Talk of the Nation: NPR

[joanna.nola]

.... You and others can disparage her all you want; but don't expect me to participate.....

 

I never once disparaged Ann Davis in any of my posts. I am questioning what seemed like a very conscious messaging approach she chose. There is a difference between disparaging a person and challenging their ideas or, in this case, the ideas of the professional organization of which I'm a member. If we can't recognize that this level of engagement needs to occur for our professional growth, then we are already dead in the water.

[burnpac]

I never once disparaged Ann Davis in any of my posts. I am questioning what seemed like a very conscious messaging approach she chose. There is a difference between disparaging a person and challenging their ideas or, in this case, the ideas of the professional organization of which I'm a member. If we can't recognize that this level of engagement needs to occur for our professional growth, then we are already dead in the water.

 

My apologies for my choice of words. Just recognize that all of these issues are complexed and nuanced beyond what is generally portrayed on this and other forums. I do my best to give my perspective, but recognize my bias. Thanks for being a part of the solution ....

[EMEDPA]

Of course PAs do more than "routine work" in every practice.

.

this was my point. what you do is far from routine. I couldn't do it. an fp doc couldn't do it. many surgical residents couldn't do it. you deliver high level care of the same quality as that delivered by your sp. I am proud of the work you do. I also deliver high level care. so does andersen. so does contrarian and jmj11, etc.

I'm sure you are recognized in your community as a fine surgical pa however most folks asked what a surgical pa does would say "holds retractors" or " "hands the doctor instruments". these are the kinds of stereotypes that need to go away.

I would like to see pa's delivering extraordinary care highlighted just as often as pa's assisting , doing truly routine work, and doing administrative scheduling and other scut. I would like to see "pa's practice medicine" at the start and finish of every discussion of our jobs. many folks don't realize that. even physicians and nurses. there is a post on c1 now by a doc who is surprised that pa's are allowed to check bp's for example.

stuff about extraordinary pa's is all over our internal info(magazines, etc) but when we talk to the public that info never gets brought up and it's always "pa's help doctors by doing routine care so they can see sicker pts....pa's take call on weekends so those hard working doctors can take well deserved vacations....pa's help grandma make her appointments....where is "joe smith the pa works solo at xyz rural family practice in wyoming. his sp is 6 hrs away and they meet once/month for lunch to discuss the practice. joe delivers babies and runs the local er by himself and stabilizes and transfers all trauma pts in a 3 county area. joe also first assists the county's only general surgeon on all emergency cases. joe practices medicine and is the only primary care provider in a 300 mile area. his personal panel has 2000 patients in it who he is responsible for". THAT is the guy I want highlighted. not the guy who works down the hall from his sp seeing sore throats all day(although there is a place for this type of provider as well of course).

[burnpac]

this was my point. what you do is far from routine. I couldn't do it. an fp doc couldn't do it. many surgical residents couldn't do it. you deliver high level care of the same quality as that delivered by your sp. I am proud of the work you do. I also deliver high level care. so does andersen. so does contrarian and jmj11, etc.

I'm sure you are recognized in your community as a fine surgical pa however most folks asked what a surgical pa does would say "holds retractors" or " "hands the doctor instruments". these are the kinds of stereotypes that need to go away.

I would like to see pa's delivering extraordinary care highlighted just as often as pa's assisting , doing truly routine work, and doing administrative scheduling and other scut. I would like to see "pa's practice medicine" at the start and finish of every discussion of our jobs. many folks don't realize that. even physicians and nurses. there is a post on c1 now by a doc who is surprised that pa's are allowed to check bp's for example.

stuff about extraordinary pa's is all over our internal info(magazines, etc) but when we talk to the public that info never gets brought up and it's always "pa's help doctors by doing routine care so they can see sicker pts....pa's take call on weekends so those hard working doctors can take well deserved vacations....pa's help grandma make her appointments....where is "joe smith the pa works solo at xyz rural family practice in wyoming. his sp is 6 hrs away and they meet once/month for lunch to discuss the practice. joe delivers babies and runs the local er by himself and stabilizes and transfers all trauma pts in a 3 county area. joe also first assists the county's only general surgeon on all emergency cases. joe practices medicine and is the only primary care provider in a 300 mile area. his personal panel has 2000 patients in it who he is responsible for". THAT is the guy I want highlighted. not the guy who works down the hall from his sp seeing sore throats all day(although there is a place for this type of provider as well of course).

 

Thanks for the recognition, but you sort of missed my point. We should value the routine work along with the brain surgery, because it contributes to a better health care system. Some of what I do is "scut" work, but that is what our practice needs done to keep the money rolling. It improves everyone's QOL in the practice, and that is a good thing.

 

But I get your point that we need to recognize the extraordinary PAs among us as a demonstration of the highest use of PAs in the HC system. I agree. Getting this stuff on the air and in print is the challenge in large media markets considering the competing priorities. I will object to your assertion that this info never gets brought up, because it did when I did interviews and background, and I know that it was a hot button issue for President Killeen, who as one of his priorities changed the wordage about how we talk about PAs externally.

 

BTW, any physician (and I doubt by his comment that he really was; he sounds like someone trying to pull PAs' chain....) who thinks like that probably hasn't practiced medicine in the last two decades. Pretty ridiculous comment.

[EMEDPA]

BTW, any physician (and I doubt by his comment that he really was; he sounds like someone trying to pull PAs' chain....) who thinks like that probably hasn't practiced medicine in the last two decades. Pretty ridiculous comment.

she signed her name. it was a posted article from print. check it out, I think you are a C1 member, yes?

[andersenpa]

Joanna - I have known Ann Davis for a long time and consider her a stellar individual and exceptional leader. She has been a mentor of mine my entire career. Some of the comments in the interview are unfortunate and not representative of how I know that Ann feels about these issues. You and others can disparage her all you want; but don't expect me to participate. Due to my respect for her, and having been in the same situation, I will give her the benefit of the doubt every time. My apologies if that doesn't meet the approval of folks on this forum.

 

BTW, I'm not "forced" to represent the AAPA or anything or anyone else. My opinions and observations are exactly that; mine. They are based on my experience as a professional PA, and as a leader, over a four decade career. Please take whatever I say with a healthy grain of salt.... :-)

 

If you want to know the official AAPA position on this or any other issue, contact President Delaney. He currently speaks for the AAPA as their official spokesperson.

 

I will take part of that "disparage" as directed at me.

And I do disparage her poor effort in the interview.

Steve, I think you know where I'm coming from. She did a poor job, regardless of her previous efforts for the AAPA or the profession.

 

This is starting to sound like the guy who invites his friend to the party, they puke on the rug, and then spends the rest of the night saying "No, guys, he's a good guy! He's cool! Really!"

 

Like the fund companies say, past performance is not necessarily an indicator of future results. In the here and now this interview was an AAPA flop.

[andersenpa]

My apologies for my choice of words. Just recognize that all of these issues are complexed and nuanced beyond what is generally portrayed on this and other forums. I do my best to give my perspective, but recognize my bias. Thanks for being a part of the solution ....

 

let's not overstate it.

It's not that complex and nuanced. It requires a basic awareness of what's going on in PA practice to know that we are not coordinators or procedure machines.

She was asked basic questions and gave some of the most ill-conceived protrayals of PAs that I have seen come from an AAPA official.

 

Furthermore, since these reps are supposed to have the verbal skills to steer the question into the territory they want (if she's as awesome as you say she is), then it only speaks more to the fact that this was an intentional narrative (NOT THE REAL FACTS). For that she deserves even more shame.

[andersenpa]

Thanks for the recognition, but you sort of missed my point. We should value the routine work along with the brain surgery, because it contributes to a better health care system. Some of what I do is "scut" work, but that is what our practice needs done to keep the money rolling. It improves everyone's QOL in the practice, and that is a good thing.

 

Routine work has value but it should not be our selling point. We as PAs are the stewards of our profession and should be directing the conversation towards how WE want to pre presented, not what the health care system at large wants to see us as.

 

Docs also do routine work, all the time. Patient phone calls, coordinating consultants, discharging their pts from the hospital, removing sutures. But you won't see medical groups or hospitals advertising that.

 

Case in point, we hired a new interventional cardiologist at my facility this past yr. There is a large foamboard poster on an easel in our clinic lobby with his photo and specialty. "Dr Smith is here to help you with your heart health. He is specialized in general cardiology, interventional cardiology, and myocardial imaging..." etc.

It sure doesn't say "Dr Smith does the post cath groin check on all his patients in the recovery room. It doesn't even require advanced training."

 

It is absurd to highlight the mundane things we do when our real value lies in practicing medicine and providing real cognitive AND procedural clinical care.

[EMEDPA]

It is absurd to highlight the mundane things we do when our real value lies in practicing medicine and providing real cognitive AND procedural clinical care.

that was what I was trying to say. you said it a lot more eloquently.

[mktalon]

I believe that this line was particularly upsetting because of the fact that she, herself, places a possessive on the profession. It is bad enough that the AAPA won't address the name change issue, and now an official representative, on national radio, perpetuates the idea that PAs belong to doctors as their assistant.

 

"DAVIS: You know, I think early on that was the case. Now we're really seeing an emphasis on everybody's part on team-based care. Medicine just has to be a team sport. And physicians, particularly ones that are newer physicians, who trained with PAs and get out of their residency program and look around and say OK, now where's my PA so I can get to work, that's what you see more now."

[EMEDPA]

yup. would have been better as "OK, now I need to find a PA to join me in my practice so we can get to work"

 

even the president of the aapa in last month's pa professional wrote an article regarding how we need to do away with terms like "supervision", "midlevel provider", "allied healthcare worker" and "dependent practitioner"

source: PA professional june/july 2012 p. 33 Left bottom, "defining ourselves" section.

 

If the president of the aapa gets it then the official voices coming from the aapa in interviews and print should as well.

I have corresponded with President Delaney in the past, and although we disagree on the name change issue I respect a lot of his ideas and positions on other issues.

[NeoTrion]

I have to agree with Chris on this. We are in exactly the same situation, but I chose to hold off on joining. I think part of the problem is that we are stuck to the old way and old guard of doing things. I agree with the analogy about puking on the rug, and trying to tell everyone he/she is a good person. We can only let so many of these opportunities pass us by before we stagnate our own profession. I know I would like to see a little more aggression on the state and national levels, but it seems that people in those positions are pretty happy not making waves and want to keep the status quo. This is why the NP profession has pulled way ahead of us in different areas. They are aggressive and listen to what their members want.

 

I am not saying anyone is bad or otherwise, and I know I could not have done better. But the fact is that this is her job, and she fumbled the ball on this one. How many times are we going to make excuses for people in the upper echelons of leadership, and just say "oh well, another missed opportunity." There will always be should have, would have, could have in this types of situations. But when are we going to wake up and say "Thank you for your previous service, but we really need you to get aggressive in the arena of public opinion! If this is a problem, then maybe we need someone with a different perspective, and that will voice that when the time comes."

 

The point is that we all get tired and comfortable with the conceived notions and responsibilities as we know them, that sometimes we loose site of what is important in the future. Perhaps some of the younger crowed need to step up and grab some responsibility for themselves. The point is that things are changing and there is a faction that wants more vocal advocates for the profession and less apathy for the status quo. There is no doubt that she has done some great things, but perhaps the fire isn't burning as brightly. That is only my .5 cents worth............

[burnpac]

I will take part of that "disparage" as directed at me.

And I do disparage her poor effort in the interview.

Steve, I think you know where I'm coming from. She did a poor job, regardless of her previous efforts for the AAPA or the profession.

 

Like the fund companies say, past performance is not necessarily an indicator of future results. In the here and now this interview was an AAPA flop.

 

Poor analogy. We are not talking markets here. Past legislative affairs experience and success does provide an indicator for future results.

 

I talked with Ann, she has read this thread, she was receptive to feedback about the interview posted here, and will take the comments into consideration in all future public affairs communications. She was happy to see that people liked the new content on the AAPA website.

 

It should also be noted that Ann received more than 50 e-mails from PAs who thought that the information presented in the interview was good.

 

I have carefully re-read the transcript, and I think that you are reading and listening what she said through the filter of your own bias regarding what is important to you. I do the same thing. This was an interview about global issues regarding the supply and demand of health care providers. In my opinion, and in this context, Ann did a good job of not only painting PAs in good light, but also effectively framing PAs in a team context, a role in which PAs are well trained, and are infinitely qualified and acculturated to assume. One of Ann's many strengths is her ability to look at the global picture in health care, and avoid what can be perceived to be a self-serving agenda typical of many organizational representatives in media interviews. In my opinion, this serves us well in the long run. Obviously, some here feel that we should be more self-serving in this arena, but I will go with Ann's approach in serving the mission of the AAPA / profession and achieving our long term goals.

[mktalon]

One of Ann's many strengths is her ability to look at the global picture in health care, and avoid what can be perceived to be a self-serving agenda typical of many organizational representatives in media interviews. In my opinion, this serves us well in the long run. Obviously, some here feel that we should be more self-serving in this arena, but I will go with Ann's approach in serving the mission of the AAPA / profession and achieving our long term goals.

 

The global picture is that there are areas in medicine that doctors are fleeing from. Isn't that the cornerstone of the profession? How are PAs going to serve the public in all those underserved areas if they are busy calling grandma for the Docs, or corresponding with the family to set up appointments? To be effective in the mission, the public needs to know that PAs practice medicine competently and autonomously, especially where the doctors won't do so. If the problem was just a matter of freeing up doctors from some phone calls and making appointments, so they can do the important stuff, then medical assistants could be the solution to the whole problem.

[EMEDPA]

The global picture is that there are areas in medicine that doctors are fleeing from. Isn't that the cornerstone of the profession? How are PAs going to serve the public in all those underserved areas if they are busy calling grandma for the Docs, or corresponding with the family to set up appointments? To be effective in the mission, the public needs to know that PAs practice medicine competently and autonomously, especially where the doctors won't do so. If the problem was just a matter of freeing up doctors from some phone calls and making appointments, so they can do the important stuff, then medical assistants could be the solution to the whole problem.

 

well stated.

[Gordon, PA-C]

The global picture is that there are areas in medicine that doctors are fleeing from. Isn't that the cornerstone of the profession? How are PAs going to serve the public in all those underserved areas if they are busy calling grandma for the Docs, or corresponding with the family to set up appointments? To be effective in the mission, the public needs to know that PAs practice medicine competently and autonomously, especially where the doctors won't do so. If the problem was just a matter of freeing up doctors from some phone calls and making appointments, so they can do the important stuff, then medical assistants could be the solution to the whole problem.

 

I need to see some data on where newly graduated PAs end up practicing, but my anecdotal data with involvement at 2 PA programs suggests that a sizable percentage of them are NOT going into primary care. After all, who could blame them? If you are given the option of starting out at 120-140k in a subspecialty vs 80k in primary care, its not hard to see why most of the PA students I know are talking about going into surgical fields or other lucrative subspecialties.

 

I think PAs and NPs are driven by EXACTLY the same kind of financial incentives that drive MDs. NPs can open up their own clinic solo in rural New Mexico but who wants to mess with raising the kind of money it takes to do that, recruiting a patient base, lose money for several months before the business gets going, take paltry bottom barrel medicaid wages? Especially when you can walk into a subspecialty job and make double the amount of money as an employee with none of the headaches?

[andersenpa]

I need to see some data on where newly graduated PAs end up practicing, but my anecdotal data with involvement at 2 PA programs suggests that a sizable percentage of them are NOT going into primary care. After all, who could blame them? If you are given the option of starting out at 120-140k in a subspecialty vs 80k in primary care, its not hard to see why most of the PA students I know are talking about going into surgical fields or other lucrative subspecialties.

 

I think PAs and NPs are driven by EXACTLY the same kind of financial incentives that drive MDs. NPs can open up their own clinic solo in rural New Mexico but who wants to mess with raising the kind of money it takes to do that, recruiting a patient base, lose money for several months before the business gets going, take paltry bottom barrel medicaid wages? Especially when you can walk into a subspecialty job and make double the amount of money as an employee with none of the headaches?

 

for all PAs, ~30% by the last census

new grads may be a bit off, hard to say

PAEA data?

 

Your numbers may be influenced by the type of program you are dealing with.

If you looked at my local program (UW MEDEX, Lesh's program in CA) you'd have a different perspective

Overall more PAs are entering specialties as years pass

however you still have the people who "love" primary care and would do nothing else regardless of money (just like those of us who "love" surgery and would do nothing else)

 

Bottom line it's probably short sighted to say money is the prime factor

[burnpac]

The global picture is that there are areas in medicine that doctors are fleeing from. Isn't that the cornerstone of the profession? How are PAs going to serve the public in all those underserved areas if they are busy calling grandma for the Docs, or corresponding with the family to set up appointments? To be effective in the mission, the public needs to know that PAs practice medicine competently and autonomously, especially where the doctors won't do so. If the problem was just a matter of freeing up doctors from some phone calls and making appointments, so they can do the important stuff, then medical assistants could be the solution to the whole problem.

 

I don't get your point. We are many things positive to the health care system, including and most importantly, the practice of medicine. Last I checked, MAs can't prescribe, perform procedures, etc.

 

My point was that Ann looks at HC as an intricate system, with many moving, interrelated parts. She is an excellent representative PA, and also a health policy and legislative expert. She focuses on overall patient-centered needs. It is good for PAs to be seen in this light. Which was my point.

[Guest Paula]

Poor analogy. We are not talking markets here. Past legislative affairs experience and success does provide an indicator for future results.

 

I talked with Ann, she has read this thread, she was receptive to feedback about the interview posted here, and will take the comments into consideration in all future public affairs communications. She was happy to see that people liked the new content on the AAPA website.

 

It should also be noted that Ann received more than 50 e-mails from PAs who thought that the information presented in the interview was good.

 

I have carefully re-read the transcript, and I think that you are reading and listening what she said through the filter of your own bias regarding what is important to you. I do the same thing. This was an interview about global issues regarding the supply and demand of health care providers. In my opinion, and in this context, Ann did a good job of not only painting PAs in good light, but also effectively framing PAs in a team context, a role in which PAs are well trained, and are infinitely qualified and acculturated to assume. One of Ann's many strengths is her ability to look at the global picture in health care, and avoid what can be perceived to be a self-serving agenda typical of many organizational representatives in media interviews. In my opinion, this serves us well in the long run. Obviously, some here feel that we should be more self-serving in this arena, but I will go with Ann's approach in serving the mission of the AAPA / profession and achieving our long term goals.

It is heartening to know Ann is aware and taking our comments into consideration for the next PR campaign. BTW..what is the mission of the AAPA/Profession and our long term goals?

[burnpac]

so for the good of the patient, its best to be the doctors helper? it keeps them safe? is that what you mean when you say " She focuses on overall patient-centered needs. It is good for PAs to be seen in this light. Which was my point."?

 

Again, you are also missing the point. PA's possess a broad variety of skills, training, experience and scope of practice that makes them infinitely adaptable in the present HC system. I would never use the term "doctor's helper" as it is not descriptive of the PA role. Neither would Ann Davis.

[burnpac]

[/u]

It is heartening to know Ann is aware and taking our comments into consideration for the next PR campaign. BTW..what is the mission of the AAPA/Profession and our long term goals?

 

Page one of the Policy Manual.

 

AAPA Mission

To ensure the professional growth, personal excellence, and recognition of physician assistants, and to supporttheir efforts to enable them to improve the quality, accessibility, and cost-effectiveness of patient-centeredhealth care.

AAPA Vision

The American Academy of Physician Assistants is the leader in providing support and advocacy for physicianassistants, the primary organization advancing the profession, a premier participant in health caretransformation, and a passionate champion of patient-centered care.

[burnpac]

"DAVIS: You know, I think early on that was the case. Now we're really seeing an emphasis on everybody's part on team-based care. Medicine just has to be a team sport. And physicians, particularly ones that are newer physicians, who trained with PAs and get out of their residency program and look around and say OK, now where's my PA so I can get to work, that's what you see more now."

 

you'll have to forgive me. i originally used the term "doctors helper". i should have put in an apostrophe like you did...to show possession. i needed to do that because Anne Davis gave me the impression that a physician out of residency has the ability to own PAs.

 

As long as my various SPs and contracts continue to pay what they are currently paying me, they can call me what ever they like.... :-)

[andersenpa]

Poor analogy. We are not talking markets here. Past legislative affairs experience and success does provide an indicator for future results.

 

PAs are investing their money in an organization which is supposed to represent their profession. They support an organization when they believe in its mission statement, just as people invest in securities based on a sound business plan. When the mission statement no longer matches their desires, they will shop the "market" of representation (or just sell their shares and cash out!). The organization can either commit itself to a directional change, or keep on the same course and lose investors. I would ask the AAPA how they weigh their organizational goals against the vocal wishes of their constituents...whether that be how PAs are presented in public relations events, the name change, or anything else.

 

I talked with Ann, she has read this thread, she was receptive to feedback about the interview posted here, and will take the comments into consideration in all future public affairs communications. She was happy to see that people liked the new content on the AAPA website.

 

If she is reading this I would like to (as a forum moderator) invite her to post in response.

 

It should also be noted that Ann received more than 50 e-mails from PAs who thought that the information presented in the interview was good.

 

A broken clock is wrong twice a day. If I will be accused of looking at things through a biased lens, I will extend that same notion to the possibly biased supporters of her AAPA-written narrative.

 

I have carefully re-read the transcript, and I think that you are reading and listening what she said through the filter of your own bias regarding what is important to you. I do the same thing.

 

We all do. We have our individual beliefs and philosophies which inform our opinions. The question arises- what does an organization do when their internal objectives don't jibe with their members? What do they do when the membership consensus exceeds a majority? What do they do when their representative says something which insults and undercuts thousands of primary care PAs?

 

This was an interview about global issues regarding the supply and demand of health care providers. In my opinion, and in this context, Ann did a good job of not only painting PAs in good light, but also effectively framing PAs in a team context, a role in which PAs are well trained, and are infinitely qualified and acculturated to assume. One of Ann's many strengths is her ability to look at the global picture in health care, and avoid what can be perceived to be a self-serving agenda typical of many organizational representatives in media interviews. In my opinion, this serves us well in the long run. Obviously, some here feel that we should be more self-serving in this arena, but I will go with Ann's approach in serving the mission of the AAPA / profession and achieving our long term goals.

 

I'll agree that we do need to be more self serving. We as a profession need to aggressively advocate the degree to which PAs practice medicine, and in a way which observes ideas like supervision and team practice without kowtowing to them.

 

Eg, highlight the fact that PAs can be de facto solo PCPs while practicing under the construct of a team model. THAT really demonstrates the competency of PAs (something we should be celebrating), as well as the advantages of telecommunication and EHRs (allowing remote supervision/consultation). Hospitalists and internists use specialists for consultation. PAs do the same with specialists, as well as their SPs.

 

By acting more self serving (an idea that has worked well for nursing), we can advance our profession in the eyes of patients and the public. Top-down appeal to physicians will work in some ways. Bottom-up appeal to patients is another key component to our advancement. And portraying a profession which is trained at the graduate level to practice gold standard medicine as coordinators and procedure monkeys is hardly going to inspire the lay public to seek out PAs as their PCPs or specialty providers.

 

Ann's approach may serve the mission of the AAPA well; how that matches the mission of working PAs remains to be seen.

[andersenpa]

and I'll add that there is an overriding theme from the AAPA that how we serve the health care system as a whole supercedes how PAs wish their profession to be defined....the name change, the term "supervision", the old apostrophe issue, the description of our work ("coordinator"), etc....are all part of the same mix.

 

So your comment that "as long as my SP keep paying me, he can call me what he wants" (while being a bit tongue in cheek) contains a morsel of that sentiment. As long as the docs allow us to play in the big house, we'll live by their rules. Sorry, this is not the way a profession should operate. We need to take some ownership of the role we have earned in the health care market, based on >40 yrs of excellent, competent medical practice.

[Guest hubbardtim48]

I agree. Primary care is where my heart is.