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sas5814

The Paternalistic Attitude of Physicians

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The title is a bit of a generality and I understand that but I recently had an experience that brought this up. I have "enjoyed" this attitude at the state and national levels in matters of regulation and policy but this was the first time I ever got it locally from a leader in my own organization.

For the first time in almost 3 years I had direct access to a physician at the highest level of our organization. We are a huge organization and do not have a senior PA or NP or APP at the top of the organization. We have 3 mid level APPs who are really in charge of nothing except being one more level of management to carry policy to the hoi palloi.

So, after a department meeting he came to me and thanked me for my comments (which was BS because I called him out for not having a "maximum number of patients" policy in the UC) so Itold him this organization employes 300 PAs and NPs in this region and needs a senior APP to help make sure the organization is using us to maximum benefit. Without any dicussion he said "no we don't." The  shallow follow on discussion basically said we don't need an APP at his level of management because the physicians will make sure we are taken care of. I asked him who at his level was responsible for the APPs. The answer? The CNO. I told him flat out that was wholley inappropriate and his reply was "I hear you." End of discussion. I went home and drank a lot.

As giant corporate medical machines go this one is better than many. They value work/life balance and people being treated with respect. I am well paid with better than average benifits. I am about 5 years from semi-retirement (unless my new business takes off then I am gone) and I'm wondering if this is a windmill worth tilting at.

Edited by sas5814
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I wish I any some answers.  I run up against the same brick wall time and time again.  Physician assistants are valued for what we can generate for a practice and pretty much nothing else.  It's why we rarely see PA's in a position of leadership and I swear I really believe after 26 years of practice that it is 100% due to our name.  Admins and docs are not going to place someone with the title "Assistant" in any position of authority.  

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Scott, travel a bit to the west and you won't have to deal with this mess.  See patients at a very reasonable pace, no stress, go home, collect the paycheck, and enjoy the bennies.  I've just had enough of patients in general so that's why I'm stepping aside.  You may have to take a hit on the salary but it would still be reasonable.

Edited by GetMeOuttaThisMess

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My entire career I advocated for myself.  Did not need anyone in higher up management to help.  Your 5 years out.  Make it a smooth transition. 

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Too many "Sheep PAs" out there willing to sit as "management lap dogs" which is what these Chief or Senior APPs are expected to be. I've never seen PA's as a group stand up and fight for their professional due within large organizations! I've observed individuals who fought for just and right treatment within the organization get worn down and burn out before leaving while the vast majority of their peers stood by chewing their cud waiting to be led to the corporate medicine slaughter house. I can't stand speaking to 99% of administrators because they are all two faced liars who will sell you out in a minute to increase profits or their stature within the organization. So to avoid the heartburn and aggravation I just avoid them and find reasons to miss "meetings" which would just further increase my contempt for  the Suits and their minions with various professional alphabets splayed across their lab coats!!!!! I'm one foot out of the door as a PA and fully committed to remain as detached from the Janus faced machinations of the corporate Borg as I can be! They have paid me well over the years , but I was never for sale nor did I ever sell out!!

Edited by CAdamsPAC
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yes it is worth fighting for, but it will be a long fight to change corporate mindset and the doc's in Admin

We are valued by corp medicine as we can generate like a doc but cost 1/3 to 1/2 as much, and we have NO seat at the table.....

 

I have never like unions, but I think in todays medicine world PA and NP should be in a union of their own that stands up and fights for what is right....

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1 hour ago, ventana said:

yes it is worth fighting for, but it will be a long fight to change corporate mindset and the doc's in Admin

We are valued by corp medicine as we can generate like a doc but cost 1/3 to 1/2 as much, and we have NO seat at the table.....

 

I have never like unions, but I think in todays medicine world PA and NP should be in a union of their own that stands up and fights for what is right....

Completely agree.  I've never been a big fan of unions, but our corporate overlords have made it pretty much the only option to protect what few benefits we have left.

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On 9/12/2019 at 7:05 AM, sas5814 said:

The title is a bit of a generality and I understand that but I recently had an experience that brought this up. I have "enjoyed" this attitude at the state and national levels in matters of regulation and policy but this was the first time I ever got it locally from a leader in my own organization.

For the first time in almost 3 years I had direct access to a physician at the highest level of our organization. We are a huge organization and do not have a senior PA or NP or APP at the top of the organization. We have 3 mid level APPs who are really in charge of nothing except being one more level of management to carry policy to the hoi palloi.

So, after a department meeting he came to me and thanked me for my comments (which was BS because I called him out for not having a "maximum number of patients" policy in the UC) so Itold him this organization employes 300 PAs and NPs in this region and needs a senior APP to help make sure the organization is using us to maximum benefit. Without any dicussion he said "no we don't." The  shallow follow on discussion basically said we don't need an APP at his level of management because the physicians will make sure we are taken care of. I asked him who at his level was responsible for the APPs. The answer? The CNO. I told him flat out that was wholley inappropriate and his reply was "I hear you." End of discussion. I went home and drank a lot.

As giant corporate medical machines go this one is better than many. They value work/life balance and people being treated with respect. I am well paid with better than average benifits. I am about 5 years from semi-retirement (unless my new business takes off then I am gone) and I'm wondering if this is a windmill worth tilting at.

I think it’s rare to escape the paternalism. But physicians as a whole, when they are arrogant, are like islands of arrogance. They are better than you, me, other physicians (even their practice partners), neighbors, staff, patients, the guy who details their car. Even the ones that are dialed in to listening to their patients still tend to carry with them the idea that they are right about what they want to do. I feel fortunate to have dealt personally with quite a few who have humble hearts and acknowledge to themselves that they aren’t capable of grasping everything that crosses their minds in a given day. I’m running into more of these kinds of good docs as time goes on. What you have with a physician executive is he same thing you see in just about any executive... nurse executive, business executive, etc.... so double whammy. It could be the physician in them causing the frustration, but it’s just as likely the boss in them. I can’t tell you how many times in my career as an RN that every boss I had would basically develop their own version of “thank you for your opinion but go F yourself... I’ve got this figured out.” That kind of treatment was more of a daily thing, rather than a monthly or quarterly thing, and it was at every level of the food chain. And they had their own meetings where they had that message passed down to them from their bosses.  

So...is this what OTP looks like? Physicians still in charge? Or worse.... nurses in charge by means of delegation? Yay for the future! Looks just like the past. 

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I love the new word to my vocabulary "cashectomies".   Well put and sadly true.  Patients have no idea what goes on "behind the scene" to perform "cashectomies"  I guess because it doesn't hurt and they don't lose blood or a limb!!!

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Before the cashectomy is performed we always perform a wallet biopsy.  If it comes back positive then we are full speed ahead with that visit no matter what the complaint is...

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