physasst Posted August 8, 2012 Share Posted August 8, 2012 In another thread, we were discussing the disrespect that PAs often encounter, and emedpa and others agreed, however, it dawned on me that most pre-PAs and students likely might not understand what we mean.... It is rarely what many might think, and is usually not secondary to patient respect (although that occurs too)..... Here are some examples, most of which have occured over years at various institutions (which is more discouraging to me, cause it seems to be universal), and other experienced PAs, Ventana, EMEDPA, etc, feel free to add to this..... 1. Had one surgeon who would require that ANY non MDs raise their hands before speaking in the OR. 2. Heard of another that flatly refused to speak to ANY non MDs during a case...including CRNAs...he requested that they inform their staff anesthesiologist, and ONLY if they felt they needed to interrupt him, would it be acceptable to address him in a case.... 3. Another had their child seen in the family medicine clinic, and when they were scheduled to see a PA, called the Chair of the department to dress them down for having a physicians kid see a PA "which was completely inappropriate"... 4. Saw a surgeon throw a PA out of the OR because he dropped a retractor..claiming that "I don't know why PAs think they are so f'n special, my 10 year old son can hold a f'n retractor"...... 5. Another hospital I have moonlighted at (jmj11 knows this hospital well, as he worked there too), well, there are TWO clinics that staff the hospital, and the physicians of the one clinic group will NEVER take report on an admission from a PA...that's right....if you work up a patient and need to admit them, you need to find the ED physician, tell them all about the case, and THEY have to call report to the admitting physician.... 6. One time one of the PAs I know was staffing the fast track area of an ED, and was within in an hour of her last patient. Triage can room complicated level 2 and 3 patients if needed to flex, but the charge nurse is supposed to talk to the PA about it and decide which patients can be seen in Fast Track. 45 minutes before her shift was supposed to be wrapping up, a new attending comes on and tells the charge nurse to "fill up Fast Track with whatever you have"........He would never, EVER, in a million years have done that to one of his physician colleagues. He would have approached them and asked, "Hey, the waiting room is kind of full, can you help me out?" It didn't even occur to him to extend the same courtesy to the PA..... 7. I once saw a mass trauma incident, where the trauma/critical attending came over to our hall to ask who we could spare....our attending looks around and says "Well, we don't have any EM folks"......I replied "Ummm, I'm standing right here". She meant EM residents, but still, her thought was clear. 8. At one institution, when the PAs asked to be included in the resident education rounds, one of the physicians stated "I don't know about that. That could be insulting to the residents, I mean, how would you feel if you went through medical school and then found out that you could get the same resident education being only a PA"...... EMEDPA was right in the other thread.....disrespect from patients occurs rarely....maybe once every month or two for me.....it's not them..... But the physician disrespect occurs frequently.......even nursing as well, but only rarely from nurses. I once had a nurse tell me that she would take orders from me, as I was not a physician (this was a long time ago), it wasn't until the physician called her administrator that she changed her tune, but she would make snide comments all the time. I still hear that once in a great while. And how sad was it that it had to be like that.... When we say disrespect....this is what we mean. And it wears on you......I wish I could just ignore it.....but I can't....and I for one, demand equal respect now. Maybe I come off like a prick, or someone with a chip on their shoulder....that's possible, but I simply won't go through the things I did early in my career again. I won't be treated as a welcome mat. I'm not saying ANY of this to detract from our profession (it's not really our fault, but rather a status theory problem)...or to make someone not want to be a PA, but there is a cultural gap now....it's there...it's real and you have to go into this with your eyes wide open. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 8, 2012 Moderator Share Posted August 8, 2012 consultants who won't talk to pa's on the phone, even specialty pa's. nurses who say"shouldn't a doctor see this pt or do this procedure" I left my last job when the nursing supervisor/unit manager direspected me by saying "you're just a physician's assistant, you don't know what you are talking about". I handed her my pager and told her to replace me and walked out(she has since been fired for other issues). Link to comment Share on other sites More sharing options...
Contrarian Posted August 8, 2012 Share Posted August 8, 2012 Rounded at a hospital that suddenly banned PAs from the "Physicians Lounge." For those that don't know... this is where the Surgeons, Anethesiologist, Invasive Cardiologist and Surgical/Trauma PAs traditionally hung out in between cases. There was usually a LARGE T.V., big comfy recliners... a refrigerator stocked with beverages and snacks... and there was usually some fresh hot soup, and sandwiches for these folks who were doing 3-8hrs surgeries. So they banned all non-physicians, but allowed physicians who didn't even see hospitalized patients in the lounge. _______________________________________________________________________________________________ Another hospital remodeled and added a wing and a new parking lot. They then expired all of the previously issued parking placards and access key cards. Then only issued new ones to Physicians. The 20 something PAs and NPs were on their own and had to jockey for parking spots in a undersized outdoor lot, 3 blocks away, through the inclement weather... like the rest of the "Ancillary Staff." "Physician only" lot rarely completely full, so they started letting admin types park in that lot. ________________________________________________________________________________________________ Know a PA who was moved out of his office and into a Freekin HALL CLOSET right next to the lobby on one side and a bathroom on the other. They took the door off the closet and put a VERY small micro desk in it. He had to look at EVERY patient brought in from the lobby in the eye because they were walked by his desk. Dude had to find places to dictate, because of HIPPA issues with him speaking into the recorder with the lobby door 6 ft away and patients walking by every few minutes. He also had to check to see who was in the bathroom before he could dictate. The really crappy part of this insult was... the guy (newly hired physician) who they gave the office to would regularly take a big, foul, fiberless, protein ladened "Duece" in that bathroom... right next to his desk (that would vibrate when te toilet flushed) and leave the whole area uninhabitable... ________________________________________________________________________________________________ Nurses directly challenging PA's orders. Nurses telling/insisting PAs need to ask the doctor before writing a plan of care.. Patients questioning the PAs plan of care to the nurse... instead of the nurse clarifyng the plan with the PA... they simply walk past the open office of the PA and ask the Physician. Physicians refusing to come to the phone when PA's courtesy call them to discuss a mutual patient, instead having their nurse tell the PA on the phone to "have your SUPERVISING Physician call to speak to the doctor because Dr. A$$hat don't talk to Mid-Levels"... (PA's supervising Physician has never seen the patient and wouldn't know them from a "can of paint.") Just a few off the top of my head... Contrarian Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted August 8, 2012 Moderator Share Posted August 8, 2012 I have been very fortunate to not (yet) have significant issues, but then again I've only been a PA for a few years- and am very thankful to you guys and others who blazed trails to help get us to where we are. I have had the "admitting hospitalist who wouldn't speak to a PA about a patient, even if the patient was never seen by the doc". One of our ER doc's response to this was "I never saw the patient, but our perfectly capable PA did see the patient, and can tell you whatever you wish to know about them". Or he would have the admission doc hold the line between each and every question to ask the PA sitting next to him answer all the questions- I guess because it came from the "dulcet tones" of a physician it somehow made it sweeter-sounding. Link to comment Share on other sites More sharing options...
coloradopa Posted August 8, 2012 Share Posted August 8, 2012 I've been lucky to have good physician support. Similar to Contrarian, the dinosaurs wanted the physician lounge for a physician only. Friend of mine moved an entire weeks worth of spine cases to a competing hospital. When the OR director called up to find out why, he said he wanted to work in a hospital where he could eat his lunch without being bothered by people in the cafeteria. When the OR director called the surgeon, he said, Kyle decides where the cases go you should probably keep him happy. This led to the medical director calling and telling him that there had been a mistake and of course he and all PAs were welcome in the Physicians lounge. YMMV. Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 8, 2012 Moderator Share Posted August 8, 2012 I've been lucky to have good physician support. Similar to Contrarian, the dinosaurs wanted the physician lounge for a physician only. Friend of mine moved an entire weeks worth of spine cases to a competing hospital. When the OR director called up to find out why, he said he wanted to work in a hospital where he could eat his lunch without being bothered by people in the cafeteria. When the OR director called the surgeon, he said, Kyle decides where the cases go you should probably keep him happy. This led to the medical director calling and telling him that there had been a mistake and of course he and all PAs were welcome in the Physicians lounge. YMMV. boy I want to work with that person.... That is great When I was hospital empolyed I had some of this - PA's can't possibly do conscious sedation - that is a Doc level thing only (never mind I was doing IR and putting ports, HD cath, Bx anything Iu could see with U/S or flouro, venous access....... the whole shooting match) yet I could not give 2 and 50 as that was "a doc level thing..." Or the Resident that "refused to learn from a PA" Told them they could go sit and read CXR's with the rads (politely "get out of my specials room) Or for years we got lumped in with the general parking rules - never mind we were dong crazy hours - was not till a female PA complained she felt endangered as she was leaving late every night and having to walk to the middle of no where alone that admin changed honestly seems to be slowly changing (or I just have thicker skin these days or I am not exposed to it as much.. unsure which one) With the cost containment issues that health care is facing I can not see PA's and NP's not gaining ground on all these issues as Admin is going to be more and more inclined to see the value we bring..... I hope anyways Link to comment Share on other sites More sharing options...
jen0508 Posted August 8, 2012 Share Posted August 8, 2012 Thankfully no issues yet where i work As a student, i rotated at a hospital that wouldnt let PAs into the physicians lounge unless they were accompanied by their supervising MD. in my opinion this is almost more insulting than not allowing PAs in the lounge period. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted August 8, 2012 Moderator Share Posted August 8, 2012 As a hopeful future Navy PA, do you see these indignities suffered by military PAs? Most military docs I've spoken with seem to think of PAs as colleagues. Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 8, 2012 Moderator Share Posted August 8, 2012 military = rank rank demands respect but it is not as clear as that - an E-9 'outranks' an O-1 and maybe an O-2 in day to day happenings (a fact new officers struggle to learn sometimes) So in the military you have your profession and your rank - but you still need to earn the actual respect Link to comment Share on other sites More sharing options...
PAstudentCanada Posted August 8, 2012 Share Posted August 8, 2012 I dont' want to cause any trouble here and I too like the idea of chilling in the physician's lounge (and really enjoyed having lunch with my program director, a physician, there a few times) but it is the "physician's" lounge, not the "physician's and PA lounge." While I think it might be great to have a lounge for us both, I don't see why it should be offensive to anyone that anyone, including PAs, who is not a physician shouldnt be allowed to hangin the physician's lounge. Perhaps we should have a PA's lounge? Again, I am not trying to stir trouble here. I am hoping someone can reply and explain to me why I am wrong about this. We are not physicians, we are PAs. So why should we be allowed equal access in a lounge made exclusively for physicians? Link to comment Share on other sites More sharing options...
physasst Posted August 8, 2012 Author Share Posted August 8, 2012 I dont' want to cause any trouble here and I too like the idea of chilling in the physician's lounge (and really enjoyed having lunch with my program director, a physician, there a few times) but it is the "physician's" lounge, not the "physician's and PA lounge." While I think it might be great to have a lounge for us both, I don't see why it should be offensive to anyone that anyone, including PAs, who is not a physician shouldnt be allowed to hangin the physician's lounge. Perhaps we should have a PA's lounge? Again, I am not trying to stir trouble here. I am hoping someone can reply and explain to me why I am wrong about this. We are not physicians, we are PAs. So why should we be allowed equal access in a lounge made exclusively for physicians? It depends on your perspective. When I was younger and right out of PA school, I thought similarly to what you express. But when decades pass, and you are teaching residents, watching residents and fellows that you taught become your attendings and realizing that while you taught them, that they are now "supervising" you, and when you watch a new attending physician struggle with a diagnosis or procedure that you are good at, only to have them scoff at you when you try to help them, and when you hear a new attending sarcastically question your management plan, even though you realize that they are doing so only out of a personal fear that they don't know what they are doing...well....it gets old. When you realize that you are performing all of the same duties as a physician and that, depending on your specialty, you are essentially equivalent...well, it bugs the living sh*t out of you to be honest... You end up feeling like a door mat....... Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted August 8, 2012 Moderator Share Posted August 8, 2012 So I may have a doc not speak with me because I'll be an O-2? Are you saying that a physician won't disrespect me only if I outrank him? Or I might get disrespected until I reach a certain rank like o-3? Seriously, I see what your saying and agree that respect is earned, but what about PA specific respect with administration, consulting physician (who wouldn't know me), and privileges (like a lounge/parking/personal caf) in the military? To simplify the question, have you seen the same thing that has been described above in this thread happen in the military because the person was a PA. Link to comment Share on other sites More sharing options...
PAstudentCanada Posted August 8, 2012 Share Posted August 8, 2012 I understand the situation you are in and I know I would feel that way too. The weird thing about being a PA, especially an experienced PA, is that you are essentially a physician but in legal terms you are not. It is odd, and it seems odd every time I explain my role to people. That's why I think there should be a bridging opportunity for PAs to become physicians. It depends on your perspective. When I was younger and right out of PA school, I thought similarly to what you express. But when decades pass, and you are teaching residents, watching residents and fellows that you taught become your attendings and realizing that while you taught them, that they are now "supervising" you, and when you watch a new attending physician struggle with a diagnosis or procedure that you are good at, only to have them scoff at you when you try to help them, and when you hear a new attending sarcastically question your management plan, even though you realize that they are doing so only out of a personal fear that they don't know what they are doing...well....it gets old. When you realize that you are performing all of the same duties as a physician and that, depending on your specialty, you are essentially equivalent...well, it bugs the living sh*t out of you to be honest... You end up feeling like a door mat....... Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted August 8, 2012 Moderator Share Posted August 8, 2012 I understand the situation you are in and I know I would feel that way too. The weird thing about being a PA, especially an experienced PA, is that you are essentially a physician but in legal terms you are not. It is odd, and it seems odd every time I explain my role to people. That's why I think there should be a bridging opportunity for PAs to become physicians. There is: http://lecom.edu/college-medicine.php/Accelerated-Physician-Assistant-Pathway-APAP/49/2205/612/2395 Not saying it's easy...but it's there Link to comment Share on other sites More sharing options...
KMD16 Posted August 8, 2012 Share Posted August 8, 2012 I've had severely bad experience, too numerous to count in my few years in practice. Link to comment Share on other sites More sharing options...
Guest hubbardtim48 Posted August 8, 2012 Share Posted August 8, 2012 Do you mind elaborating? Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted August 8, 2012 Moderator Share Posted August 8, 2012 you might also have to get used to nurses "outranking" you as well... obviously not overuling your clinical judgement, but holding rank over you. I understand I can be outranked by any commissioned officer. A nurse (or a PA) could be a Surgeon General, theoretically. I'm not worried about it. What I am concerned with is the above scenarios occurring in the military. I imagine it very collegial from my research, but thought I would ask on here as well to get a larger sample size. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 8, 2012 Moderator Share Posted August 8, 2012 at my facility we have a medical staff lounge accessible to pa's and docs. at one of my per diem jobs pa's get physician all access parking passes. at my rural em job I am treated like a colleague and was recently told by the chief of em that I could do whatever I felt comfortable with, no limitations. if I could put all the good features of my various jobs together it would be a great job. unfortunately no single job is perfect. the job I like the most with the best docs, best scope of practice, etc pays the least and has the worst benefits.(rural em job). might still take a full time job there at some point anyway even though it would probably cost me 50k/yr. Link to comment Share on other sites More sharing options...
PAstudentCanada Posted August 9, 2012 Share Posted August 9, 2012 I'm not impressed with that. It isn't much of a bridging opportunity, it's just three years med school, we have a couple of those on Canada already, my med school (where I did my PA program) is a 3 year MD. There is only 6 months difference between the PA and MD programes. When I talk about bridging I mean a year course course of examinations, education, and clinical supervision that would make one eligible to practice as a physician with prereqs being that you are a licensed PA with say 3 years in practice or something like that. There is: http://lecom.edu/college-medicine.php/Accelerated-Physician-Assistant-Pathway-APAP/49/2205/612/2395 Not saying it's easy...but it's there Link to comment Share on other sites More sharing options...
andersenpa Posted August 9, 2012 Share Posted August 9, 2012 I dont' want to cause any trouble here and I too like the idea of chilling in the physician's lounge (and really enjoyed having lunch with my program director, a physician, there a few times) but it is the "physician's" lounge, not the "physician's and PA lounge." While I think it might be great to have a lounge for us both, I don't see why it should be offensive to anyone that anyone, including PAs, who is not a physician shouldnt be allowed to hangin the physician's lounge. Perhaps we should have a PA's lounge? Again, I am not trying to stir trouble here. I am hoping someone can reply and explain to me why I am wrong about this. We are not physicians, we are PAs. So why should we be allowed equal access in a lounge made exclusively for physicians? In a way I agree To twist an old phrase...... I'd rather not belong to any club that would refuse to have me as a member Link to comment Share on other sites More sharing options...
Contrarian Posted August 9, 2012 Share Posted August 9, 2012 ... So why should we be allowed equal access in a lounge made exclusively for physicians? Because even if they did make a "NP/PA"... "Mid-levels who just happen to practice the same Medicine" lounge... Physicians would likely be allowed in it... I'm willing to bet that they would be allowed in it without being required to be escorted by the PA/NPs that they work with. Because the lounge is suppose to be there for "medical staff" that are required to spend a significant amount of time in the hospital. Because the lounge should be for all "medical staff," and access should be based upon ROLE but instead discriminates against a particular credential. This is no more correct than if they disallowed DO's in the lounge. As it stands, Family practice physicians from the other side of town could come to the lounge daily and hang out, but the PA who just completed a 6hrs surgery down the hall and is about to scrub in on another 3 hr emergency surgery can't go in and sit down. Its a "Physicians" lounge so... the overnight (NP/PA) hospitalist doing a 24hr double shift can't go in ... but a Chiropractor can...??? A Cosmetic Dermatologist, and/or Dentist can can go in and have a sandwich and a beverage, take a nap and nither of these even see patients in the hospital. They make MILLIONS of dollars off of PAs doing pretty much exactly what those allowed in the lounge do. Not being allowed into that lounge is entirely too similar to this: GUESS WHO THE "COLORED" are... Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted August 9, 2012 Moderator Share Posted August 9, 2012 seems like getting dressed down in some shape or form is part and parcel of the military experience from what i hear. i would guesse that you could face "disrespect" on a bad day from anyone who outranks you...not just MDs. Getting dressed down and "I won't talk to PAs." isn't the same thing. Nor is being "disrespected" for rank about administrative duties than disrespect for your profession. But don't worry about it. I'll confirm my thoughts when I get there. It wasn't going to change my decision either way. I'll find out in October if I get the scholarship. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted August 9, 2012 Moderator Share Posted August 9, 2012 i have a cousin who is a navy doc, and is a decent human being. As are all the ones I've met. They've all stated they have no problems with PAs practicing solo on a ship or anywhere else in the military. Link to comment Share on other sites More sharing options...
andersenpa Posted August 9, 2012 Share Posted August 9, 2012 GUESS WHO THE "COLORED" are... Finally I now know what the "-C" stands for............... Link to comment Share on other sites More sharing options...
CAdamsPAC Posted August 9, 2012 Share Posted August 9, 2012 Finally I now know what the "-C" stands for...............Why do you think I refer to him as "C" and myself as "C" Adamspac???? Link to comment Share on other sites More sharing options...
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