PA student here.. How does it feel to take orders from a doctor who clearly thinks/he she is just better than you because they're a doctor

[TPA16]

23 YO male PA student here.

Experienced PAs: some words of wisdom, please.

how does a PA establish themselves as someone to be respected by staff? in class, the professors and students joke around about how PAs are stigmatized by doctors and even nurses - how some doctors/pharmacists won't even speak to PAs. "whats the difference between a piece of gum and a PA student?" "you dont step on the piece of gum" haha..

perhaps a silly question, interested in real advice.

I've been thinking about all the work put in school and how much harder i will have to work throughout life to practice good medicine. it makes me a little uneasy lately thinking about how doctors/nurses may just look down on me just because of my title while I will be working just as hard, and with the same intellectual capacity, responsibility as they will be once in the work force

 

I feel like the joke "a PA is assumed stupid until opening his mouth while a doctor is assumed smart until opening his" holds some merit to the question i am asking

 

disclaimer: yes i knew what i was getting into with the PA path, but as rotations are coming up in a few weeks, I've been reflecting on this topic more.

 

Thank you in advance

[UGoLong]

No one can take your dignity without your permission! Learn what you can, be calm, and move forward. You can win the respect of others by how you act. The same is true for medical students, interns, and new residents. And new second lieutenants and young engineers for that matter.

Rotations are brief; a few weeks and you will be on to the next one. Some will be places you'd like to work and others may teach you who you don't want to be like. Both sets of experiences are valuable.

Good luck.


Sent from my iPad using Tapatalk

[EMEDPA]

PAs don't "take orders from doctors". they consult and then decide whether or not to act on the info they have received. don't like what you heard? seek another source for confirmation. heard it twice? maybe they are right and you are wrong. go do some more research then make YOUR OWN decision......

[TPA16]

PAs don't "take orders from doctors". they consult and then decide whether or not to act on the info they have received. don't like what you heard? seek another source for confirmation. heard it twice? maybe they are right and you are wrong. go do some more research then make YOUR OWN decision......

thanks for this

[3GeronimoPA]

Many people will belittle other professions in order to massage their own egos.  I have zero issues with me operating in my scope and when I call a pharmacist they know that I will divert ALL scripts away from them if they don't process what I prescribe.  I'm not too cool for school and will gladly take a phone call from a pharmacist when they have questions but if they don't want to talk to me, then I'll find a pharmacy that will.  In an inpatient setting (been there too) I'd NEVER accept the job until I talk to the other PAs that work there and ask them their difficulties if any in practicing within their scope.  If there are no PAs there, I'd clarify things up front with the SP.  Most importantly, there are far more jobs out there for PAs that can happily work within their scope than there are places that will suck the life out of you.  Don't settle for the later.

 

An unhappy PA is a PA who is too lazy to apply for another job or was dumb enough to sign a "no compete agreement" for a job he or she had no clue what the quality of life was like.  Be a happy PA.  Interview your boss when you apply for a job and don't sign a no compete agreement at all.... and if you do, make sure you know for a fact that the job is heavenly.

 

Writing the state board of pharmacy about a pharmacist that refuses to discuss a patient's medication with you is a great remedy to your issue.  It puts patients at risk and I don't know any state boards that will take that.  Encourage your peers to do the same.

 

As far as docs, just go to the hospital staff about it.  Make sure you use the word, "disruptive".  I don't know why but they get a stick up their butts about that one.  If you're a student and people treat you bad, it's because they care or because they hate you.  Either way you should work to earn their respect for survival purposes.  If they ignore you, those are the ones that suck.  You'll never get even with them.  Let that be fuel for your fire later in life when you have students.

[3GeronimoPA]

"whats the difference between a piece of gum and a PA student?" "you dont step on the piece of gum" haha..

 

 

Oh, and that comment is right.  A PA Student is ripe for stepping on.  It's not because you're a PA Student, it's because you are a student who 99 chances out of 100 doesn't grasp the magnitude of the responsibility you have.  I treat all my students with a hostile love for this reason.  I want them to be humble.  It worked for me.  If it doesn't work for them.... they're a student.  Who cares?

 

In the modern day people are getting kinder and gentler with students and it doesn't help much.  I don't encourage abuse or hazing but I do encourage a challenging environment to include jokes like above.

[EMEDPA]

you know what I do with specialists who "don't talk to PAs"? I don't talk to them. I call their competition with my referrals. I love it when they later call the ER and say "why aren't I getting ER referrals" and the chief says "because you won't speak with our excellent staff of PAs". hit them in the pocketbook.

[overthehorizen]

I have discovered that I have more intellectual power than 50% of those doctors who practice. I know that from simply looking at my MCATs scores, GRE scores, undergraduate grades, the premeds that I met in undergrad and most importantly, my everyday experience with doctors. We as a profession are demeaned out of an abundance of fear on the part of MDs. This was the same garbage the MDs gave DOs until DOs punched back and went to court and finally got some respect. As many on this board have said, as the PA gains more experience, the doctors get more anxious. They start thinking to themselves "I went to school for 4 years of med school, 3 years of residency and 2 years of fellowship. Now the PA is doing 80 to 90 % of what I do and he went to 3 years of med school (24-27 mos) and 1.5 years of residency." They run these numbers in their head and say I am a doctor costing 250K while the PA costs 120K but does 90% of what I do for 250K. The doctor starts to realize his rosy future ain't so rosy any more. If the facts aren't helping their case, then the doctor resorts to low ball tactics. They demean, malign, deceive, misrepresent, cheat, steal, lie. All of the problems PAs experience with doctors are based on the doctors fear that they will be supplanted by the PA profession. They probably will be. Remember, it isn't actual competence and outcomes that permits doctors to earn three to five times the PA while performing the same services. WHat maintains this difference in pay is plain old regulatory protectionism. If you take away the legal support that keeps doctors entrenched, they will fall down. Markets will correct. Information will be freely exchanged between buyers and sellers. Patients will see value or the absence of value and refuse to pay artificially inflated prices. The system is built to support inflated prices which in turn supports doctors. The bubble will burst in medicine. When it does, PAs will reap benefits if we have independent practice.

[CAAdmission]

If someone gets $hitty with me, I have found it is often a good response to look them seriously in the eye and ask, "Who do you think you are?"

 

And if a pharmacist won't deal with you, drop a complaint with your state's pharmacy board. They will get pimped.

[south]

At the risk of coming off like a jerk, I can't be the only one thinking that honestly, you have much more important things to worry about.  I say this both as a minor kick in your butt and as your #1 biggest fan and supporter.  

 

Your path is chosen, and you can either be one of those folks who are sensitive about it, or you can more or less laugh it off.  That's really up to you.  

 

I'm a recent graduate and older than about half the physicians I generally encounter.  I was successful in another career previously in a way that some might find hard to believe.  As was said previously, I'll suck up a lot, but if you kick me real true disrespect, I am going to give you a very strange, very intense look (as a student, it's generally critical to keep the big hole in the lower part of your face SHUT).  And make a mental note.

 

On rotations, I had an attitude that I know pretty much nothin' about nothin' and I'm here to learn and bust my ass working, I appreciate the opportunity.  I just don't have time for anything else.  

 

I forget who said it earlier but the "consults go to competition" thing is 100% real.  You know someone's got your back when they hear of some trouble with you and they are like "OK, f--- that guy from now on".  Usually in those words.  

 

In one of my office based rotations, the doc fired a patient over her remarks to me.  "If she asks why, tell her Don't f--- with my PA students" he told the office manager.

 

Does it happen?  Sure.  But it's getting better.  I have seen a lot of 100% attitude turnarounds when docs who were super negative on the concept finally see the light.  Work with us, and we can help you out a lot.  Our field was created by doctors for doctors!

[south]

One more thing I'd like to mention...in case no one has told you, more than likely a few of your rotations are going to SUCK for one reason or another.  I say this in case you are buying the rose-colored glasses they generally pass out at the end of didactic year; clinicals tend to be presented as all sunshine and rainbows.  (well, maybe it is compared to the previous year) .

 

I had about average time overall, with some great and horrible stuff mixed in.  In our case, the clinical department at school was staffed with lazy idiots who were anxious to simply fail you and extend your school experience and tuition bill.  (that was their version of "helping you with a problem".  )  I was sent on a rotation that the previous 2 students failed.  As well as the 2 that came after me.  They openly despise students but are in a "critical" area of clinicals. 

 

So be prepared to suck it up and work with difficult people, eh?

[Rhizopus]

It's a learning experience either way. Make a note of certainly personalities you work well with and be sure to seek them out later on when it comes to finding a job.

 

The medical profession is full of individuals that are all to eager to jump on someone for making a single mistake. We can't know it all, but they don't know it all either (no matter how they act).

 

My advice: if you can, go in early and read the charts of the patients you are likely to see. Jot down quick notes of questions you would ask, how you might treat them, etc. Google things you don't know so you're not caught off guard. You can even come up with a few intelligent questions to ask. There will be all to many times you read something and think, "I know of this..." or "I remember learning about this topic but can't remember any details about it..." Reviewing charts early allows you catch it on your own than in front of others. You'll feel way more prepared. Trust me. 

[BruceBanner]

Newsflash here bud but you can get treated like this in any job. The WORST I have been treated was at a blue-collar mechanical job I had back before college.

 

There are sh!tty docs but like others have mentioned you are somewhat responsible for how others treat you. The tricky part here is to make sure you are RIGHT before you make a stink about being corrected. Many times, especially in your first few years of practice, you will be corrected because you are WRONG. You have to take this with humility because there is no room for ego in medical decision making. Most docs will know more than you for a long time. You may be intelligent---we all are---but they have more experience than you.

 

When you get closer to your 5 year mark you will be just as experienced as most junior attendings. You get this experience not just by virtue of time, but by constantly asking questions and double-checking your decision-making. Be confident, but always ask someone if unsure. Develop a relationship with a few docs you can relate to. This is how you learn.

 

Some personalities are just prickly and some you will clash with. Better to avoid them if you can. If you cant, this is where you have to be assertive and maybe have a few red-faced moments where you put your foot down when talked down to. This probably wont happen, because most of the rudeness you will encounter at work is of the passive-aggressive variety. Physicians LOVE to dump on PAs when they know they can get away with it. This can be tricky to navigate, believe me, because you dont want to be seen as Mr. Sour Grapes. But cross that bridge when you get there. You are a professional just like them. 

[cinntsp]

My experience thus far has been that pharmacists are pretty laid back and that docs that are an a-hole to you are usually an a-hole to everyone, so don't take it personally.

[SedRate]

Prove yourself! Know your stuff; be prepared, confident, and professional; take your job seriously (but not too seriously); and be kind and helpful to others (especially ancillary staff). Things will get better as you get more experienced and confident, but you will need to put in the work.

[rev ronin]

My experience thus far has been that pharmacists are pretty laid back and that docs that are an a-hole to you are usually an a-hole to everyone, so don't take it personally.

Indeed.  My experience has been that pharmacists love collaborating on patient care.  They know more stuff than I do about drugs, and when I talk to them as peers, we get stuff done.

[sk732]

Indeed.  My experience has been that pharmacists love collaborating on patient care.  They know more stuff than I do about drugs, and when I talk to them as peers, we get stuff done.

 

We have a clinical pharmacist in our ER - he's actually a Godsend, since he keeps our med reconciliations in order when dealing with the countless cases of polypharmacy we deal with on a daily basis...and is a wealth of information on interactions, alternates, etc.

 

SK

[ventana]

I might present a slightly different opinion....

 

schooling sucks, medical school (so I have been told) sucks

Doctors like nurses, sometimes like to eat their young..... honestly I think PA education is so much harder, more condensed, practical we don't tend to do this but that is a different issues al together..

 

So, buckle down, get thick skin, don't become a doormat(stand up for yourself a little bit) but realize that our rotations are short, and the volume of info to learn is HUGE

 

Demand excellence from your instructors - they are there for you - but if some of them like to piss on PAs - prove them wrong with professionalism, and if you can knowledge - but in general just learn as much as humanly possible in the 2-8 weeks of the rotation then say bye bye.....  and let other PA-S and your program to never send someone there again....

 

 

Once you graduate it is a bit harder - first year out you really have no leg to stand on - you are still just trying not to kill someone - and learn the whole provider roll. 

After first year you start to stand on your own, treat your own, make your own decisions - heck the doc can't correct you if you are sure in your Dx, and treat the patient and never ask for their opinion (but you have to be an experienced PA to do this)

 

Then you need to stand up to what you feel is right, but never totally contradict a Doc till we get Full Practice Responsibility cause we still are that darn "dependent" role....

[overthehorizen]

Then you need to stand up to what you feel is right, but never totally contradict a Doc till we get Full Practice Responsibility cause we still are that darn "dependent" role....

I have worked with many doctors who are fresh out of residency and fresh out of fellowship. You would think that they are fully educated and PAs are "in training." I have found many discrepancies where my recommendations to the doctor was met with responses like "No that isn't right" or "I don't know of any evidence for that." The problem here isn't that they do NOT want to be shown that it is right or that there is evidence (I wouldn't have recommended something had I not already read it fully and understood it fully). The problem is that a doctor cannot allow a non doctor (PA) to say something that contributes to the discussion because the doctor feels as if he or she is now perceived to be less competent that originally believed. So, this is like "Driving Miss Daisy" all day long. It gets old because the PA knows the doctor is ill informed but the PA has to play along to get promotions and good reviews. It gets sickening. This is why I says we must have independent practice rights. 

[rev ronin]

The problem is that a doctor cannot allow a non doctor (PA) to say something that contributes to the discussion because the doctor feels as if he or she is now perceived to be less competent that originally believed. 

Contribute to which discussion where?  I'm never going to pipe in with something new in front of the doc and the patient: If I called him in, I need help, and if he called me in, he wants me for something I'm better at OR because I will be seeing the patient in follow-up.  We educate each other outside of patient earshot--no egos, or at least none on display.

[EMEDPA]

the interval solution for this once you are a few years out is to work in a setting where docs have no input into your practice in real time. at my practice now I am essentially independent. no required chart review and no doc on site. the state requires the doc have an "ongoing understanding of my practice patterns" and he gets that when we discuss fun cases or sign out to each other at shift change, etc.

[jwells78]

For crying out loud.

 

Some of these responses sound like somebody had their cheerios peed in.

 

You all knew what you were getting into when you went to school; just like the SGM can lead as well or better than the Battalion commander--- (Sergeant Major) still answers to him. We play second fiddle; thats just the way it is.

 

 

To the OP- the answer is simple: be better.

Become a subject matter expert in your practice and know what the Attendings and consultants would do/would want before they even ask. This takes attention to detail and will.

 

Make your charting the best and most thorough,

make your patient care and workups as precise and good as they can be; make your weaknesses strengths and become well-rounded.

 

Once youre in the mix, you will understand that this whole career field is based on perception. If the MDs around you come in thinking you are inferior, or lazy, or stupid, or dangerous (and a lot do), prove their a$$es wrong.

 

The easiest way to gain respect from someone who doesnt want to give it is to let your actions prove their impression wrong; earn it.

 

My 2 cents.

[overthehorizen]

Any PA with a strong work ethic like Jwells78 can appreciate his contribution to this conversation. We all agree that raising the bar on performance should be our first priority. The issue is that nobody is arguing for lower standards. People here are making a case for a status that confers the right to practice without the burden of physician oversight and frees the practitioner to devote his or her efforts into the specialization of their choice. Abandoning the mythical Physician-PA partnership and breaking the collaborative relationship requirement will create opportunities for PAs. These opportunities will create greater demand for more PAs and salaries will rise because free markets will equilibrate the supply and demand to a higher price point. At present, PA salaries are artificially low and Physician salaries are artificially high. What supports these artificial prices is nothing more than legislative protectionism. Nurse Practitioners are smart. They see protectionism as a threat. They defeated it. Now they are properly valued. Jwells78 has directed the discussion away from the central point. As a PA, do you want to be properly valued. If not and you like being undervalued, continue on your present course. If you find being undervalued "what you signed up for", keep doing what your are doing. However, if you see that you have greater value but the market doesn't compensate because of artificial barriers, then for God's sake, mount an assault and take down the barrier. 

 

"Most humbly my lord, on my knee, I beg thee the leading of the vayward." - York "Battle of Agincourt" 

[bch23]

While I can understand your concern, I can tell you as a PA student who is over 1/2 way done with clinicals, this is a really minor thing to worry about. Echoing what others included in responses, you must EARN respect...Yeah many people you encounter won't want to hear your opinions and ideas and won't take you as seriously as they would a more experienced provider, but honestly why should they? Study hard, and know your stuff, so when the opportunity arises, you can show them why you should be respected. And of course, treat them with respect from the get-go...Drs and PAs alike roll their eyes at the "entitled student" who is too good to do things and who refers to tasks as "nurse jobs". You're there to learn, but don't be the student who makes a total mess of a procedure room because a nurse will take care of it...

 

People can give orders in any profession, and I would think you had some type of real-world experience prior to PA school that should have prepared you for what you are asking. Also, sounds like your school has some poor attitudes about the PA profession! I have been treated fairly during clinicals and have found many people who value the PA role. If they don't understand what we do or why they should respect us, SHOW THEM, and try not to complain about it before you even start. Have an open mind, and realize that not everyone you encounter needs to be your best friend.

 

You don't have to be a know-it-all to earn respect either, that's actually discouraged and people can see right through it. Be HUMBLE about your knowledge. You are not expected to know all the answers.

 

Best of luck during clinical year. I can guarantee you won't have time to worry about many things besides studying and working once it begins.

 

 

 

[tunafish]

PAs don't "take orders from doctors". they consult and then decide whether or not to act on the info they have received. don't like what you heard? seek another source for confirmation. heard it twice? maybe they are right and you are wrong. go do some more research then make YOUR OWN decision......

 

I do not think it always can be done as you say it. There are plenty of places with "rules" regarding what can and can not be done. Somethings like PA can not order MRI without consulting attending first, or get a consult/suggest admission without discussing it with the attending. I know your situation is different but it is a real thing unfortunately