Are we not ASSISTANTS

[ArmyVetDude]

So a  PA working on a surgical floor said something like this the other day:  " Why are we even having the name change? Aren't we Assistants to doctors anyway? We assist them with their procedures and whatever plan THEY ALWAYS Come up with. No one perceives us differently just because people in our department refer us to  "Assistants""  

Of course that PA deserved to get beaten down. I am surprised some PA's have views like this. UNACCEPTABLE!

 

 

[PAMEDIC]

FWIW,... Since graduating from school, I've never actually assisted a physician. In fact, the overwhelming majority of the last 3 years, I didn't even have a physician in the same building.

 

[EMEDPA]

yup, I have not worked on shift a doc directly at my primary job for > 5 years

[UGoLong]

I too am wherever the doc isn't, but I can see that that may not be the case for a PA in surgery. The point is, if we are one profession, we would benefit from a title that describes us better than just someone who waits for orders from a supervisor.

In my case, I have a more knowledgeable colleague (the doc) whom I can call and discuss a complex case with if necessary, and whom I try to keep up to date on our hospital cases in case he gets a call when I'm off.

[ventana]

Last time I worked with my doc under the same roof (or any doc for that matter). 2012

 

nope no one’s assistant. 

 

I have heard some hospital based pa’s that don’t do much think they are assistants.  Yuk

[Cideous]

2 hours ago, EMEDPA said:

yup, I have not worked on shift a doc directly at my primary job for > 5 years

The only time I have worked with a doc in the last 20 years is when they were getting so hammered in UC they needed an extra provider so they called me in to bail them out.  Other then that, I always work alone in urgent care.  I'm no ones assistant, but alas, that's not what my name badge says....

[ArmyPA]

I think there may be a difference in perception for PAs who work in surgical specialties because they...for the most part...are in fact assistants. They assist in surgery and follow post op protocols set by the surgeon. No matter how well paid and skilled they may be, they do not tend to have the level of autonomy enjoyed by primary urgent and emergent care PAs. Foods for thoughts...

[thinkertdm]

I don't think the "assistant" in physician assistant ever, ever meant "stand there until I ask for something" or "get me coffee, Moneypenny".  

Today I did not hold a single retractor, kiss any surgeons ass, run around in my scrubs looking flustered while the surgeon strolled in.

I met with my team, made clinical decisions on 15 patients, advised one on life sustaining measures, refilled numerous prescriptions, but had to review the chart to make sure they were still needed and appropriate until the next appointment; and dealt with one pompous asshat DDS who did not understand how the VA deals with prescriptions from non VA providers.

I did hold the door for one of my patients, so maybe that makes me an assistant.

[Walkoffshot]

Wait, I’m confused. The point of this post is to discuss why PA’s aren’t assistants... instead it turned into a pissing match between ArmyPA and why surgical PAs are the true “assistant”. Whose team are you on?

I’m sure there are a lot of PAs in UC or EM that need the guidance of the doc, just as there are a lot of surgical PAs who can practice autonomously until surgery is necessary; thus requiring input from the surgeon. If I were a patient, I would hope my surgeon would at least see me once before cutting me open. If you think practicing without autonomy = assisting, then there would be several examples in ANY field of medicine of PAs “assisting”.

Regarding your N=1 case presentation in your initial post about the discussion you had with the surgical PA. That’s all it is... 1 encounter. Please don’t overgeneralize.

[ArmyPA]

I wasnt in a pissing contest with anyone, I presented and opinion and possible explanation of a difference in perception between certain specialties. Im all for PA autonomy in primary care and even some subspecialties if they are experienced...hell as a military PA I would bet I practiced with more autonomy than 90% of civilian PAs and that was right out of school.  But I am also realistic and call it how I see it...you can mince words and feel special all you want, while I agree experienced Surgical PAs may do many tasks autonomously and make decisions, they would have no job if not hired by a surgeon, and they may do surgeries while the surgeon surfs face book, but unless someone knows something that I do not, they are assistants to a surgeon and will never have provledges to perform surgery aitonomously. Throw your rocks if you like but the fact is primary care and UC EM PAs in many parts of the coutry are practicing at levels very close to that if not the same level as the physicians, I dont see that with surgical PAs. There is a reason surgical residiencies are 5 years plus and primary care em usually 3...

[thinkertdm]

True, it was a sample size of 1.  Maybe they were having a bad day.  Maybe they felt unappreciated.

Consider this:

"I'm an assistant" said no NP, ever.  23 states allow NPs to practice independently, without any apparent  limitations to their scope of practice.  

50 states, plus the District of Columbia, make me have a physician attest that they are providing oversight in my clinical decisions as a "supervising physician".

NPs are actively moving forward as establishing themselves as a credible alternative to seeing a physician.  Their newsletters, forums, and day to day conversations focus on getting the next state to allow them to practice independently

.

Malibu Stacy is the same, just with a new hat.  And that hasn't even appeared yet.

 

[ArmyVetDude]

1 hour ago, thinkertdm said:

True, it was a sample size of 1.  Maybe they were having a bad day.  Maybe they felt unappreciated.

Consider this:

"I'm an assistant" said no NP, ever.  23 states allow NPs to practice independently, without any apparent  limitations to their scope of practice.  

50 states, plus the District of Columbia, make me have a physician attest that they are providing oversight in my clinical decisions as a "supervising physician".

NPs are actively moving forward as establishing themselves as a credible alternative to seeing a physician.  Their newsletters, forums, and day to day conversations focus on getting the next state to allow them to practice independently.

We actively voted against the only resolution close to independent practice -OTP- in favor of... changing the name of our profession.

Malibu Stacy is the same, just with a new hat.  And that hasn't even appeared yet.

 

We didn't vote against OTP. We are just not doing enough. 

Also any PA's who feels that status quo is okay and that we are fine being called ASSISTANTS, they deserve to get beaten. No it is not okay. We need change and we need it now. 

[thinkertdm]

3 minutes ago, ArmyVetDude said:

We didn't vote against OTP. We are just not doing enough. 

Also any PA's who feels that status quo is okay and that we are fine being called ASSISTANTS, they deserve to get beaten. No it is not okay. We need change and we need it now. 

You're right, it was early.  However, I semi-disagree with you about the name change. 

[hlj25950]

I love being a PA. I didn’t want to be a nurse.

I hate our title and stagnant leadership that sits by and does little no nothing to promote our profession.

I work in primary care right now (trying to do ER, hopefully soon). I have little interaction with my SPs.

Once I am in that room with my white coat on, Im the provider. I’m often called doctor. I always introduce myself as a PA.

I had to fight for my job because “they only hire NPs because we have to supervise PAs and sign off on their charts.”

I had to find the laws and correct them.

I got my job.

I have people ask me in the community. “What do you do?”

“I’m a PA.”

“What is a PA?”

[emoji849]”I’m a physician assistant. I diagnose and treat patients. I write prescriptions.”

“Huh?”

“Kind of like a nurse practitioner.”

[emoji362] “Ohhhhhhhhhh!”

Which I get is part of the problem, but do I really have time to explain everything in every interaction? The public knows what an NP is. They think I’m a “medical assistant.”

Meanwhile commercials are running all the time here about nurse practitioners and independent practice and how wonderful NPs are.

We have no effective lobby. We have no effective public education measures. Our title is not reflective of our training, of our practice, of what we are. We are getting demolished.

[Guest Paula]

On ‎3‎/‎6‎/‎2019 at 4:28 PM, Cideous said:

The only time I have worked with a doc in the last 20 years is when they were getting so hammered in UC they needed an extra provider so they called me in to bail them out.  Other then that, I always work alone in urgent care.  I'm no ones assistant, but alas, that's not what my name badge says....

It's sad that doctors get hammered.  Isn't it dangerous to drink on the job.....they should have been fired.  

[Guest Paula]

First 4 years out of school:  sole provider on a reservation, doc 75 miles away, rural practice in a trailer house clinic.  No docs, was a great job.

Next 3 years: walk-in clinic at a rural CAH, no doc ever worked in the Walk-in and I was sole provider on my scheduled days.  Never once did the SP ever work in the clinic or step his foot in this part of the clinic.  I loved it and avoid doctors as much as possible.

Next 3 years: Back on the rez (different location, doc on site, rarely needed to consult with him), and was the head medical lead when he was off every Friday.  Loved my Fridays being the boss

Next 3 years that brings me up to today: Jumped into larger corporate medicine type of job with rvus, metric, satisfaction scores, feeling like a hamster, made a lot of money, completely autonomous and SP said PAs are as good as doctors. 

Burned out and now moving on to a cash only clinic that does not take insurance.  Can't wait.   

[ventana]

I used to say (many years ago) when people asked what a PA was that we were similar to NP.   Stopped that a few years ago.  Now I answer “we go through a slightly shorter medical school then come out and function just like a doc, see patients , managediseases, write scripts.....”.  No more do I compare to the political challenger that puts my profession down.  We are now the stated enemy to nursing lobby (which is anyone not in the nursing lobby). So be it, last time I checked I gave them orders, not the other way around.   

 

Now we we just need to get our name changed and severe the connection to docs and I will retire.  

[Hope2PA]

Thank you

18 minutes ago, ventana said:

I used to say (many years ago) when people asked what a PA was that we were similar to NP.   Stopped that a few years ago.  Now I answer “we go through a slightly shorter medical school then come out and function just like a doc, see patients , managediseases, write scripts.....”.  No more do I compare to the political challenger that puts my profession down.  We are now the stated enemy to nursing lobby (which is anyone not in the nursing lobby). So be it, last time I checked I gave them orders, not the other way around.   

 

Now we we just need to get our name changed and severe the connection to docs and I will retire.  

Thank you, thank you, thank you, for seeing beyond your professional future. I've heard many PA's in their later years, in the profession, not necessarily age, who only see their current position. They think all has been fine, is fine now, and no need to make anything different. They have no clue as to the politics of medicine and how FPA or lack of OTP and subservient title ARE impacting opportunities and perceptions. So again....THANK YOU!!! 

[Boatswain2PA]

On 3/6/2019 at 5:15 PM, ArmyPA said:

I think there may be a difference in perception for PAs who work in surgical specialties because they...for the most part...are in fact assistants. They assist in surgery and follow post op protocols set by the surgeon. No matter how well paid and skilled they may be, they do not tend to have the level of autonomy enjoyed by primary urgent and emergent care PAs. Foods for thoughts...

Thank you for moderating your opinion a bit, from "deserving of a beat down" to allowing for a difference of perception.

I work extremely autonomously, but not because I am more competent in my EM jobs than my fellow surgical/ortho/other specialist PAs are in their job, but simply because I (mostly) work in single coverage EDs (where I compete with lower trained/skilled NPs for positions).  Many specialist PAs, not just surgical specialties, act as true "assistants", or maybe better defined as an "extender" of the physician.  Many of my EM cohorts are not as autonomous as they work in EDs where they generally take the lower severity patients, required to run all patients by the attending, etc. 

Are they considered "assistants?"  

Should we break our profession into two?  Those of you in family practice who practice independently, along with perhaps the rare EM PA who is practices utterly independent, become a new profession?  Good luck with that, as you will now be halfway between the much higher trained physician, and the much lower trained NP.

[Boatswain2PA]

On 3/7/2019 at 9:54 AM, ArmyVetDude said:

Also any PA's who feels that status quo is okay and that we are fine being called ASSISTANTS, they deserve to get beaten.

Well sh**...there you went and did it again.  Are you going to provide such beating?  Shall we meet??

Or better yet, let's ratchet back the rhetoric please.  No need for jackboot thuggery to impose your will on people who may disagree with you.

When I meet the rare person who doesn't know what a PA is...I answer "I practice Emergency Medicine."  That being said, I just had a family member ask me if I knew how to suture.  <sigh>

[8404PA]

On 3/6/2019 at 11:06 PM, Walkoffshot said:

Wait, I’m confused. The point of this post is to discuss why PA’s aren’t assistants... instead it turned into a pissing match between ArmyPA and why surgical PAs are the true “assistant”. Whose team are you on?

I’m sure there are a lot of PAs in UC or EM that need the guidance of the doc, just as there are a lot of surgical PAs who can practice autonomously until surgery is necessary; thus requiring input from the surgeon. If I were a patient, I would hope my surgeon would at least see me once before cutting me open. If you think practicing without autonomy = assisting, then there would be several examples in ANY field of medicine of PAs “assisting”.

Regarding your N=1 case presentation in your initial post about the discussion you had with the surgical PA. That’s all it is... 1 encounter. Please don’t overgeneralize.

This individual gets it.  

[Joelseff]

Thank you for moderating your opinion a bit, from "deserving of a beat down" to allowing for a difference of perception.

 

I work extremely autonomously, but not because I am more competent in my EM jobs than my fellow surgical/ortho/other specialist PAs are in their job, but simply because I (mostly) work in single coverage EDs (where I compete with lower trained/skilled NPs for positions).  Many specialist PAs, not just surgical specialties, act as true "assistants", or maybe better defined as an "extender" of the physician.  Many of my EM cohorts are not as autonomous as they work in EDs where they generally take the lower severity patients, required to run all patients by the attending, etc. 

 

Are they considered "assistants?"  

 

Should we break our profession into two?  Those of you in family practice who practice independently, along with perhaps the rare EM PA who is practices utterly independent, become a new profession?  Good luck with that, as you will now be halfway between the much higher trained physician, and the much lower trained NP.

Hey boats, I think you got "ArmyPA" and "ArmyVetDude" mixed up... It got me too lol. I was like "is this the same dude?"

 

Sent from my SAMSUNG-SM-G891A using Tapatalk

 

 

 

[mmiller3]

We are BetaMax, HD-DVD, and anything else that has lost out to a competitor with better organization and marketing.