Non-PA PA question

[dm123]

I had to be a patient in a specialists office about a month ago. I have MS and from time to time have to play the patient roll. I see this particular specialist every 6-8 months and usually see the NP the doc has working for him. To my surprise, at my last visit everyone from check-in person to check-out person and all assist persons in between had a name tag that said "John Doe or Jane Doe, Physician Assistant". It kind of gave me a dose of the tight butt but I didn't make an issue out of it, probably should have.

 

After thirty years of busting my tail trying to explain to patients that a PA is more than just a go-for, the more I thought about it the more steamed I got.

 

How would others handle this? Remember I was/am a patient here.

[Contrarian]

I feel the same way when I log into THIS site and everyone has a profile tag that says "John Doe or Jane Doe, Physician Assistant" but then go on to ask for assistance or info about things that anyone with 30 days in a PA program would know.

 

According to many here... I'm NOT "handling it" well...:heheh:

 

So can't really assist you here.

 

YMMV

 

Contrarian

[just_me]

wonder what the consequences would be of having a chat with the MD or the office manager and explainning that just as people cannot go around claiming to be a physician, neither can they go around claiming to be a PA and that maybe they should look for another title as having a front desk clerk (or any other unqualified staff member) advertised as a PA could not only cause issues with their malpractice insurance but also cause legal issues as well. perhaps they need to be reminded thata PA is a legal title given to a mid-level practitioner that has had the training, certification and liscensing to be called such

[Contrarian]

^^^ What she said^^^

 

Maybe go to the state website and print out the law concerning protected titles and misrepresentation.

Forward this to the MD, NP, PM and follow up with a personal conversation either face to face or by phone.

 

YMMV

 

Contrarian

[EMEDPA]

another reason to support the name change to physician associate. major national campaign coming soon...stay tuned....

[MCHAD]

another reason to support the name change to physician associate. major national campaign coming soon...stay tuned....

 

Major national campaign...please tell more!

[EMEDPA]

Major national campaign...please tell more!

give it 2 weeks and I will spill the beans...it's a work in progress.......

[rcdavis]

I think I would be a bit more reactive.

 

I would ask the NP if she knew what I did for a living. Then I would construct an argument that by her ( as a mid level) allowing the front desk personnel to represent themselves as PAs, she was demeaning you/ our profession. And that you take that pretty seriously.

 

Then, I would speak with the doc.. And maybe wear a name tag which prominently read RC DAVIS, MD on it, during the conversation.

 

And if it persisted, I would take a pict with mu cell phone and send it to the state board of medical examiners, which most likely enforces your state's probable law enjoining anyone except those allowed to from representing themselves as a PA.

 

Forward said picture to the NCCPA and the AAPA.

 

I would not... No, I do not, take this lightly.

 

If you would forward me the name of the clinic, perhaps it might be better if I wrote to them.

 

There is no excuse for this.. Starting with the NP who simply KNOWS BETTER, and is uplifting her profession by belittling ours.

 

This sucks a big one.

 

davis

[rev ronin]

Anyone can call themselves a physician assistant. It's a combination of two English words.

 

If they were calling themselves PA-C's, then AAPA, etc., might have cause to be involved. Doesn't mean it's right, doesn't mean it's appropriate, but it's not actionable as far as I can tell.

 

If I saw an MA with a name tag that said "physician assistant", I'd be inclined to ask if she was making six figures.

[Contrarian]

So by YOUR logic... we can all call ourselves "Physicians," or "Doctor" in a clinical setting... you know.. because these are just "English words"...

 

 

18.130.020

Definitions.

 

 

(12) "Unlicensed practice" means:

 

(a) Practicing a profession or operating a business identified in RCW 18.130.040 without holding a valid, unexpired, unrevoked, and unsuspended license to do so; or

 

(b) Representing to a consumer, through offerings, advertisements, or use of a professional title or designation, that the individual is qualified to practice a profession or operate a business identified in RCW 18.130.040, without holding a valid, unexpired, unrevoked, and unsuspended license to do so.

 

 

Here... a case could be made that the physicians and NP are engaging in "Unprofessional Conduct:

Unprofessional conduct is defined three ways by state law, including "incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed ... misrepresentation or fraud in any aspect of the conduct of the business or profession."

 

 

18.130.180

Unprofessional conduct.

 

</B>The following conduct, acts, or conditions constitute unprofessional conduct for any license holder under the jurisdiction of this chapter:

 

(3) All advertising which is false, fraudulent, or misleading;

 

(10) Aiding or abetting an unlicensed person to practice when a license is required;

 

(13) Misrepresentation or fraud in any aspect of the conduct of the business or profession;

 

[rcdavis]

Actually, in north and south Carolina it IS illegal.

 

GS 90.18.1. Limitation on physician assistants

 

a. Any person who is licensed under.. ( the provision) may use the title physician assistant. Any person who uses the title in any form or holds out to be a physician assistant or to. Be so licensed.. Shall be in violation of these statutes"

 

In point of fact, I believe that the title IS codified in law and IS protected in law, and non PA are prohibited from using the title.

 

We PAs don't know this .?.???

[Contrarian]

It has always been my understanding that misrepresentation and/or misleading behavior related with a professional title is not only a breach of ethics but also a criminal matter.

It is never appropriate for a licensed or unlicensed individual to misrepresent himself or herself as a licensed health care provider (e.g., RN, LPN, PA, MD/DO). This prohibition is included in most, if not all state nurse and medical practice acts.

[medic25]

I don't know what state you are in, but at least in Connecticut it is a crime to fraudulently represent yourself as a physician assistant, punishable by up to $500 fine and 5 years in prison for each instance of misrepresentation.

 

 

(d) No person shall practice as a physician assistant or represent himself as a physician assistant unless he holds a license or temporary permit pursuant to this section or training permit issued pursuant to section 20-12h.

 

(e) Any person, except a licensed physician assistant or a physician licensed to practice medicine under this chapter, who practices or attempts to practice as a physician assistant, or any person who buys, sells or fraudulently obtains any diploma or license to practice as a physician assistant, whether recorded or not, or any person who uses the title "physician assistant" or any word or title to induce the belief that he or she is practicing as a physician assistant, without complying with the provisions of this section, shall be fined not more than five hundred dollars or imprisoned not more than five years, or both. For the purposes of this section, each instance of patient contact or consultation that is in violation of any provision of this chapter shall constitute a separate offense. Failure to renew a license in a timely manner shall not constitute a violation for the purposes of this section.

[rcdavis]

Ummm... yeah WE PAs do know this.

 

Liberalism gone to damn far...

 

 

It is something, I am not sure what.. But it seems to be that there is a large segment of PAs which has a low opinion of the name..

Has a sense that we need to apologize for the name.

 

Whether or not we end up changing the name - and I pray hat we do-, right now PA is what we are, and it is OUR TITLE.

 

Is insulting that front desk and non clinical personal along with medical assistants are using MY TITLE so cavalierly, without reproach.

 

The OP is a patient of that clinics, hence is in a potentially akward position.. There ain't a lotta good MS clinicians around... And there are more MS patients than slots...

 

So if she will send me the clinic's particulars, I will divert some energy and cash in trying to have a prayer session with them and lifting their veil of ignorance.

[Contrarian]

I hear ya bro...

 

Its just that some folks try to make me out to be some kind of raging A_ _Hole and snob because I'm fed up and verbalize that I too find it "insulting that front desk and non clinical personal along with medical assistants are using MY [earned] TITLE so cavalierly." TO ME its even MORE insulting when they come into our clubhouse... onto out turf [This Site] and do it.

 

Interestingly, many of these same folks who come here and do this, then get "called out" on it, then are subsequentely defended by others as it being a simple honest mistake... are also registered at SDN, where they have asked the same questions, but made sure NOT to list themselves as "medical students," "physicians," or a"ttendings."

 

For me... it cuts deep because I used to be many of these things.

Psych Tech--> CNA--> Army Medic (EMT-B then I then P) --> LPN --> RN --> FNP/PA-C

I EARNED every one of those titles by buckling down and continuing my education to increase my knowledge and scope of practice.

 

Now I'm being told that "They are JUST titles" and to get over it...

[Joelseff]

major national campaign coming soon...stay tuned....

 

Wait wait wait....whaa???? C'mon E start spillin', we wont say nuthin!!!

[just_me]

ok so Im NOT crazy....it IS illegal to call yourself a physician assistant just as it is illegal to call yourself a physician without the proper training and license. PA-C is simply an abbreviation...the correct title IS Physician Assistant both the full title as well as its abbreviation should be protected by law.

 

werent there a couple stories posted on the board about people who falsely calimed to be physician assistants and that was one of the many crimes they were charged with?

[rev ronin]

ok so Im NOT crazy....it IS illegal to call yourself a physician assistant just as it is illegal to call yourself a physician without the proper training and license. PA-C is simply an abbreviation...the correct title IS Physician Assistant both the full title as well as its abbreviation should be protected by law.

 

werent there a couple stories posted on the board about people who falsely calimed to be physician assistants and that was one of the many crimes they were charged with?

Good luck getting any prosecutor, anywhere, to file charges over the title on a name badge. It is ALWAYS illegal to practice medicine without a license, just as it's impermissible to represent yourself as a licensed medical practitioner when you have no such license. The WA RCW's Contrarian posted, however, wouldn't sustain charges against the MAs and receptionists wearing tags that say "physician assistant" for any number of reasons:

1) They're not trying to practice medicine. They're doing things that are clearly not covered under the practice act, at least as far as I read the original posting.

2) They lack mens rea, and misrepresentation is not a strict liability issue. Combined with #1, this makes things a non-starter.

 

Indeed, if a person was saying "I'm Joe Smith, PA. Yes, I can diagnose and treat you" that's a far different thing than office staff who have every right to claim that they're physician's assistants wearing name tags that drop the 's.

 

That doesn't mean it's not inappropriate, nor does it mean that it's not in extremely poor taste, but calling it "illegal" is stretching things a bit too far for my liking.

[just_me]

You know...I had this nice response all typed out but to be honest Im not in the mood to go back and forth on this (guess Im not really concerned with anyones "liking" of my verbiage) so Ill agree to disagree and stick with my previous statements--Ive read enough to know that there could be legal/ethical/insurance implications for misrepresentation.....intentional or not

 

as far as legal issues in healthcare, do you use any other sources besides wikipedia, I tend to avoid that as a primary or secondary source but I wouldnt mind reading anything else thats credible

 

Good luck getting any prosecutor, anywhere, to file charges over the title on a name badge. It is ALWAYS illegal to practice

medicine without a license, just as it's impermissible to represent yourself as a licensed medical practitioner when you have no such license. The WA RCW's Contrarian posted, however, wouldn't sustain charges against the MAs and receptionists wearing tags that say "physician assistant" for any number of reasons:

1) They're not trying to practice medicine. They're doing things that are clearly not covered under the practice act, at least as far as I read the original posting.

2) They lack mens rea, and misrepresentation is not a strict liability issue. Combined with #1, this makes things a non-starter.

 

Indeed, if a person was saying "I'm Joe Smith, PA. Yes, I can diagnose and treat you" that's a far different thing than office staff who have every right to claim that they're physician's assistants wearing name tags that drop the 's.

 

That doesn't mean it's not inappropriate, nor does it mean that it's not in extremely poor taste, but calling it "illegal" is stretching things a bit too far for my liking.

[rcdavis]

Rev,

Like it or not, stretch or not, the simple truth is, it is illegal to present, label, claim, or to represent oneself as a physician assistant.

 

And it matters not wether the imposter is actually "performing" medical acts.

 

Although in this case, they were doing more than merely saying that they were PAs in a casual bar conversation.. They were LABELLING. Themselves as such while performing tasks in a medical setting.

 

Do you not think that the public's perception of the PA profession is affected? And, in this case, negatively?

 

Let's see.. NP or PA... I went to my neurologist's office and my NP. Examined, diagnosed and prescribed treatment for me while the office PA filed my paperwork, escorted me to a room, cleaned the room, and opened the vial of betaseron for the NP... hmm.. Here is an ER PA, should I see him or the NP?

 

And the DA. May not have a choice.. The "injured party's" representative, in this case, would be the body empowered by the legislature to enforce the rules of " medical law" .. The medical board. Which would have the power to enjoin, to supina, to compel attendance, etc.

 

Rev, why is it that this seems to matter so little to you?

 

Is there something I am missing?

 

Or is it that you might feel there are bigger fish to fry, and that this cause isn't important?

 

If WE do not stand up for ourselves, then who should?

 

I do not think this is a trivial thing at all.

 

And I understand that we may disagree.

 

However, on the face of it, the hot spit truth is that your assertion that the actions taken by the clinic is not illegal is simply wrong. Dead wrong.

 

And though you do not have to enter the fray to correct the injuries I am incurring each day they continue this practice, please do not allow yourself to get hurt standing in my way as I do.

 

I consider anyone not willing to fight this as tacitly agreeing with the clinic's position.

 

Which implies something else entirely if that person is himself a PA.

 

This clinics's actions are illegal. Period.

[browndog]

rcdavis,

 

Your position is that the NP has constructed, or otherwise supported, this scenario to further his/her profession???

 

Holy crap

[rev ronin]

Rev, why is it that this seems to matter so little to you?

 

Because the solution is to move forward with the name change, not to try to defend an easily-misunderstood and flawed title against all comers. Anyone can "assist" anyone with anything; assistant doesn't imply the level of autonomy and responsibility PAs have and need in the day-to-day exercise of their responsibilities. But that's been rehashed in other threads; bottom line as I see this as yet another example of why "Physician Associate" is a more appropriate name for the profession.

 

However, on the face of it, the hot spit truth is that your assertion that the actions taken by the clinic is not illegal is simply wrong. Dead wrong.

 

Unless you're even more multi-talented than I already know you to be, neither one of us is a lawyer. I DO have a decade or so working for lawyers, and understand that there's an enormous gulf between what people see as right or wrong and what can or will actually be taken to court, especially when there's prosecutorial discretion involved. Working for a large company, I've seen prosecutors fail to file charges against employees caught stealing, dead-to-rights. Best we could figure is that they thought it might look bad to be taking the side of the big, faceless corporation against the "little guy"--even when that little guy was clearly a thief who'd abused the trust placed in him or her.

 

Let's look at the headlines from the prosecutor's standpoint: "Small clinic faces charges for typographical error" or "Medical assistant or physician's assistant: a question or a crime?" or "Patients out in the cold: naming dispute shutters clinic" Whether it's technically illegal or not is a moot point: prosecutors are generally elected, often wanting to be re-elected and/or seek higher office, and will avoid cases with such a potential downside because they have nothing to gain by settling such a fine point of law. Unless this happened in North Carolina or some other place with an ironclad and specific legal restriction on the use of the term "physician assistant", this will never see a courtroom. And since it won't, no court will authoritatively declare it illegal.

 

There's a difference between saying the clinic's action are a good idea and saying they will be prosecuted for it. I've heard all sorts of loony legal theories over the years that make this look downright sane and sensible, but they all have the same problem: courts aren't interested in hearing them, so getting all worked up about 'em does no one any good.

 

PS: I don't blame you for being steamed. I think it's tacky at best, and I would definitely say something right away if that were any medical office where I went as a patient. Your anger is righteous, even if I disagree that the legal apparatus will take the offense as seriously as you do.

[rev ronin]

as far as legal issues in healthcare, do you use any other sources besides wikipedia, I tend to avoid that as a primary or secondary source but I wouldnt mind reading anything else thats credible

 

Use Wikipedia like a "Idiot's guide to..." or "... for Dummies" book. It's generally got good, layman's introduction to topics, but if you're planning on doing anything that really matters with the info, read the references directly. It's also got great uptime, things tend to stay more current than personal sites, and is ad-free. I would never trust ANY Internet source for specific legal advice.

[rcdavis]

rcdavis,

 

Your position is that the NP has constructed, or otherwise supported, this scenario to further his/her profession???

 

Holy crap

 

Not constructed, but actively and consciously ignored.

 

And by thus doing, implicitly supported and encouraged.

 

I would gently venture to suggest that her reaction would have been different had the techs and front desk personnel been wearing " nurse practitioner" name tags.

 

I ascribe that nurse practioner's " blind eye" in this instance to be a complicit acknowledgment and support of the action.. Which does nothing but ENHANCE her position by DEMEANING mine for reasons detailed in a previous answer.

 

As most old timers here know, my bias is that, collectively and institutionally, I consider the NP profession to be solidly and covertly working against the PA profession's well being. and consider that, collectively, they look forward to my profession's diminishment and eventual demise.

 

ANY midlevel practitioner ( and in the work place we ALL are aware of our presence and status.. NP or PA), who sees a non PA or NP labeling himself as such, and ignores that action by inaction, is doing so because they have a hidden, usually self serving, agenda.

 

If you can think of another reason why the NP allowed this to occur, I'll consider it.

 

What would you do in this circumstance? And why?

[dm123]

I had planned on trying to be as tactful as possible at my next visit, but have nothing scheduled with them at present. I have basilar joint arthritis in both thumbs. Had arthroplasty on one about 12 years ago. That is when I found out ortho surgeons sometimes have a knack for the understatement. He told me “you are gonna hate me post-op for a few months”. I get the other thumb injected once or twice a year now instead. This particular clinic that does the injection is run by an anesthesiologist who uses flouro and for what ever reason, I get the best results from him. The NP always has to do an evaluation before an injection. It’s a $$ thing to get the most from insurance companies.

 

I haven’t given their name tags a lot of thought lately as I have been preparing to take the PANRE. I had encephalitis in 2007, spent three days in neuro ICU on a vent and dang near died. Sequalae resulted in three brain stem lesions in the area of the cranial nerves and two c-spine lesions, diagnosed as Multiple Sclerosis. Cerebrum and cerebellum are clear, thank the Lord. Guys in their late 50’s an early 60’s are not supposed to get MS but fate is not always predictable. I was getting better and stable until about two months ago. Had all my CMEs caught up, and cleared by the NCCPA to take the PANRE. Then the three brainstem lesions flared up and do not want to cool down, even after 1,000 mg IV Solu-Medrol a day and my routine q month Tysabri. MS fatigue is the issue. Until the lesions cool back down, I don’t know from one day to the next if I would have 4 hours in a row to put toward the PANRE. Some days I'm fine all day. Others, not. I can suck it up for a few hours if it is a bad day but then hit the wall known to marathon runners. I did find out that the NCCPA, with doctor verification of disability, would allow me to take the exam in two sessions over two days. Patience is not one of my virtues and hate sitting around. I’m already licensed in NC as a PA, just in the inactive file and need my “C” back to get out of that file. At present, I doubt I’ll ever be able to work full-time. Even if work just involved H&Ps for studies, DOT physicals, or FAA flight physicals, pre-op anesthesia H&Ps, plus maybe a bit of moon-lighting at urgent cares, I’d be happy.

 

I’m normally a not in your face kind of guy. I suspect it is more a matter of not knowing than an attempt to undermine or usurp the Physician Assistant title. I did a bit of internet legal research a few weeks back and so far, since the folks are not practicing as PAs, I don’t see anything legally preventing them from wearing a nametag with physician's assistant on it. It isn’t a registered trademark and the state laws only deal with rules for those that practice. If I saw them regularly I’d even offer to buy them new name tags but I don’t. Hopefully, after explaining to the office manager, that in the medical community “Physician Assistant” implies an upper level practitioner that entails education, training and sacrifices, and those who call themselves “Physician Assistant” are kind of protective of the term, they would pick another title. A legal case might be able to be made under the premise that they are working in a doctor’s office even though they are not actually performing the duties of a Physician Assistant. I’ll send them a letter and see what kind of response I get. If it isn’t satisfactory, I’ll turn RC loose on them.

 

Way back when, Duke Graduates called themselves Physician Associates. As far as I know, they were the only school that did. Most schools were afraid the AMA would shut them down and tried to take a more sub-servant title. Back then the AMA and state medical boards were made up of docs more inclined to believe that MD stood for minor deity. Nurses had to wear the little white hats and had to stand up showing respect when a doctor walked into the room. Thankfully, times have changed. PAs really need to do something about their title. You younger types deserve better.