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Specialty with least amount of "disrespect"


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In my humble opinion, dependent roles, like surgery, earns you more money and creates a tag team with the MD that the patient seems to understand. In the more independent roles, ER, Family Practice and etc., where the PA is in total replacement of the MD, is where you hear the questioning the most.

 

I decided to market my practice as a PA-centric practice so those who come to me know exactly what they are getting. They would never, ever ask, "When do I get to see the doctor."

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I would agree with JMJ to a certain extent (being in surgery), but also know that when there is mutual respect publicly demonstrated between and among physician and PA team members in front of patients, then the patients perceive you in a more favorable light, and those questions never come up. It is when you don't have the support of your physician partners, or when they have issues regarding their own worth and self esteem, when the pecking order emerges. Physicians in this situation and of this mind set feel compelled to make sure everyone on the team is "in their place."

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You're right True Anomaly, I rarely get that. The four years that I was sole provider I never got that comment. I still am called "doc" or Dr. Paula or "the doctor" and I still reply to those patients "I'm a PA". I love it when my patients say "I've never had a lady doctor do my prostate exam before" and I say to them, "you're in luck, I'm not a doctor, so don't worry!" They laugh.

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You're right True Anomaly, I rarely get that. The four years that I was sole provider I never got that comment. I still am called "doc" or Dr. Paula or "the doctor" and I still reply to those patients "I'm a PA". I love it when my patients say "I've never had a lady doctor do my prostate exam before" and I say to them, "you're in luck, I'm not a doctor, so don't worry!" They laugh.

 

That's too funny! Do you mind if I ask how rural/underserved is the community in which you practice? How long would it take you to get to the nearest "big city" ??

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I hardly ever get those statements in my practice, but for different reasons.

On my service the PAs operate and run the ICU. The patients are either asleep or just coming out of anesthesia, under the influence of opioids, delirious, etc. They are in no state to understand or complain.

 

Setting those aside, even those that are compos mentis are still so appreciative to have made it through major surgery successfully that they are appreciative of anyone who is there to care for them.

And of course there are those who still call us doc despite our displayed credentials.

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The nearest "big city" is 2 hours away. The nearest critical access hospital is 30 minutes away in a small town of about 2,000 or less. The big city is maybe 50,000 or so. We rarely send our patients to the big city. Even tho the CAH is 30 minutes away, it still takes 20-30 minutes for an ambulance to arrive, as the EMS staff are all volunteers. We have one tribal employee who is on the volunteer EMS staff so she responds to the clinic immediately from her job and the tribal police send someone over ASAP. They can get to the clinic in less than 5 minutes as we share the same parking lot. The EMS system does not have anyone who is able to put in IVs or administer medications, they monitor the patient on the way to the CAH. We will place the IV and give certain meds before EMS arrives. We do not use morphine. We will administer meds such as aspirin and nitro for Chest pain patients. I work in the Upper Peninsula, Michigan. This clinic has an MD on staff 3-4 days weekly, but I swear to God, he is rarely here when CP patients come in. ....always seems to be on his day off! The NP and I manage quite well and have our routine down pretty slick. We obtain the EKG before EMS comes, and are already on the phone to the CAH by the time they arrive. We seem to have a lot of CP and stroke symptoms come in, and severe exacerbations of COPD.

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primary care pa's get far more respect in most cases than specialty pa's because their scope of practice is essentially 100% that of their sp's. any time you have a situation with a perceived group of pts seen only by doctors the disrespect creeps in. "that's not a pa level case". "pa's aren't allowed to do that procedure", etc

in 16 yrs as an em pa I have been treated as a colleague and respected at exactly two jobs out of six. one had an fp residency there and I was treated as a resident. the other is my current rural per diem job. they almost throw a party every time I show up there because they are so understaffed the vast majority of the time. I created that job from scratch with a cold call asking to do 1 weekend/mo 5 yrs ago. they had a full time job posted for years and no one took it. my current family situation is not conducive to working there full time. someday maybe when the kids go to college.

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I think respect is very much dependent on your relationship with your SP. If they show respect to you in front of patients (that is key) then the patients will key off of that. Also your confidence plays a big part too. If you know your stuff and patients sense that, there is less need for them to hear the same thing from your SP. Now that doesn't mean coming off cocky and quoting statistics, but just having a full understanding of your specialty.

 

I have specialized since graduating 12 year ago. My first year in allergy and asthma was dreadful. The other PAs and I were treated like second class citizens and patients picked up on that. My current job (in derm) has been a dream. I am treated as an equal with the other MDs, including making decisions for the practice, they solicit my opinion on what derms we should or shouldn't hire, etc. I see my own patients and the patients know they are seeing a PA. I have never had one ask to see the doctor. Occasionally I will bring my SP in to reinforce a point though because sometimes I think patients need to hear the same news twice, to drive it home. And she will back me up 100%. That goes a long way in my book. My 0.02 cents.

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I'm currently in Family Practice/Pediatrics with a SP who's had the practice for over 30 years in the same place. Wise, respectful (except when he fooled me into working on my day off). Gave me my own key on my first day as well as my own office. I'm on the Call schedule and we're moving towards getting me credentialed where he was Chief of Staff but now just rounds. He's even helping me get a house this week and is letting me sleep in my office until we get it. I have respect from him that I would never belay. As for my patients, my presence demands respect from most ... or if it doesn't in the beginning, it sure does in the end ;)

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I would believe that. whenever I see former or ex-military folks it's always "yes sir, no sir, thank you sir".

 

Nowadays they're all officers, but the senior PA in my office was actually demoted from warrant officer to Spec-6 when they RIF'ed most of the PA's from the Army a few decades back. He was entitled to return to his permanent rank as a corpsman, and ended up keeping his PA-C up on his own and moonlighting until he got to 20 and out.

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Nowadays they're all officers, but the senior PA in my office was actually demoted from warrant officer to Spec-6 when they RIF'ed most of the PA's from the Army a few decades back. He was entitled to return to his permanent rank as a corpsman, and ended up keeping his PA-C up on his own and moonlighting until he got to 20 and out.

 

Had a nurse buddy that the same thing happened to because he had an associates instead of a bachelor's degree. He got the last laugh, however, by completing his twenty years. Guidelines at the time allowed retirement at the highest grade held, so he got 50% of his AF captain's pay instead of TSgt.

 

I am working now in a rural clinic owned by a PA. Our supervising physician has never set foot in the building. It's nice to never hear "I want to see the doctor". These folks are just glad to have a place to be seen.

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I work in primary care .... In my practice you choose who you make an appointment with. It is not a clinic where you show up and wait / hope to be evaluated. Here you make an appointment and know exactly who you are meeting. If you are meeting with me .. you know I am a PA. And if you google muy name or go to the practice website you can see my entire professional summary. In the last 4 and change years I have had a handfull (6-7) of people ask when are they going to meet with Doctor .... I usually tell them they should schedule an appointment and follow up with him if that is who they are most comfortable with. I have had a few of those types return to see me a few months later because they found my approach better. I often those people who snub you for being a PA (and made an appt with you fully knowing what they were doing when they could have done across the street to the urgent care place and met with an MD) have an underlying personality issue ... and its obvious just looking at the medical history. You cannot get upset by moments like that ... just feel bad for the person and use it as an opportunity to improve the profession and persons health.

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There is a strong aspect of social identity theory and status interplay in healthcare. One of the papers I am just finishing....or I should say, I am done with, but waiting on my co-author to finish his part is on how status and different sociological status theories affect inter-professional relationships between physicians and NP/PA providers. How this status can be detrimental, and how different approaches USING status can improve not only inter-professional relationships but can improve patient care by enhancing teamwork.

 

For myself, this has always been somewhat of an issue, although to be honest, it is partly a result of my own biases as well. I've worked in surgical situations where it was made VERY clear to me, the patient, the residents, and everyone else that I was an underling, and I've worked with true professionals who valued my input. Respect is a difficult topic, for starters, you have to ask yourself....am I more concerned with PEER respect, or PATIENT respect? The study I completed as part of my doctoral dissertation found some interesting differences in PAs....

 

Primary Care PAs to a greater degree (statistically significant) cared more about respect from patients....whilst specialty PAs to a greater degree cared about respect from peers.......I'm still not sure about the significance of this, but it was an interesting distinction to find.

 

It took me a while, but I found a lot more respect in my last two specialties than when I worked in the surgical one.....My 0.02 cents at least.

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