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| Doctor, Doctor Give Me the News…….. |
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by David Mittman, PA - May 18, 2010
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 Provided by: Clinician 1
Last week the number of posts on physician sites talking about NPs and PAs hit a record. I was checking a number of sites all week. If you have not been following some of them you should.
There is Fox News where Dr. Ablow insinuated that “nurses” (and others?) were not bright enough to become physicians (probably would have been turned down for med school anyway) and seemed to say “nurses” (seems to not purposely have said NPs) did not have the training to treat medical illnesses. Most significantly, he clearly said “No man or woman in his or her right mind would prefer to routinely talk to an on-call nurse when his or her child is sick, rather than a doctor”.
We also had the New York State Medical Society send out an email (it appears with their MSSNY site info on top) where the new incoming President asks all physicians to join and says “Change is possible but only if we unite and raise an army of physician warriors”.
Interestingly, in today’s age, it chillingly sounds like she called for a jihad against us “infidels”. I do not mean to offend anyone but it really reminded me of that.
There was also Dr.Pho’s blog on WedMD called KevinMD. There are a number of posts about the “PA Leaders Name Change Statement”. A physician cut and pasted it on Sermo and others have started new threads on this site. Most of the physicians were against a change but not why you think they would be. They were concerned with PAs wanting independent practice, while PAs clearly maintain that independent practice is not the issue and the statement went out of its way to point that out. Many physicians in Sermo and on Kevin’s blog also felt that PAs wanted to add PHYSICIAN to our title (someone MUST explain that to me). One physician did post another whole new blog saying a PA name change would be no big deal and to not oppose it.
Lastly, there is a new site called “No ShortCuts” where DNP information is posted and reviewed. The author told me that the sites mission is to “Inform about the proliferation of DNP’s. I have nothing but respect for PAs and NPs, but when there’s a strong lobby to equate NPs with primary care physicians, with a fraction of the training and education, something needs to be done”. I have emailed this person twice (who I think is a physician) and he seems not to be speaking for anyone but himself. I asked him to consider building bridges rather than looking at the situation negatively.
So what have I learned?
- Few to none of the people that wrote really negative things were in primary care; most seemed to be specialists.
- Some subset of physicians really, really dislikes both NPs and PAs. Many to the point where it scared me. I suspect many of them are the same people. Some names even start to stick out.
- I would think that these physicians, as they are very vocal, can change some minds.
- NPs are disliked for a number of things. Wanting to be called “Dr.” seems to be the main trigger point. IMHO, many NPs and many more PAs are also confused by the DNP and how it came to be mandated so quickly. Still it seems to be the main physician reaction to NPs.
- One common line about PAs was “What part of assistant don’t you understand?”
- Another one was both professions don’t know or learn medicine. Never mind that PAs are “licensed” by the Board of Medicine. They even mocked the line in the name change statement where we say “PAs are held to the same standard of care as physicians”. Obviously no one told them.
- When challenged about another name for PAs than “Physician Associate”, no physicians who are “social” had any ideas. They tended to make fun of our wanting a name change but came up with nothing. These physicians have no empathy for either profession. Nor should we expect any.
- Both PAs and NPs are VERY appreciated by the physicians that work with them. A few commented with force. Obviously the rest are too busy to be active on these sites. Both NPs and PAs will comment when attacked.
So where does this leave all of us? I’ll leave that for another blog, but I will say two things.
One is keep checking Clinician 1. We will post whatever negative press we find. Let’s answer them with well thought out measured responses. We are not physicians, but we do provide medical care at very high quality and with great patient satisfaction. What we do, we do very well.
Secondly, both the PA and NP professions should ask organized medicine for structured courses to be put into place at both the medical school level and the in practice/attending level that explain both professions to them. Some of that should address our feelings and also courses on “How to Work with NPs and PAs”. How to be a leader.
It’s about time.
Dave has been a PA, and later NP, leader for thirty years. He strongly believes that NPs and PAs must work together to insure a better future for both professions. Most recently Dave has been busy launching another dream; Clinician 1, the first internet community for PAs and NPs. In October 2008, Dave was honored by the New Jersey State society of PAs with its “Lifetime Achievement Award”.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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| Jane Miller (Syracuse, New York) |
on 10 Apr 2011 at 8:46 pm |
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Dear Dave,
I found out that PAs are very valuable to a speciality practice as much as a primary care office-I do psychiatry. I have been an Psych/Mental Health NP for 10 years and a Psych RN for 38 years. Contrary to some doctors thoughts if I had wanted to be an MD I would have found a way, but I never wanted to be one.. I have 2 MS degrees and 2 Post-Masters and the next logical step is the DNP. I you do some homework you will find out some of us don't want to get a PhD and the DNP focuses on clinical practice and not research as the PhD. We call people in other profession DR. why not an NP with a DNP
I learn so much from my PA colleagues and have a very good friend who is a PA I used to work with in-psychiatry! She had only her PA education and 6 years of experience. This is as good as my 38 years! She and I got along famously and were not ones to travel where no man(woman) has gone before. I mean we are both cautious practictioners and do not believe in getting in deeper than we should and know when to call-HELP!
I do wish that both PAs and NPs to work together.I think some of your fellow PAs need to do some homework about how the NP organizations have been resistant to antagonism toward MDs as well as PAs. They need to realize some NPs may by feel they need to be protective of the ground we have made-it took some 40 + years. Some of the PAs that have made comments may not have been born yet. MDs have long tried to continue their Mighty Deity status-not all by any means but they have come down somewhat from the pedetal since I was a young nurse. Also remember, for decades MDs were men and nurses and NPs were women we were considered their "handmaidens". So we have a right to be "a little" anger at this stage of the game.
Thanks,
from an "old" RN and NP |
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| Two Bears |
on 01 Jun 2010 at 1:43 pm |
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@ tk above 4:40 p.m. May 26:
"The nursing lobby is as viscious as they come."
does this mean that the 'nursing lobby' is sticky and goo-ey.... or did you mean VICIOUS? At least we can spell ;-)
A delicious and VISCIOUS NP |
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| Anita (FL) |
on 30 May 2010 at 8:30 pm |
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| Now is the time for us (PA and NP) to work together. The quality of the education should be that both be educated the same. NP's do not want to be MD's and if you ask patient what they would perfer, most would perfer the (w)holistic approach of a NP. We do not separate the person into individual parts, we look at how the parts affects the whole. Most nursing programs have always included this approach. Educationally, we are both working towards the same goal, a doctorate level education. The ultimate goal is the best care for the patient. |
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| tk (OH ) |
on 26 May 2010 at 12:40 pm |
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Angel-
It's very interesting to me that you have such a difficult time understanding why physicians don't gladly welcome you into their fraternity, yet you seem offended at the idea of using MedTechs in place of nurses. Do I sense a double standard here? Having worked in both the pre-hospital and hospital arenas for over 20 yrs. I know that paramedics can perform most (not all) nursing functions with a degree of competence equal that of nurses. But, pity the poor paramedic who wanders into nursing turf!! The nursing lobby is as viscious as they come.
I don't think it would be much of a stretch for you to understand how a physician might feel when an NP, who has a fraction of a physician's training ( nursing "doctorates" are irrelevant) and isn't even trained in a medical model pushes for autonomy, threatens his livelihood, and poses as a "physician extender".
When you refer to "midlevel practitioners" there is no "us". PA's are dependent practitioners and are true physician extenders. Philosophically, PA's and NP's are diametrically opposed. If you seek a more amiable working relationship with the physician community I suggest you apply for PA school and begin spreading the word to physicians that, unlike NP's, PA's cannot threaten physician practice but only enhance it. |
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| Angel (FL.) |
on 26 May 2010 at 3:41 am |
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Having been an Advanced Practitioner for many years as well as loving what I do and am able to do, I am stunned when MD colleagues denegrate our professions (NP, PA), Our alphabet soup letters before and after our names can be confusing to anyone, but the standards of practice we bring to health care and provide for our patients is a gift of humanity to what has become a very clinical science. Specialists have displaced the family doctor.
Healthcare is essential to life, and we NPs/PAs practice care, prevention and empowerment. We amaze our patients with what we know, what we provide,as well as how well we do what we do for the good of each individual patient their families and the communities in which they live,
BUT the "aura" of Doctor is still a palpable hurdle and mind-set we need to acknowledge and address head-on. When we are bringing in clients/money to the practice our physicians tell us how invaluable we are, but put physicians in a room by themselves and we "mid-levels" are a "blot" on their profession. These are the same colleagues who tried to eliminate nurse, who promoted Med-Techs and capitalize on the revenue we generate.
That double-edged sword is still with us after so many years of us reassuring our MDs, that we are colleagues, collaborators, a team. Is it insecurity or just plain hubris. Some days it is hard to tell.
I practice in one of the two states that still won't allow us to write for Class II drugs, even tho I have 2 masters, a post-masters and a PHD.
What a dilemma, but then who has or is creating the dillemma? |
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| Cindy (Tennessee) |
on 25 May 2010 at 5:19 pm |
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Dave and tk,
I am a nurse practitioner with the utmost respect for midlevel providers and for mentoring physicians and have seen nursing and PA programs that were excellent and those that left much to be desired. The issue is that all of us do not practice with the same evidence base and those who do not value practice standards cause the population to view our professions as less than respectful, but there are physicians who equally give medicine a bad name if they practice with the wrong heart . I have worked in large practices providing full spectrum family medicine and in small practices where the physician has his own "special" population and depending on practice management, I had to develop skills and knowledge to care for the population that I was faced with. The demand for midlevel providers is significant and should be an indicator that we are valuable to healthcare. I would like to believe that our value has something to do with the time we spend with patients and for me as an NP, how diligently I am focused on preventive care. I think that collaborative practice versus antagonistic competition would be much healthier between PA's and NP's. In the location in which I practice, there is no shortage of patients to be cared for and cared for well and I value the relationships of the physicians, PA's, and NP's I have worked with. I cannot imagine that a PA's satisfaction level would be increased by how diligently he disrespected another profession. I would like to see graduate programs structured so that skill sets and theory are comparable regardless of PA/NP program, however I am incredibly thankful to have been taught by a nursing model rather than a medical model because I think that sometimes we stop to listen to the patient a little while longer. I don't allow patients to call me "doctor" because I never chose to be a doctor and am very proud to be a nurse practitioner who has taken care of people for over twenty years. tk, I would ask how you know such a great deal about the education of nurse practitioners if you are a PA because I can tell you I am not aware completely how PA's are educated and frankly I don't think that information is relative. We all have a job to do and how well we do it depends on whether we care about taking care of people in excellence, mediocrity, or in a substandard manner.....that doesn't relate to title. |
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| tk (OH) |
on 20 May 2010 at 4:43 pm |
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Dave-
You would make a great NP! |
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| DAVE Mittman, PA (LIVINgston, NJ) |
on 20 May 2010 at 9:56 am |
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tk:
I could not disagree more. To a large extent, PAs and NPs are in this together. I spent the first 15 years as a PA leader believing that NPs are the bad guys. No more. More NPs are hired by physicians every year than PAs. Physicians have shown that they do not favor either. Physicians will hire either profession, so THE EVIDENCE told me we both must be good. Also I met some great NPs who were as close to me professionally as you can get and understood my PA frustrations, as they were their frustrations also.
Physicians have no nothing for PAs EXCEPT (and I realize it's huge) provide us jobs. In return we have given them an associate who can do what they do and make them lots of money. So they like us. There is no recognition of PA education, to lauding of PAs for the good job they have done, no higher standing in medical school. They oppose much of what we wqant to do as they think we want to take their power/money away and have never trusted us. With all our loyalty to them, they have had little for us.
Again just my opinion but it would be foolish to think they are our friends collectively. That being said, individual docs have been great to us and to NPs also and must be acknowledged for that.
Dave
What I advocate for is that PAs and NPs have a rightful place in our healthcare system. |
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| tk (OH) |
on 18 May 2010 at 8:39 pm |
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Dave-
You certainly make some strong and timely points. Point one, which you illustrate clearly, is that there still remains misunderstanding among physicians regarding the purpose and scope of PA practice. Point two: at least some physicians perceive NP's as a threat, and to the extent that they mistakenly equate PA's with NP's,veiw PA's with the same suspicion. Point three: the growing number ot physicians that use PA's ( and NP's) are very, very pleased with the work of PA's and value their association with them.
With that being said Dave, I'm at a loss to understand how you maintain your "position" as "physician assistant and NP activist". You must experience a great deal of cognitive dissonance. As a physician assistant you clearly understand that we are dependent practitioners and that by design. We are trained, as physicians are, in the medical model and function as true "physician extenders". Our "dependent" status should remove us from any association with "turf" wars. The threat that NP's pose to physicians is real. Only the most naive would deny that nurses/NP's are pursuing autonomous practice, independent of physicians. The economic threat is secondary. The primary concern is that these "midlevel practitioners" truly do have "only a fraction of the training" that a physician has, and in most cases is training in the nursing model. They present themselves to patients as physician extenders when their training and philosophy do not support that title.
It seems to me Dave that, given the satisfaction level that physicians have with PA's- those that use them or are properly informed, 100% of our efforts as PA's should go toward educating physicians, advocating for PA's and creating job opportunities for PA's. As health care continues it's metamorphysis in this country PA's need as many strong advocates as we can rally. I'm sure you're aware of the size of the nursing lobby- believe me Dave, they are going to be just fine.
I think that it's clearly time for us as PA's to strengthen our relationships with physicians, educate physicians and public alike in the clear differences between PA's and NP's, and politically distance ourselves as PA's from a nursing lobby that remains antagonistic toward physicians and PA's. |
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