Physicians refusing to speak to PAs

[eighthnote24]

If you were writing a letter/complaint to a hospital, regarding a physician who refuses to speak to a PA simply because they are a PA....therefore delaying the care of patients....what would you say?

[rev ronin]

I would describe specific actions and specific outcomes.  I would have the letter co-authored by whomever else witnessed the behavior, ideally the physician that the other physician who refused to talk to a PA made the PA get.  Avoid hysterics, just state the facts and the impact on patient care.

[sas5814]

A grown up.....

[eighthnote24]

12 minutes ago, sas5814 said:

A grown up.....

These are ETMC ER physicians..... you might know them heh

[sas5814]

If they are refusing to speak to a PA who is attempting to send a patient to the ER I would simply document that in the chart and let the patient know. ER doc may not care about your opinion but the public complaints and surveys they might...though ETMC is just about broke so they may simply not care. Call Mother Francis. They are way nicer. Then send the ETMC CEO a nice note about why you are sending all your patients to Mother Francis.

 If they refuse, for some reason, to take the patient you are calling about that is an EMTALA violation.

I had to call a grouchy ass old ortho yesterday and he got all horsey about reviewing an x-ray (he was on call) and I just "review it or refuse. I'll just write it in the chart. I didn't call to negotiate and I'm not your nurse."  He reviewed it and hung up on me. Life is too short to play into those kinds of childish games.

[Reality Check 2]

We have only 3 cardiology groups in town. One employs 3 doctors who REFUSE to speak to PAs or NPs.

EVERY other cards doc knows about it - so, if one of them is on call and won't take our call - we have an unspoken agreement to call one of the other docs - whether on call or not - and they will happily take our calls and referrals and admits.

No one has been able to change them. They have been advised and counseled. But they are DOCTORS and therefore deities and cannot be held responsible for being jerks. 

Their group gets the LEAST number of referrals in town and if they don't know why - they are stupid. 

Someday these guys will retire and maybe a changing of the guard will change their group. Meanwhile - the other groups are totally PA friendly and supportive - even handing out their cell phone numbers for person to person talks. And these are the folks who see my own family. 

I felt complemented when a doc on the phone found out it was me and said "I am glad it is you, I will get the whole story". 

I have called hospital admin about an ER doc who refused to talk to me. That was all it took. Suddenly, our phone calls to the ER were taken "eagerly". Must be a unique admin who can get things done - not enough of those. 

I would document the situation, time, circumstances, names and write it up like a police report - just the facts, m'am. Send it to the ER group's admin or medical director, send it to the hospital admin and send it to the state medical board.

 

[sk732]

Had an ortho actually say to me on the phone "I want to talk to a real doctor..."  I looked at the phone and looked at my doc, and without covering the mouthpiece, said " Dr So and So feels too important to talk to merely me so you have to talk with him".  I'd had a problem with the same asshat in primary care...unless it's an orthopedic emergency, I wait until the call turnover to consult if they're on call.  I just hit them in the pocket book.  And incidentally, they're a good surgeon, but even the patients think he's a knobber.

SK

 

[loliz]

I had a resident acting like an ass one day. He apparently thought I was some sort of "assistant" and kept making stupid demands which I refused to go along with. The only reason I kept talking to him was that I actually needed the specialty service to do something that no one else could do. The final straw was when he interrupted a lecture that his attending was presenting to "call me out." He literally went up to the podium as the attending was speaking to tell him how the PA was so awful. The attending immediately realized what was going on and shut him down. The attending called me from his cell phone to apologize and reassure me that the resident would be getting extensive advising on being respectful of his colleagues and a lesson in all of the various providers that are present in the hospital. I thanked Dr. Soandso for calling and fixing the situation and he interrupted me to say-- call me "Jim," we are colleagues and we work side by side so please skip the formalities. 

I'm pretty sure the resident won't forget what a PA is now ;)

[sas5814]

Well just for fun I sent an email to the CEO and senior leadership at ETMC last night. I outlined the issue including the physicians that were doing it (one of whom is the ER medical director) and let him know thousands of PAs all over the country are discussing this. I also told him it was childish, unprofessional and , most importantly, put the best interests of the patients in second place behind these guys egos. I mentioned that over here at Mother Francis (their main competitor in town) were were happy to take all their patients and our physicians treat PA like colleagues or at least politely. Turns out the CEO is the same one I worked for at ETMC 20 years ago.

[8404PA]

15 hours ago, sas5814 said:

EMTALA violation.

That is one expensive violation. Enough to make any MD sallow pride. We had an MD get a $40,000 for improper transfer documentation last month. 

[sas5814]

I decided to go full on with a follow up email to the ETMC senior leadership.

 

Good morning. I have an issue to bring to the attention of senior leadership regarding your ER and specifically Dr. (redacted) and Dr. (redacted). I am on a national Physician Assistant discussion board with more than 50,000 members (about 1/2 the PAs in the US) and there is a vigorous discussion about ETMC, your ER, and the 2 physicians. It seems when a Physician Assistant calls from an outlying clinic to speak to the ER to advise them of a transfer or get guidance on a better way to manage a patient issue the transfer center has been advised by the above physicians that they will not speak with a Physician Assistant.
I could innumerate a lot of reasons this is both inappropriate and unprofessional but the biggest concern is patient care is being put in second place behind the egos of these 2 physicians. Patient are being delayed in getting to the place they need to be and, under the right (or wrong) circumstances this could be an EMTALA violation. I don't think I even have to outline how bad this makes ETMC look as we all discuss with everyone including our patients how these physicians and your ER place the feelings of 2 physicians over the best interests of the patient. 
 As a PA in urgent care for CTMF I deal with the ER here and specialists almost every day and I receive great advice and all the support I need... the patient's needs being the priority. It would be very easy to just laugh up my sleeve while our main competitor continues to do this but I am concerned for patient care more than anything else and, as 30 year advocate for the Physician Assistant profession, like to address and resolve these issues that, quite honestly, I thought went the way of the dinosaur a long time ago. Physician Assistants have been a critical part of the health care delivery system for more than 50 years and our importance in primary care, where the physicians won't go, is becoming greater every day. Refusing to deal with them, besides showing a lack of common courtesy, just denies the reality of our current system.

Scott A. Stegall PhD, PA-C

[sk732]

10 hours ago, loliz said:

 I'm pretty sure the resident won't forget what a PA is now ;)

I had a resident when I was on one of my orthopedics rotations that was a complete knob to me (and other PA students going through) - first morning in the OR he looked up at me and said "The only thing you're here for is to do our scut on the floor".  As that wasn't what the written rotation objectives were, I looked down at him (he was about 5'3", I'm 6'2" and change) and said "I don't really see that happening."  There was a hugely noticeable difference in how I was treated vice the Med 3 that was on my team.

I just noticed an online add for a PA and was surprised to see it was Dr Shortperson who was hiring...as much as I want to get into ortho, not sure I'd want to start there.

SK

 

[sas5814]

Try "I think you confused me with your wife. What you wouldn't speak to your wife that way? Then why would you talk to anyone else like that."

[sk732]

I have my doubts that anyone with any self-esteem at all would marry that creature...that was Army SNCO mode coming out.  I was polite in my tone, just direct.

SK

 

[GetMeOuttaThisMess]

I decided to go full on with a follow up email to the ETMC senior leadership.
 
Good morning. I have an issue to bring to the attention of senior leadership regarding your ER and specifically Dr. (redacted) and Dr. (redacted). I am on a national Physician Assistant discussion board with more than 50,000 members (about 1/2 the PAs in the US) and there is a vigorous discussion about ETMC, your ER, and the 2 physicians. It seems when a Physician Assistant calls from an outlying clinic to speak to the ER to advise them of a transfer or get guidance on a better way to manage a patient issue the transfer center has been advised by the above physicians that they will not speak with a Physician Assistant.
I could innumerate a lot of reasons this is both inappropriate and unprofessional but the biggest concern is patient care is being put in second place behind the egos of these 2 physicians. Patient are being delayed in getting to the place they need to be and, under the right (or wrong) circumstances this could be an EMTALA violation. I don't think I even have to outline how bad this makes ETMC look as we all discuss with everyone including our patients how these physicians and your ER place the feelings of 2 physicians over the best interests of the patient. 
 As a PA in urgent care for CTMF I deal with the ER here and specialists almost every day and I receive great advice and all the support I need... the patient's needs being the priority. It would be very easy to just laugh up my sleeve while our main competitor continues to do this but I am concerned for patient care more than anything else and, as 30 year advocate for the Physician Assistant profession, like to address and resolve these issues that, quite honestly, I thought went the way of the dinosaur a long time ago. Physician Assistants have been a critical part of the health care delivery system for more than 50 years and our importance in primary care, where the physicians won't go, is becoming greater every day. Refusing to deal with them, besides showing a lack of common courtesy, just denies the reality of our current system.
Scott A. Stegall PhD, PA-C

Should've mentioned to the CEO that they need to change the color of those putrid green ambulances that they drive around also.

[sas5814]

Well if they can ever find a "strategic partner" to save their sinking ship maybe the color scheme will change too. Rumor has it they are in talks with a few different groups but nobody wants to buy in. I think they are waiting for a fire sale which may not be all that long coming.

[DizzyJ]

I've had this happen twice....

First time calling an FP about her patient I was seeing in the office.  The FP said she didn't talk to PAs.  My response "I am fully capable of examining a patient and talking on the phone thank you very much.  So, you can either let me discuss your patient with you or I will be happy to contact the hospitalist group to admit your patient".  She then listened to me and I was the only PA she would allow to call her.

Second time, also working ER, and I had to staff patients with an attending (got the heck out of that job fast).  Saw a guy with a split lip all the way down full thickness of lip V shaped open that had purulence coming out both side and was grossly contaminated with road debris.  My first thought....plastics should probably clean this out and close it because just cleaning it up and closing it myself would not allow drainage and then be worse.  The attending (< a year out of residency) disagreed with me and told me to close it.  So, I called plastics who huffed and puffed how dare I just a low pathetic PA call him and wanted to know who the senior attending on duty was to file a complaint.  Plastics then went on and said "Now if you would have just discussed this with your attending he would have told you not to saw up an infected split lip..."  Uhh actually I told my attending that and he disagreed.

[eighthnote24]

ETMC responded with contact info for the ER admin today.  I'll be writing an email tonight....

[sas5814]

I received this today. I am satified with the response but will keep my ear to the ground to make sure there is follow through.

 

Dr. Stegall,

 

Thank you for bringing the above issue to my attention. My nurse director, Angela Bower, forwarded the issue to me. After research, I have:

1. Forwarded the complaint to Dr. (redacted), primarily to make him aware of the issue
2. Sent the issue to my group of emergency physicians at our main campus at ETMC. Specifically to speak directly to APP providers seeking transfer or consultation to our emergency physician. If additional information, a rare event, is requested, the supervisory physician will be sought. The supervisory physician should be rarely requested. I do not tolerate rude and condescending behavior 
3. We strive hard to not prolong any patient seeking transfer under EMTALA regulations

Over the previous twenty seven years, I have spent many years working side by side with NP and PA professional including as faculty in San Antonio faculty involved with PA EM fellowship, Additionally, I have precepted many NP in the last twenty years, Additionally, I have supervised both NP and PA over the last twenty hours at our trauma center, as well as our free stand ED. I do not require a supervise physician to speak to me when I'm approached by an APP to  transfer a patient.

 

Again, thank you for approaching us regarding this issue. Should you need anything further, please contact me.

 

Sincerely,

 

Robert G Creath MD FACEP FAAEM

Chief, Emergency Services

ETMC

[Reality Check 2]

NICE WORK!

A positive response that will hopefully come with regard for the author from the other ER docs and providers.

I agree, follow up - watch, monitor, make sure they accept this from the chief.

Kudos!

[LKPAC]

Good for you!  You took our profession another step forward today by handling this in such a professional manner.

[eighthnote24]

Funny, since that doc was one of the two who committed the acts in the first place....he sure changed his tone....per the transfer center rep his words were "I'm done talking to midlevels...." ...having not even ever spoken to me before....then demanded I consult neurology for a non-neurologic issue....delaying transfer....

but hopefully, this changes things.

I started my new faculty job today and haven't had a chance to send my email...but it will be done this weekend.  Just to add my first hand experience.

I feel like this should be done each and every time this happens, everywhere.  

 

[eighthnote24]

He responded to me with the same email basically word for word that Scott got.

[UGoLong]

I have encountered this kind of thing every so often. I'm big on networking and maintaining relationships and these have generally been used to fix things up. For example:

I round at a hospital with an internist service that normally provides the attendings. One new attending refused to speak with me and insisted on speaking to my SP, who was doing a cath at another hospital at the time. I mentioned the issue to a more senior attending who I've known for years. It then apparently spread like wildfire to all the other attendings, including their chief, who I've known for a long time. For days, various other attendings came up to me and apologized for their service, noting that the new attending was being "remediated." No further problems since.

My only advice: there's always somebody who becomes a problem. Keep your network strong and it's almost self-correcting.

[sillycibin]

At my hospital for a while the hospitalist group refused to hear consults from ER PAs.  Your attending had to make the call on your behalf no matter how much they were involved in the workup.