Are PAs "Experts"?

[andersenpa]

I know this is an open ended question but I hope you will all provide some explanation behind your answer.

[andersenpa]

I know this is an open ended question but I hope you will all provide some explanation behind your answer.

[IdahoPA]

I think it would be fair to say PAs are experts within a range. "I'm an expert at X,Y,Z." To me, that would be true of any medical/educational venture as there are a billion facets to medicine and it's just not possible to have a handle on all of them. But if you see 30 knee patients a day for 20 years, well, one can assume you're pretty darn knowledgeable in that subject. Not having a more advanced degree doesn't limit the provider's curiosity or ability to continuously gain knowledge.

[IdahoPA]

I think it would be fair to say PAs are experts within a range. "I'm an expert at X,Y,Z." To me, that would be true of any medical/educational venture as there are a billion facets to medicine and it's just not possible to have a handle on all of them. But if you see 30 knee patients a day for 20 years, well, one can assume you're pretty darn knowledgeable in that subject. Not having a more advanced degree doesn't limit the provider's curiosity or ability to continuously gain knowledge.

[andersenpa]

5 responses and 1 comment

Please, add your input!

[andersenpa]

5 responses and 1 comment

Please, add your input!

[Jason09]

Expert: having, involving, or displaying special skill or knowledge derived from training or experience. I think 100% we are considered experts in the medical field. How much of the human population knows what we know about medicine. Not saying PAs or even MDs know everything about medicine but that is not what an expert means. You don't have to know everything about your particular field to be an expert. We meet all facets of the definition of an expert in my opinion. Ask yourself this. Would you let just anybody treat your mother or perform procedures on your family. No. You want an expert in that field to do so.

[Jason09]

Expert: having, involving, or displaying special skill or knowledge derived from training or experience. I think 100% we are considered experts in the medical field. How much of the human population knows what we know about medicine. Not saying PAs or even MDs know everything about medicine but that is not what an expert means. You don't have to know everything about your particular field to be an expert. We meet all facets of the definition of an expert in my opinion. Ask yourself this. Would you let just anybody treat your mother or perform procedures on your family. No. You want an expert in that field to do so.

[EMEDPA]

I know of many specialty practices in which pa's are experts on a particular issue. all the members of the practice refer their pts with that issue to the given pa.

it is harder for a pa to be an expert in an entire field. guys like Mike Jones have done it with the h/a field but in many other practices the area of expertise would be more narrow for example a neuro practice might have a pa who only sees pts with MS for example and they read everything that comes out about it, know all the new studies, do all their cme regarding MS, etc or a GI practice might have a pa that sees all the hep c pts, etc

[EMEDPA]

I know of many specialty practices in which pa's are experts on a particular issue. all the members of the practice refer their pts with that issue to the given pa.

it is harder for a pa to be an expert in an entire field. guys like Mike Jones have done it with the h/a field but in many other practices the area of expertise would be more narrow for example a neuro practice might have a pa who only sees pts with MS for example and they read everything that comes out about it, know all the new studies, do all their cme regarding MS, etc or a GI practice might have a pa that sees all the hep c pts, etc

[CAAdmission]

They might be considered so by another PA. But if it came down to a trial and a PA expert witness is up against a physician expert, I'm pretty sure we would get eaten alive...

[CAAdmission]

They might be considered so by another PA. But if it came down to a trial and a PA expert witness is up against a physician expert, I'm pretty sure we would get eaten alive...

[EMEDPA]

They might be considered so by another PA. But if it came down to a trial and a PA expert witness is up against a physician expert, I'm pretty sure we would get eaten alive...

probably so but that is just semantics. if the pa really is on top of the condition and knows as much or more about it than a doc practicing in that field they are in fact an expert, regardless of what " a jury of our peers " might be convinced of. a lot of generalist specialists(say gi) know common modalities regarding disease processes in their field(say hep c) but might not be up on the most current research and tx like a pa might who only deals with that issue. if most of the docs practice relates to doing colonoscopies and dealing with colon ca. they probably only know the basics regarding hep c management. that is why they hire a pa to deal with all of their hep c pts.....that and colonoscopies pay much better than medical management of hep c....

[EMEDPA]

They might be considered so by another PA. But if it came down to a trial and a PA expert witness is up against a physician expert, I'm pretty sure we would get eaten alive...

probably so but that is just semantics. if the pa really is on top of the condition and knows as much or more about it than a doc practicing in that field they are in fact an expert, regardless of what " a jury of our peers " might be convinced of. a lot of generalist specialists(say gi) know common modalities regarding disease processes in their field(say hep c) but might not be up on the most current research and tx like a pa might who only deals with that issue. if most of the docs practice relates to doing colonoscopies and dealing with colon ca. they probably only know the basics regarding hep c management. that is why they hire a pa to deal with all of their hep c pts.....that and colonoscopies pay much better than medical management of hep c....

[jdtpac]

This is a very open-ended question. I will say yes, within the scope of practice of the PA. In a medical legal sense we are experts within our profession because our expertise can judge or be judged by (and only by) an individual or panel of our peers. Regardless of what specialty you are in your performance is measured by how well you perform the service or procedure as compared to other PA’s within that specialty and not the physicians. Notwithstanding that over time a PA probably does perform at a similar clinical level as their supervising physician, under our current medical legal system the physician is held at a much higher standard and therefore are considered the "experts" in that specialty. Even though it could be said without a doubt that a PA can perform at a certain level of "proficiency " skillfully and demonstrate they have a plethora of knowledge in a particular area, unfortunately, in today's health care environment we are considered competent but not expert.

However, based upon other posts on this forum, I suspect there are PA’s who would take exception to my comments.

[jdtpac]

This is a very open-ended question. I will say yes, within the scope of practice of the PA. In a medical legal sense we are experts within our profession because our expertise can judge or be judged by (and only by) an individual or panel of our peers. Regardless of what specialty you are in your performance is measured by how well you perform the service or procedure as compared to other PA’s within that specialty and not the physicians. Notwithstanding that over time a PA probably does perform at a similar clinical level as their supervising physician, under our current medical legal system the physician is held at a much higher standard and therefore are considered the "experts" in that specialty. Even though it could be said without a doubt that a PA can perform at a certain level of "proficiency " skillfully and demonstrate they have a plethora of knowledge in a particular area, unfortunately, in today's health care environment we are considered competent but not expert.

However, based upon other posts on this forum, I suspect there are PA’s who would take exception to my comments.

[andersenpa]

They might be considered so by another PA. But if it came down to a trial and a PA expert witness is up against a physician expert, I'm pretty sure we would get eaten alive...

 

in my experience this doesn't happen- PAs act as expert witnesses regarding PA practice; they wouldn't comment on the role of physicians. Not that it hasn't happened, but I can't see it realisitically since the court wants an apples-to-apples comparison.

[andersenpa]

They might be considered so by another PA. But if it came down to a trial and a PA expert witness is up against a physician expert, I'm pretty sure we would get eaten alive...

 

in my experience this doesn't happen- PAs act as expert witnesses regarding PA practice; they wouldn't comment on the role of physicians. Not that it hasn't happened, but I can't see it realisitically since the court wants an apples-to-apples comparison.

[andersenpa]

This is a very open-ended question. I will say yes, within the scope of practice of the PA. In a medical legal sense we are experts within our profession because our expertise can judge or be judged by (and only by) an individual or panel of our peers. Regardless of what specialty you are in your performance is measured by how well you perform the service or procedure as compared to other PA’s within that specialty and not the physicians. Notwithstanding that over time a PA probably does perform at a similar clinical level as their supervising physician, under our current medical legal system the physician is held at a much higher standard and therefore are considered the "experts" in that specialty. Even though it could be said without a doubt that a PA can perform at a certain level of "proficiency " skillfully and demonstrate they have a plethora of knowledge in a particular area, unfortunately, in today's health care environment we are considered competent but not expert.

However, based upon other posts on this forum, I suspect there are PA’s who would take exception to my comments.

 

I don't because I think about the perspective that you are referring to.

Physicians are the gold standard for expert level medical knowledge according to the general public, courts, and the legislature for the most part. I can't see a situation where a PA would be used as a consultant expert being considered equal to a physician, certainly never exceeding a doc. And I would have to say rightly so, based on their amount of standardized academic and clinical training.

 

Having said that, we all know there are PAs who have more expertise in certain areas than physicians in their very practice.

 

So suffice it to say PAs have expertise in certain facets of their specialty, but aren't generalized EXPERTS for that specialty in the court of general opinion or the court of law.

 

i don't know how to interpret that PAs are experts "in the scope of practice as a PA". Our scope of practice is medicine. It's what our license says. We are medicolegally held to the same gold standard as physicians, so our scope is theirs. Perhaps that is open to difference of opinion but I would bet that most PAs feel that way.

 

To me, it should follow that if our scope is the practice of medicine (or our SPs specialty), and we are held to that standard in terms of diagnosis and tx, then how can we separate "scope of practice as a PA" from scope of our docs? The definition of what we are allowed to do includes "those duties performed by the SP", aside from other state and practice restrictions.

[andersenpa]

This is a very open-ended question. I will say yes, within the scope of practice of the PA. In a medical legal sense we are experts within our profession because our expertise can judge or be judged by (and only by) an individual or panel of our peers. Regardless of what specialty you are in your performance is measured by how well you perform the service or procedure as compared to other PA’s within that specialty and not the physicians. Notwithstanding that over time a PA probably does perform at a similar clinical level as their supervising physician, under our current medical legal system the physician is held at a much higher standard and therefore are considered the "experts" in that specialty. Even though it could be said without a doubt that a PA can perform at a certain level of "proficiency " skillfully and demonstrate they have a plethora of knowledge in a particular area, unfortunately, in today's health care environment we are considered competent but not expert.

However, based upon other posts on this forum, I suspect there are PA’s who would take exception to my comments.

 

I don't because I think about the perspective that you are referring to.

Physicians are the gold standard for expert level medical knowledge according to the general public, courts, and the legislature for the most part. I can't see a situation where a PA would be used as a consultant expert being considered equal to a physician, certainly never exceeding a doc. And I would have to say rightly so, based on their amount of standardized academic and clinical training.

 

Having said that, we all know there are PAs who have more expertise in certain areas than physicians in their very practice.

 

So suffice it to say PAs have expertise in certain facets of their specialty, but aren't generalized EXPERTS for that specialty in the court of general opinion or the court of law.

 

i don't know how to interpret that PAs are experts "in the scope of practice as a PA". Our scope of practice is medicine. It's what our license says. We are medicolegally held to the same gold standard as physicians, so our scope is theirs. Perhaps that is open to difference of opinion but I would bet that most PAs feel that way.

 

To me, it should follow that if our scope is the practice of medicine (or our SPs specialty), and we are held to that standard in terms of diagnosis and tx, then how can we separate "scope of practice as a PA" from scope of our docs? The definition of what we are allowed to do includes "those duties performed by the SP", aside from other state and practice restrictions.

[physasst]

That's just it...PA's can develop a certain expertise in their field of practice, but they cannot ever really be considered experts....I mean, how would you measure that expertise? For physicians we have a rigorous (for some specialties at least) specialty board exam process. To claim that you are an expert, would mean that you have equivalent knowledge to other experts in that field of study. But how do you know? How do you measure it? I might be the only one that voted no...but we have to remember, despite ALL of our education, high standards of practice, etc.etc.etc.....we are still dependent providers who must practice under the supervision (I prefer collaboration) of a physician. By that very standard, we are not experts. I would argue instead that the greatest value of the PA profession is just that...

 

that we ARE NOT experts. We are the modern day GP's....the modern day general practitioner who handles just about everything, including minor surgeries etc.

 

SO, I would argue that while a PA can develop a certain expertise, and certainly can practice with a high level of autonomy, they cannot, nor were they ever designed or educated as "Experts". I know that many will disagree with me, and that is fine.

[physasst]

That's just it...PA's can develop a certain expertise in their field of practice, but they cannot ever really be considered experts....I mean, how would you measure that expertise? For physicians we have a rigorous (for some specialties at least) specialty board exam process. To claim that you are an expert, would mean that you have equivalent knowledge to other experts in that field of study. But how do you know? How do you measure it? I might be the only one that voted no...but we have to remember, despite ALL of our education, high standards of practice, etc.etc.etc.....we are still dependent providers who must practice under the supervision (I prefer collaboration) of a physician. By that very standard, we are not experts. I would argue instead that the greatest value of the PA profession is just that...

 

that we ARE NOT experts. We are the modern day GP's....the modern day general practitioner who handles just about everything, including minor surgeries etc.

 

SO, I would argue that while a PA can develop a certain expertise, and certainly can practice with a high level of autonomy, they cannot, nor were they ever designed or educated as "Experts". I know that many will disagree with me, and that is fine.

[jdtpac]

i don't know how to interpret that PAs are experts "in the scope of practice as a PA". Our scope of practice is medicine. It's what our license says. We are medicolegally held to the same gold standard as physicians, so our scope is theirs. Perhaps that is open to difference of opinion but I would bet that most PAs feel that way.

 

To me, it should follow that if our scope is the practice of medicine (or our SPs specialty), and we are held to that standard in terms of diagnosis and tx, then how can we separate "scope of practice as a PA" from scope of our docs? The definition of what we are allowed to do includes "those duties performed by the SP", aside from other state and practice restrictions.

 

Herein lays the Catch-22 of the PA profession. Although, in our clinical practice we are expected to provide service on par with our physician colleagues, legally we cannot be held culpable in the event of an unto wart patient outcome if we practice within our role as a dependent provider. As much as many of us would not like to admit, in the medical legal world there is a PA scope of practice. And to be quite honest it, in large part, is defined and developed for our protection. If it was not then there would not have been a need to pass enabling legislation in all 50 states, the District of Columbia, Guam and the American Virgin Islands. In my over 30 years of practice I have been extensively involved in drafting PA laws, rules and regulations, medical staff bylaws and served as an expert witness (for both the defense and the plaintiff) in over 20 medical malpractice suits. And I can tell you without a shadow of doubt that PA’s who believe that their scope of practice is the same as their supervising physician are those who unfortunately run the risk of ending up on the wrong side of a medical malpractice suit or a medical boards professional inquiry panel.

 

I am sure we all recall one of the most important things we were taught as students was to always remember to know one's limitations, and to recognize when it was time to step back and involve our supervising physicians in the care we are providing to the patients. And until the day comes when we are considered independent practitioners involvement of the supervising physician whether they are in the building or 60 miles away, consulted after-the-fact or just required to review a certain percentage of your caseload, will always be a factor in any PA’s scope of practice. Now I could go on site examples of how a PA’s breech of not knowing their limitations placed their license in jeopardy or knowing their limitations prevented catastrophic events from occurring and saved them and their supervising physician millions of dollars in lawsuits, however that would be the basis for writing a book and not answering your question simply enough for you to understand what I meant when I said there is a PA scope of practice.

 

As I always tell my students, younger PA colleagues and yes even some of my physician colleagues, when we have step out of our normal scope of practice and into that of the recognized “experts" scope of practice and something goes wrong, you lose.

[jdtpac]

i don't know how to interpret that PAs are experts "in the scope of practice as a PA". Our scope of practice is medicine. It's what our license says. We are medicolegally held to the same gold standard as physicians, so our scope is theirs. Perhaps that is open to difference of opinion but I would bet that most PAs feel that way.

 

To me, it should follow that if our scope is the practice of medicine (or our SPs specialty), and we are held to that standard in terms of diagnosis and tx, then how can we separate "scope of practice as a PA" from scope of our docs? The definition of what we are allowed to do includes "those duties performed by the SP", aside from other state and practice restrictions.

 

Herein lays the Catch-22 of the PA profession. Although, in our clinical practice we are expected to provide service on par with our physician colleagues, legally we cannot be held culpable in the event of an unto wart patient outcome if we practice within our role as a dependent provider. As much as many of us would not like to admit, in the medical legal world there is a PA scope of practice. And to be quite honest it, in large part, is defined and developed for our protection. If it was not then there would not have been a need to pass enabling legislation in all 50 states, the District of Columbia, Guam and the American Virgin Islands. In my over 30 years of practice I have been extensively involved in drafting PA laws, rules and regulations, medical staff bylaws and served as an expert witness (for both the defense and the plaintiff) in over 20 medical malpractice suits. And I can tell you without a shadow of doubt that PA’s who believe that their scope of practice is the same as their supervising physician are those who unfortunately run the risk of ending up on the wrong side of a medical malpractice suit or a medical boards professional inquiry panel.

 

I am sure we all recall one of the most important things we were taught as students was to always remember to know one's limitations, and to recognize when it was time to step back and involve our supervising physicians in the care we are providing to the patients. And until the day comes when we are considered independent practitioners involvement of the supervising physician whether they are in the building or 60 miles away, consulted after-the-fact or just required to review a certain percentage of your caseload, will always be a factor in any PA’s scope of practice. Now I could go on site examples of how a PA’s breech of not knowing their limitations placed their license in jeopardy or knowing their limitations prevented catastrophic events from occurring and saved them and their supervising physician millions of dollars in lawsuits, however that would be the basis for writing a book and not answering your question simply enough for you to understand what I meant when I said there is a PA scope of practice.

 

As I always tell my students, younger PA colleagues and yes even some of my physician colleagues, when we have step out of our normal scope of practice and into that of the recognized “experts" scope of practice and something goes wrong, you lose.

[andersenpa]

Herein lays the Catch-22 of the PA profession. Although, in our clinical practice we are expected to provide service on par with our physician colleagues, legally we cannot be held culpable in the event of an unto wart patient outcome if we practice within our role as a dependent provider. As much as many of us would not like to admit, in the medical legal world there is a PA scope of practice. And to be quite honest it, in large part, is defined and developed for our protection. If it was not then there would not have been a need to pass enabling legislation in all 50 states, the District of Columbia, Guam and the American Virgin Islands. In my over 30 years of practice I have been extensively involved in drafting PA laws, rules and regulations, medical staff bylaws and served as an expert witness (for both the defense and the plaintiff) in over 20 medical malpractice suits. And I can tell you without a shadow of doubt that PA’s who believe that their scope of practice is the same as their supervising physician are those who unfortunately run the risk of ending up on the wrong side of a medical malpractice suit or a medical boards professional inquiry panel.

 

I am sure we all recall one of the most important things we were taught as students was to always remember to know one's limitations, and to recognize when it was time to step back and involve our supervising physicians in the care we are providing to the patients. And until the day comes when we are considered independent practitioners involvement of the supervising physician whether they are in the building or 60 miles away, consulted after-the-fact or just required to review a certain percentage of your caseload, will always be a factor in any PA’s scope of practice. Now I could go on site examples of how a PA’s breech of not knowing their limitations placed their license in jeopardy or knowing their limitations prevented catastrophic events from occurring and saved them and their supervising physician millions of dollars in lawsuits, however that would be the basis for writing a book and not answering your question simply enough for you to understand what I meant when I said there is a PA scope of practice.

 

As I always tell my students, younger PA colleagues and yes even some of my physician colleagues, when we have step out of our normal scope of practice and into that of the recognized “experts" scope of practice and something goes wrong, you lose.

 

It's interesting that you bring that up. I've had the opportunity to do some expert witness testimony. My experiences are more limited than yours, but the cases involved PAs where there were errors of omission, not cases of being cavalier or not respecting limits as a PA. While I was asked to evaluate how the PA performed relative to the accepted standard of a PA in that role, their failing (in these cases) was no different than if a doc had seen them and failed to do the same thing. So while there may be a true definition of PA scope (somehow in a different box than physician scope), the Venn Diagram crossover of those two is significant. The cases I have reviewed were not simply "PA failed to notify the physician", but "PA failed to order X diagnostic test" (just as a doc would be expected to) or "PA failed to admit pt" (just as a doc would be expected to.

 

So while the descriptors that are in place may try to define what PAs do, it seems the reality in many cases still expects us to act identical to how a physician would.

 

It seems to state that we are expected to provide service on par with our physician colleagues, and we legally can be held culpable in the event of an untoward patient outcome when practicing within our role as a dependent provider. Dependent, yes, but still practicing gold standard medicine.