Define "autonomy"

[NC30]

Practicing PAs of the forums (or those who will be practicing soon), what does autonomy mean to you? Where is the line between collaboration/supervision/micromanagement? I guess in other words, what is your ideal practice situation. Also- what state/specialty do you work in?

 

I've browsed around and have seen a wide range of opinions... also have encountered grumblings from physicians about "the mid-levels who are pushing so hard for autonomy, they should have gone to med school." What is your take on that? Not trying to be inflammatory, just want to start a dialogue on this.

[BruceBanner]

Loaded question.

 

In primary care, if I can get through most days without direct unnecessary intervention in my care, then I consider myself autonomous.

 

I came from a private FP where I was essentially a PCP. I now work for a major HMO, and PAs here are truly "mid-levels". We dont see our own panel of patients (officially), yet we work mostly independently. We're not part of the docs group yet we're not part of the nursing arm either. It's weird. It's like being a teenager. You are trusted with some adult tasks but not fully trusted in others.

 

There is an art to medicine. Everyone practices a little bit differently, and everyone thinks they are right. If I get a lecture for doing/not doing something, and it is evidence-based or medically sound, then I'm not above correction. But if I'm getting nitpicked or lectured on matters of opinion or things that arent very clear in the literature, then that is just micromanagement and I will proceed as usual.

 

You'll find some physicians will treat you as an equal and some will treat you like a subordinate. It's maddening at times but you gotta be careful what toes you step on if you want to keep your job. As a PA if you are seen as undermining or questioning a physician's authority that is a big taboo. But, at the same time, you are still a professional and you have to stand up for yourself in certain situations or you will just get walked on. It depends on the job, then doc, the clinical issue, etc.

 

There are a lot of threads going deep into the whole autonomy issue. Most of us here feel experienced PAs should have autonomous privileges in primary care after a certain point.

[EMEDPA]

I view appropriate autonomy as allowing a provider to work to the top of the license and to the level of their training and experience. basically, let me do what I am capable of and be available for consult for those patients and procedures outside my level of comfort or experience.

[DizzyJ]

Autonomy to me is being able to practice with little input/direction/guidance from a "boss".  I very much dislike any situation where I have to remember how Dr. So-and-so does something because I have to do it exactly that way or I am wrong.  My current situation is 99% autonomy.  My charts are reviewed per supervision laws and I follow up couple policies I probably wouldn't be so strict on, but it doesn't cause me any grief in my day.  I am in California.  I have practiced in Ohio, Hawaii, and the Northern Mariana Islands.

[Guest JMPA]

when a physician asks your opinion on a patient, when one takes full control and responsibility for patient care, the driver of the bus, the captain of the ship, the pilot of the plane, the admiral of the fleet, the commander of the army...........................

[Febrifuge]

Back when I was trying to convince the director of my post-bacc program to let me take human A&P at the other college in town, and explaining why I wanted to shoot for PA school instead of MD school, I talked about how I saw PAs as clinicians, and docs as clinicians plus practice owners/ managers/ department heads/ academic professors/ lots of other stuff that has built up around the way medicine is practiced today.

 

Not that MDs don't also report to bosses, or have administrators bugging them, but the way I saw it at the time, PAs had the double-edged privilege of being able to concentrate on "just" the patient care. The analogy was that I wanted to be a quarterback, responsible for making plays, but not be a coach, having to worry about managing every person who manages every detail, has to deal with the press, think about the salary cap, placate the owners, and all that other jazz. Years later, the analogy isn't perfect but it works well enough.

 

The crucial point here is that while there are different kinds of quarterbacks, and different approaches on different teams, coaches don't walk out onto the field and screw around with a play that's in progress. To me, that's what autonomy means.

 

Plan ahead: absolutely. Involve me in creating the playbook, ideally, so we can make best use of my skills. Craft an offense around me, even, if I'm ready and willing to lead in that way. If things need adjusting: chat with me on the sidelines, use your experience and perspective to balance out my focus on this specific quarter of this specific game. If I'm in the weeds: help me. Yell at me in the earpiece in between plays if you don't care about alienating me and giving me the jitters... but overall: trust me to move the game forward. That's my job, and I wouldn't be here if I weren't decent at it.

[rev ronin]

Autonomy is when I don't have to get prior approval from the state department of health to work within my scope of practice if I decide to start working for a new doc.

[NC30]

Thanks everyone for your replies! I'm glad to hear from those who have been doing this for a while. I think it's totally understandable to expect to function to the extent of training. I have a feeling I'll be referring back to this thread from time to time.

[CAAdmission]

Autonomy is when you can comfortably say this to your supervising physician without getting fired: