Maybe Doctors are THE problem....

[Grinder993]

I have been taking care of patients for 25 years.  Navy Corpsman, Paramedic, EMPA-C, it's been a long road.  Probably somewhere close to 100,000 patients I have cared for at this point.  BUT LET ME BE CLEAR! ....none of this matters.   I am not a "Doctor".  

I have seen over and over in my time, Physicians extend courtesy to your face, only to cut down your profession behind closed doors.  Lament the creeping decay of medicine that PA's and NP's represent to them.  I have seen MD's make many, many mistakes....I always see their colleagues make excuses for them, report how "it could have happened to anyone", circle their wagons around the fellow MD.  By the same hand I have seen PA's make strikingly similar mistakes and the MD cadre throw the PA under and the entire profession UNDER THE BUS!  The case taken to Peer Review...further illustration of the incompetence of an entire profession who "want to pretend to be doctors".  

The culture of medicine is sick.   Very sick.  It is corrosive.  I see the MD as the primary cancer.  The body of medicine is changing.  The needs of 300 million Americans is changing.  This is a need that the MD CANNOT fulfill alone.  Yet their innate egotism and reflexive territorial pissing just keeps on.  At the cost of the well being of some 300 million just so they can protect their threatened fiefdom.  

Case in point....this happened to me just last night.  I am a solo provider in a critical access ER in New England.  I have a male child with an incarcerated hernia.  The child has many neurological issues complicating his care.  The mother REFUSES to allow me to attempt to reduce this because it will require sedation, she wants him transferred to the larger regional hospital where he already has relationships with providers from multiple specialties.  I explain to her that "time is tissue", she understands, she wants him transferred.  I speak to the on call pediatric surgeon, she tells me she refuses to accept this patient without me attempting to reduce the hernia.  I explain the complicating factors of this case and most importantly that the mother refuses treatment at a small outlying critical access ER.  The surgeon refuses to accept.  

I call in anesthesia and our general surgeon, they evaluate.  Their assessment....same....transfer the patient.  So our surgeon talks to the pediatric surgeon and now.....well....since another MD saw the patient, she accepts.   Total delay of care for this surgical case 2 hours because why?   The pediatric surgeon did not think a PA competent to assess this case?  Nothing changed between my call to her and our surgeon evaluating.  Just that the gravitas of the request came from another MD.   

MD's are killing people with their egos. 

To say I am at the end of my rope with medicine is an understatement.  I am done with clinical medicine and transitioning out, I can make no meaningful changes on this side of the table.  I have recently enrolled in Healthcare MBA.  Maybe my many years experience and an MBA can lead to an office in the C-suite of a hospital.  Maybe I can make some changes from there.  Time will tell.

I do more teaching now at a local PA program.  I enjoy it, I like to pass on to the students all the things I wish someone had taught me when I was a PA student.  But the hardest thing for me is to look into their hopeful dewy-eyes and now what heart break they are in for.  To know that they will never be respected by the medical establishment now matter how good they are.  No matter how hard they study, they won't have the right credentials on their lab coat to be heard.  

Doctors elitism, egos and arrogance ARE the problem with medicine.  

[sas5814]

This is an interesting and painfully accurate description with a perspective I have felt but could never quite articulate. I am going to borrow the concept and see if I can polish it into a readable article that will provoke discussion perhaps without provoking rage (dare to dream I say).

[rev ronin]

So this surgeon at a higher level care made you CALL IN surgery and anesthesiology to evaluate a patient?

I only ever do critical access in Alaska, where there is literally no other provider to call in except another PA or an NP, but when I call a hospital, I don't ask permission, I tell them what I am sending them and why, and ask if they would like me to do something additionally while I'm waiting for the airplane.  Maybe docs in Anchorage just know that they really don't have any choice, but I've worked with 3 hospitals, and always been able to talk straight to the MD and get good feedback and no flak.  The closest thing I heard to pushback is, "well, if you can't mange them there, then yeah, I guess we need to see them here".

Maybe the culture of frontier medicine isn't quite as sick as everywhere else?

[GetMeOuttaThisMess]

1 hour ago, rev ronin said:

So this surgeon at a higher level care made you CALL IN surgery and anesthesiology to evaluate a patient?

I only ever do critical access in Alaska, where there is literally no other provider to call in except another PA or an NP, but when I call a hospital, I don't ask permission, I tell them what I am sending them and why, and ask if they would like me to do something additionally while I'm waiting for the airplane.  Maybe docs in Anchorage just know that they really don't have any choice, but I've worked with 3 hospitals, and always been able to talk straight to the MD and get good feedback and no flak.  The closest thing I heard to pushback is, "well, if you can't mange them there, then yeah, I guess we need to see them here".

Maybe the culture of frontier medicine isn't quite as sick as everywhere else?

If you ever worked with "Dr. Quinn, Medicine Woman" I think that I'd come out of retirement and work a shift.  Ahh, the allure of remote medicine.  Hubba, hubba.

Edited January 5, 2020 by GetMeOuttaThisMess

[JOhnny888]

Ah yes, generalize and make blanket statements about a whole profession, where could this go wrong.

[SedRate]

10 hours ago, Grinder993 said:

I have been taking care of patients for 25 years.  Navy Corpsman, Paramedic, EMPA-C, it's been a long road.  Probably somewhere close to 100,000 patients I have cared for at this point.  BUT LET ME BE CLEAR! ....none of this matters.   I am not a "Doctor".  

I have seen over and over in my time, Physicians extend courtesy to your face, only to cut down your profession behind closed doors.  Lament the creeping decay of medicine that PA's and NP's represent to them.  I have seen MD's make many, many mistakes....I always see their colleagues make excuses for them, report how "it could have happened to anyone", circle their wagons around the fellow MD.  By the same hand I have seen PA's make strikingly similar mistakes and the MD cadre throw the PA under and the entire profession UNDER THE BUS!  

The culture of medicine is sick.   Very sick.  It is corrosive.  I see the MD as the primary cancer.  The body of medicine is changing.  The needs of 300 million Americans is changing.  This is a need that the MD CANNOT fulfill alone.  Yet their innate egotism and reflexive territorial pissing just keeps on.  At the cost of the well being of some 300 million just so they can protect their threatened fiefdom.  

MD's are killing people with their egos. 

Doctors elitism, egos and arrogance ARE the problem with medicine.  

It really is sickening, discouraging, disheartening, and downright scary.

I just switched jobs and fields for professional development and advancement, and I am already catching oversites and errors that just get brushed off until a surgeon decides that he somehow came to that conclusion on his own and he decides to do it... Hell, why would they listen to me anyway? I'm just some newbie "Physician Extender" who hasn't been doing this for decades like they have, and my job is to "make [them] look good," be their "work horse," and "just do what [they] tell [me] to." And yes, this is what I've been told straight to my face. I'll just keep earning my paycheck and protect as many patients as I can until I've accomplished what I came here to do and then GTFO. Oh, and save my own license in the process. 

Some younger physicians seem to be more open to collaboration and discussion which gives me hope. But ultimately, my goal is to "retire" soon so I can get out of this mess altogether. Or at least not have to rely on it for financial reasons but instead do it because I enjoy it. 

[ANESMCR]

1 hour ago, JOhnny888 said:

Ah yes, generalize and make blanket statements about a whole profession, where could this go wrong.

See, this way of thinking is exactly why the PA profession is playing catch up now. Nothing has been done for decades. We’ve always been the one's to happily be complacent with dependency and playing the “nice guy” role in regard to NPs and legislative oppression. Doesn’t work, won’t work. Speak up, speak out. Stop being afraid of offending NPs and MDs. What the OP said isn’t anecdotal. 

Edited January 6, 2020 by ANESMCR

[CAdamsPAC]

8 hours ago, rev ronin said:

So this surgeon at a higher level care made you CALL IN surgery and anesthesiology to evaluate a patient?

I only ever do critical access in Alaska, where there is literally no other provider to call in except another PA or an NP, but when I call a hospital, I don't ask permission, I tell them what I am sending them and why, and ask if they would like me to do something additionally while I'm waiting for the airplane.  Maybe docs in Anchorage just know that they really don't have any choice, but I've worked with 3 hospitals, and always been able to talk straight to the MD and get good feedback and no flak.  The closest thing I heard to pushback is, "well, if you can't mange them there, then yeah, I guess we need to see them here".

Maybe the culture of frontier medicine isn't quite as sick as everywhere else?

 

30 minutes ago, ANESMCR said:

See, this way of thinking is exactly why the PA profession is playing catch up now. Nothing has been done for decades. We’ve always been the one's to happily be complacent with dependency and playing the “nice guy” role in regard to NPs and legislative oppression. Doesn’t work, won’t work. Speak up, speak out.

As one of "those Alaska Bush Village PAs" I've bumped heads and stomped on the toes of a few physicians in order to get patients needing more care than I could provide seen. Yes, far too many physicians are full of themselves and put "their status" above caring for a patient in need. One of my consistent bi***es about PAs as a profession is the group kowtowing to other professions for acceptance  and conflict avoidance when the profession is disabused. I have confronted physicians who believe their preconceived knowledge of a case they haven't examined or of my experience or competence when their attitude endangered the patient, making it clear the medical boards of the institution and state would hear from me. Up here in Alaska I've been fortunate to have SPs who respect my clinical skills and stand by me when I must deal with egotist who graduated from a medical school! As I approach the end of my PA career , the profession not being more assertive and presenting a unified front that advocates for itself publicly across the nation  is my major professional lament.

Edited January 6, 2020 by CAdamsPAC

[Cideous]

Healthcare MBA's are a dime a dozen.  If you think that degree will get you out of clinical medicine...well.

Healthcare admin MBA's almost exclusively get their jobs because they know someone.  You might, and that would be great, but here in DFW I know dozens of docs desperate to leave clinical medicine, got MBA's and in healthcare and none could find an admin job.  It was a waste of money. I hope your experience is different than theirs.

Edited January 6, 2020 by Cideous

[PACali]

17 hours ago, Grinder993 said:

 I have recently enrolled in Healthcare MBA.  Maybe my many years experience and an MBA can lead to an office in the C-suite of a hospital.  Maybe I can make some changes from there.  Time will tell.

 

Getting into the C-suite is the answer,  and we need to change our title to reflect our responsibility. You are not a assistant or an associate. You are a practitioner of medicine. 

17 hours ago, Grinder993 said:

  I do more teaching now at a local PA program.  I enjoy it, I like to pass on to the students all the things I wish someone had taught me when I was a PA student.  But the hardest thing for me is to look into their hopeful dewy-eyes and now what heart break they are in for.  To know that they will never be respected by the medical establishment now matter how good they are.  No matter how hard they study, they won't have the right credentials on their lab coat to be heard.  

 

Everyone talks about how the profession is top 3 base on the US news and report. What most of students or pre-pa don't realized is that the profession sounds "way better on paper" but not in reality. I am in education as well, and I always tell the students it will be a bumpy ride for their career.  

[Gordon, PA-C]

As bad as physicians can be, do you really want a complete corporate takeover of healthcare by MBAs with zero medical experience?

Because thats the alternative to having MDs run things.  Hell, that's already happening in most of the country.

MDs, even with their faults, are still better at running healthcare than MBAs are.  As PAs advance as a profession we will slowly get more people up there too, but make no mistake the leadership will always be mostly MDs.

[Cideous]

3 hours ago, Gordon, PA-C said:

As bad as physicians can be, do you really want a complete corporate takeover of healthcare by MBAs with zero medical experience?

Because thats the alternative to having MDs run things.  Hell, that's already happening in most of the country.

MDs, even with their faults, are still better at running healthcare than MBAs are.  As PAs advance as a profession we will slowly get more people up there too, but make no mistake the leadership will always be mostly MDs.

Umm, it's already happened. Docs are just another employee.  MBA's rule the roost now.

[ventana]

simple answer

 

Blue Cross and Blue shield was started by physicians

Physicians set the DRG rates

Physicians(AMA) is a political beast

 

So with conditions (that the NATIONAL PHYSICIANS) are he problem I totally agree

On the personal level I believe that due to the fact we are subservient (bow down to the Physician) we will NEVER be treated well.  

The days of the physician knowing more then the rest of the team are long long gone.   lo

 

On a local level, caring for the patient is the priority - period.  If you feel that is being violated speak up

 

Course I have done this twice in my career and both times a few months later I was polishing up my CV....  cause the Doc is always more powerful load of $%ap

 

 

[Lexapro]

This is an interesting thread. I’ve noticed the same thing - doctors are loathe to criticize each other, even when the doc in question is clearly in the wrong. Any time an NP or PA makes mistakes, doctors go for the jugular, "midlevels are all terrible, blahblahblah". But when a doctor makes mistakes (or is even borderline incompetent) … crickets. It’s the opposite of nursing, where we often gleefully tear each other to shreds for the tiniest of errors. Doctors are very protective of their “guild” to a fault, definitely, but nursing could learn a little bit from them. I do think the protection docs give each other elevates their brand in a way…