not by what they aren't. When it comes to practicing medicine, PAs can either accept a position of inferiority or push back against it, and the future of the profession depends on doing the latter. The inferiority will be there for as long as the profession tolerates it. Scope of practice will likely always be less than MD or DO but SOP should never be equated with ability or quality of practice. Link to comment Share on other sites More sharing options...
BruceBanner Posted November 11, 2014 Share Posted November 11, 2014 What?? Why not fight it? I'm hoping the new, larger influx of PAs will not settle for being mistreated and rise up against what has become "the norm" Doubtful. Every PA student is full of hope and hot sauce, but the reality is most will be scrambling to get jobs. Think there is a big buffet table of sweet jobs just waiting for new grads? There isnt, because you have NO EXPERIENCE. Especially if you want/need to live in a major metro area where supply and demand 101 comes into effect. You may get lucky and land a gig with a former preceptor, but I know the majority of my class took pretty modest jobs after school. As the months roll by and the student loans loom on the horizon, real life dictates you just need to work. A national union seems like it could address some of these issues on a large scale, but I think it is unlikely since collective bargaining cant happen with private clinics. As burnpac put it, they'll just say fvck off and hire someone else. There will always be PAs to fill those small clinic jobs. I agree with the OP regarding the derm clinic that asking pts if they want to see a PA is insulting and should be stopped. PAs are physician extenders and I seriously doubt that is legislated by any stretch. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 11, 2014 Moderator Share Posted November 11, 2014 anyone going to PA school today needs to look at the reality of the job situation and that is this: There are LOTS of jobs out there, BUT these jobs are not in major metro areas unless we are talking about surgical jobs. The vast majority of up and coming pa jobs are in smaller communities that can't attract enough docs. That is the niche we were created to fill and at some point many folks lost sight of that.want to get a job tomorrow? look at Alaska, the midwest, and the deep south. Look at central california > 100 miles from the coast. Look at the Federal prison system. look at the military. The jobs are there, but they are not m-f 9-5 doing primary care in downtown Boston, NYC, San diego, Seattle, or Chicago for 100k/yr. Really want to land that urban job? Do a residency right out of school then pick your place to work, the world is your oyster. Link to comment Share on other sites More sharing options...
BruceBanner Posted November 11, 2014 Share Posted November 11, 2014 anyone going to PA school today needs to look at the reality of the job situation and that is this: There are LOTS of jobs out there, BUT these jobs are not in major metro areas unless we are talking about surgical jobs. The vast majority of up and coming pa jobs are in smaller communities that can't attract enough docs. That is the niche we were created to fill and at some point many folks lost sight of that.want to get a job tomorrow? look at Alaska, the midwest, and the deep south. Look at central california > 100 miles from the coast. Look at the Federal prison system. look at the military. The jobs are there, but they are not m-f 9-5 doing primary care in downtown Boston, NYC, San diego, Seattle, or Chicago for 100k/yr. Really want to land that urban job? Do a residency right out of school then pick your place to work, the world is your oyster. ^^^True story right here. Link to comment Share on other sites More sharing options...
PACdan Posted November 11, 2014 Share Posted November 11, 2014 Doubtful. Every PA student is full of hope and hot sauce, but the reality is most will be scrambling to get jobs. Think there is a big buffet table of sweet jobs just waiting for new grads? There isnt, because you have NO EXPERIENCE. Especially if you want/need to live in a major metro area where supply and demand 101 comes into effect. You may get lucky and land a gig with a former preceptor, but I know the majority of my class took pretty modest jobs after school. As the months roll by and the student loans loom on the horizon, real life dictates you just need to work. A national union seems like it could address some of these issues on a large scale, but I think it is unlikely since collective bargaining cant happen with private clinics. As burnpac put it, they'll just say fvck off and hire someone else. There will always be PAs to fill those small clinic jobs. I agree with the OP regarding the derm clinic that asking pts if they want to see a PA is insulting and should be stopped. PAs are physician extenders and I seriously doubt that is legislated by any stretch. Not with that attitude. I think you find your niche and chip away in the corner. That's how you eventually break out of Shawshank. I do think new PAs and PA students need to drop the notion that they are going to dictate where they work AND get a great job/pay, right off the bat. Medical residents have to uproot to Timbuktu, if that is only residency match they get. I think people are setting themselves up for disappoint if they don't consider having to relocate for a better gig, part of the process. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 11, 2014 Moderator Share Posted November 11, 2014 I do think new PAs and PA students need to drop the notion that they are going to dictate where they work AND get a great job/pay, right off the bat. Medical residents have to uproot to Timbuktu, if that is only residency match they get. I think people are setting themselves up for disappoint if they don't consider having to relocate for a better gig, part of the process. yup. location, specialty, pay. pick 2. want to work in Boston as a new grad for 100k? weight loss clinic. want to do high end EM for great money? Wyoming. Link to comment Share on other sites More sharing options...
PACdan Posted November 11, 2014 Share Posted November 11, 2014 yup. location, specialty, pay. pick 2. want to work in Boston as a new grad for 100k? weight loss clinic. want to do high end EM for great money? Wyoming. Unfortunately the attitude is pretty pervasive in my class. Everyone wants to go back home or into the city. I'm the only one trying to head out west to Arizona for an adventure. I keep jumping up and down and saying that's not where the big needs and better pay is...but people want what they want. (they do have 23 months to change their minds) Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 11, 2014 Moderator Share Posted November 11, 2014 Unfortunately the attitude is pretty pervasive in my class. Everyone wants to go back home or into the city. I'm the only one trying to head out west to Arizona for an adventure. I keep jumping up and down and saying that's not where the big needs and better pay is...but people want what they want. (they do have 23 months to change their minds) one of my former students just took a sub-par job for 35/hr with crap benefits so he could stay in his home town.... Link to comment Share on other sites More sharing options...
PACdan Posted November 11, 2014 Share Posted November 11, 2014 one of my former students just took a sub-par job for 35/hr with crap benefits so he could stay in his home town....That's unfortunate. For the complexity of the work, the stress and stakes associated with it, and the training and costs that go into it; PAs are worth so much more. If I wanted minimal pay, I would have saved all the costs of school and stress and be living the life of a night shift security guard at a mall or warehouse (this is my retirement dream job; lots of time to read & solitude) Link to comment Share on other sites More sharing options...
SocialMedicine Posted November 12, 2014 Share Posted November 12, 2014 If you told me my salary was 35 an hour w minimal benefit I would leave the profession. Do something else. A Masters degree in medicine and the experience of providing primary care would be attractive to many different business and government organizations. Link to comment Share on other sites More sharing options...
problem child Posted November 12, 2014 Share Posted November 12, 2014 I don't like waiting weeks and weeks for Dr. appointments so I usually ask if they have a PA I can see earlier. Amazing how often they have PAs but didn't bother to inform me.. Today, I went to the dermatologist for a scheduled PA appointment and was asked to sign a form acknowledging that I would be seeing a PA. When I asked what the point of the form was (rhetorical question), I was told that it was a legal requirement (doubtful) for me to agree to see a PA instead of a regular doctor. When I saw the PA, I suggested he and any of his colleagues push back against this type of institutionalized discrimination which, by its very existence, suggests PAs are inferior to MDs. I asked if they would require patients to sign a form acknowledging that they would be seeing a DO or an MD fresh out of residency and he was pretty sure they wouldn't. I know they wouldn't because no practice in its right mind would want to suggest some of its MDs are superior to others, even though we all know its true. The PA thought it was a requirement of some insurance companies but that really didn't make any sense either. Regardless, IMO, this kind of thing institutionalizes the idea that PAs are inferior to MDs. The PA community and its advocacy groups need to push back against these rediculous policies that crop up spontaneously here and there. Its like a game of whack-a-mole but it needs to be played out nevertheless. I would guess it probably had more to do with the practice covering their liability. the doc is responsible for the PAs actions, so if the doc has never seen a particular patient, and the patient requests a PA right outta da box, it's probbably a CYA thing. you know the old saying, "if it ain't documented, it didn't happen!" here's another possible topic thread: "why are PAs so dang thin-skinned?" Link to comment Share on other sites More sharing options...
problem child Posted November 12, 2014 Share Posted November 12, 2014 one of my former students just took a sub-par job for 35/hr with crap benefits so he could stay in his home town.... WHUUUUUT???? that's just bad negotiating. was this practice the only game in town? Link to comment Share on other sites More sharing options...
problem child Posted November 12, 2014 Share Posted November 12, 2014 yup. location, specialty, pay. pick 2. want to work in Boston as a new grad for 100k? weight loss clinic. want to do high end EM for great money? Wyoming. uhhhh....as a boston-based PA, and a NYC-trained PA, you don't "start out as a new grad" at 100K. more like 65-75K. the more people (PAs) who want to be where the action is, the lower the PA (simple supply and demand). as for the PA who wants to go to AZ, there is HUGE need for PAs in native american reservations. just be prepared to do a lot of diabetes, obesity, and alcoholism work. I want to hit the rez too, but can't until my daughter finishes high school. maybe I'll see you out there :) ps VERY high pay in TX for some reason - the state is extremely prosperous and pay is good, lifestyle is relaxed. Link to comment Share on other sites More sharing options...
problem child Posted November 12, 2014 Share Posted November 12, 2014 <<...A national union seems like it could address some of these issues on a large scale, but I think it is unlikely since collective bargaining cant happen with private clinics. As burnpac put it, they'll just say fvck off and hire someone else. There will always be PAs to fill those small clinic jobs. I agree with the OP regarding the derm clinic that asking pts if they want to see a PA is insulting and should be stopped. PAs are physician extenders and I seriously doubt that is legislated by any stretch.>> I'm all for union, and I don't think it would be hard. if the union were national, and every PA joined, employers would have no choice but to hire PAs as per union dictates. but I'm more interested in your last comment....it is NOT insulting to ask if a pt wants to see a PA - it is ILLEGAL NOT TO!! if a pt goes to a doctor's office and is not told that the doctor is busy but they have a slot on the PAs schedule, the pt HAS to be told they will be seeing a PA. otherwise it is complete misrepresentation of the the provider's credentials, does not give the patient the option to choose, and puts the practice at risk of legal repercussions. why do PAs have such a chip on their shoulder about being PAs? so many threads and comments here suggest that many PAs WANT to be mixed up with or considered to be a doctor, and kind of get off on it...well that's just TOO BAD! you/we took the shortcut to have the PRIVILEGE of practicing medicine and you're/we're lucky to have had the opportunity to do so!!...so just eat a little humble pie and be proud of who you are, and quit whining and bitching about how you're not "treated like a doctor". NEWS FLASH: WE'RE NOT DOCTORS!!! ahem. thank you Link to comment Share on other sites More sharing options...
Acromion Posted November 12, 2014 Share Posted November 12, 2014 Not with that attitude. I think you find your niche and chip away in the corner. That's how you eventually break out of Shawshank. I do think new PAs and PA students need to drop the notion that they are going to dictate where they work AND get a great job/pay, right off the bat. Medical residents have to uproot to Timbuktu, if that is only residency match they get. I think people are setting themselves up for disappoint if they don't consider having to relocate for a better gig, part of the process. Any PA who expects great pay and an ideal location right out of school has serious entitlement issues. With the continued erosion of the middle class, there are so many educated professionals advanced degrees who would kill to be in our position, including pharmacists, lawyers, engineers, teachers, professors. There are parts of this country that are absolutely desperate for PA's. Having a less entitled patient population makes it a bit easier as well. Where I work, I have never had a patient bat an eye when I tell them I'm a PA (actually .... only one - and it was a drug seeker who wanted to see the doc who was known to be loose with the scrip pad). Link to comment Share on other sites More sharing options...
BruceBanner Posted November 12, 2014 Share Posted November 12, 2014 I'm all for union, and I don't think it would be hard. if the union were national, and every PA joined, employers would have no choice but to hire PAs as per union dictates. but I'm more interested in your last comment.... it is NOT insulting to ask if a pt wants to see a PA - it is ILLEGAL NOT TO!! if a pt goes to a doctor's office and is not told that the doctor is busy but they have a slot on the PAs schedule, the pt HAS to be told they will be seeing a PA. otherwise it is complete misrepresentation of the the provider's credentials, does not give the patient the option to choose, and puts the practice at risk of legal repercussions. You're sort of right. It's only "illegal" to falsely portray or disclose your status as a PA. So as long as you either introduce yourself or have a visible name badge, you're fine. No one has to ask the patient if they want to see a PA, they only have to be made aware you are indeed a PA. As far as a union...It sounds great on paper. But I'm not sure you understand how much of an undertaking that would be to get enough PAs on board, elect union government, collect union dues, plus get everyone to come to a consensus, vote, and draft union bylaws that would benefit the whole of the profession and not hamstring us. Keep in mind there are more NPs than PAs. If our demands were too steep, employers would just preferentially hire NPs, or those PAs who did not unionize. Unions only work when there are sufficient numbers and organization to grab employers by the balls and make them acquiesce in order to utilize our services. PAs--while vital--still have a minority market share of the midlevel workforce. I think local or practice-specific unions would work best, as in an ED providers union for a given region or group of hospitals. As to your last point, I agree some PAs fancy themselves de facto doctors, at least in their own minds. As a profession we just need to be careful we are pushing in the right direction---i.e. appropriate autonomy, fair compensation, and professional respect rather than just creeping up on MDs, which I dont really see as a problem. Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 12, 2014 Moderator Share Posted November 12, 2014 last time I checked we HAD to identify ourselves as PA and in my state we have to wear ID stating this per DPH Getting them to sign that they are seeing a PA is not unreasonable as long as the verbiage is okay Be proud of our title and degree! Link to comment Share on other sites More sharing options...
JohnnyM2 Posted November 12, 2014 Author Share Posted November 12, 2014 here's another possible topic thread: "why are PAs so dang thin-skinned?" Why do you think PAs are thin skinned? Link to comment Share on other sites More sharing options...
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