Physician Assistants and Follow-ups/Long-term care

[Kwame E]

Afternoon, 

 

I've been meaning to ask you guys' opinion on this but never got around to it. Anyways, a few months ago I got the opportunity to briefly talk to a cardiologist. He's been practicing for over 20 years, is in private practice and also does some kind of work in academia. I asked him how he felt about PAs and if he worked with any. Here's what he had to say (I'm paraphrasing a bit): 

 

"I think physician extenders (he used that term, most likely to group PAs and NPs together) are great, if they are utilized correctly. They are there to extend the care of physicians. When a patient has a procedure done, the follow-ups need to be with a doctor. If a patient has several follow-up appointments and sees the PA and never sees the MD, that's an issue. I don't agree with PA-run practices because the doctor is never there. I work with a few PAs and they are great." 

 

How do you guys feel about this? In your experience, do a lot of MDs share the same sentiment? 

 

 

[Febrifuge]

I mean, there's a continuum. Some docs who espouse this "physician extender" point of view are benig thoughtful, caring for their patients, and genuinely do value PAs and NPs as colleagues. I think if this particular cardiologist is of that stripe, then what he/she means is that patients that require a lot of follow-up should probably touch base with the MD once per [year/ 6 months/ whatever] but the majority of the contact and care can be with the PA. And it might not even be about quality of care, but liability, anyway. A good boss is one who doesn't stop feeling responsible for the patients just because he/she isn't seeing them every visit. A good doc is someone who is going to want to check in, not because they don't trust you but because they feel a need to personally know what's going on with patients.

 

I don't have an issue with this kind of thing. It's also nice for the doc to be more hands-on if the doc is a specialist, and/or has years of experience, and/or the patient's issue is more complex, involves more of the "what if" kind of thinking or otherwise kind of requires the more basic science-heavy, less strictly clinical kind of training and thinking style that the docs get, compared to us. That having been said, there is absolutely no reason why any PA or NP couldn't gain enough experience over time to be just as good. The stories about brand-spanking new attending MDs trying to tell PAs with 25 years of experience about the finer points of the job can be amusing (or really offensive, depending on your mood).

 

The other side of the coin is docs who somewhere along the line drank the poison Kool-Aid about how our training is categorically inferior, or about how we can't possibly manage to develop clinical acumen or perceive the gestalt around a specific patient, in light of their disease. These people lack for education, which is kind of ironic I suppose. They often spout nonsense and make generalizations. It often turns out they are simply regurgitating something from a PA-unfriendly mentor who is a thousand years old and/or a toxic learning environment from their past.

 

Some of them simply don't know any better, and sometimes we can actually change their minds through exposure and collaboration. They un-clench over time about the ego part, while coming to understand the value of PAs and NPs as colleagues.

 

So, to answer the question, the sentiment varies considerably by location, training, and experience. I live in a state where midlevels are valued, and the places I've worked and trained, there was no static about the hierarchy from preceptors or staff, just now and then from insecure MS3s and MS4s. Their opinions mattered as much as mine as a PA-S2, which is to say almost not at all. 6 years later, in the real world, in both the positions I work I am functionally interchangeable with the MD. I'm here when they are not, simple as that.

[winterallsummer]

Personally I think that is an ignorant view of PAs, but it doesn't really bother me on a personal level.  Sounds like he is a bit of an "old time doc" who overall has a good opinion and working relationship with PAs.  But do I agree we are extenders?  Obviously not.  Most of us have our own panel of patients, admit, round and discharge patients independently, and few of our clinical encounters are ever truly "supervised" by our physician collegues.

[ventana]

he is out of touch and out of date with primary care

 

see tag line.....