 |
|
 |
 |
| |
|
|
| |
| Physician/ PA Teams |
 |
by Bob Blumm, MA, PA-C, DFAAPA - October 2, 2011
|
One of the few differences between PAs and NPs relates to an area that is poorly defined as supervision. In the most rudimentary form, PAs require it, NPs don’t. When people hear this word, supervision, most think of a taskmaster folding his or her arms while the PA kneels submissively caring for their patient. The reality of the word supervision is that it implies that the PA is not an independent practitioner, but is one joined at the hip to a physician. This relationship is loosely called the physician/PA team. By definition it infers that the PA has access to a physician by some manner, whether in person, by telephone, or by some other means of communication. Many of these teams function successfully in this manner. Many of the PAs practicing in this role have won the full respect and confidence of the supervising physician. This issue of being joined as a team, however, has had some negative implications on our practice, especially when combined with the term assistant.
In many states the NP can practice independently of a physician, although a majority of the NPs I know have some type of agreement with numerous physicians who are on a list of back up consultants. Individuals with whom they can confer when the problems of the patient may be beyond the scope of practice or the training and education of the NP. This is good for the NP, good for the patient, good for the physician and good for healthcare in general. All General Practitioners require the expertise of specialists from time to time; the expertise of cardiologists, neurologists, endocrinologists, pulmonologists, orthopedists, and so on and so forth. This fact is irrespective of what level the provider practices at, whether a physician or an advanced practice clinician. No clinical practitioner is expert in every field or sub-specialty and we all have a list of those to whom we can, and should at time, refer a patient. The NP, though, is not hindered by terminology. Their title is one that conveys a semblance of independence. Ours does not, and it is confusing to most everyone.
Helen Keller profoundly stated, ”the most pathetic person in the world is the person who has sight but no vision.” This is a compelling statement from someone who walked in darkness all of her life. Most individuals accept life and its shortcomings, but visionaries are different. They are not limited to seeing that which is visible, but rather that which is invisible.
Dr. Eugene Stead, the founder of the Physician Associate profession, the title he saw as appropriate, was a visionary. Dr Stead believed that trained non-physicians could work alongside physicians as a team and in doing so expand the delivery of health care in America while physicians were answering the call of duty to South East Asia. Many of Dr. Stead’s contemporaries felt that his idea was a temporary loss of sanity. After all, how could anyone, other than a physician order and interpret lab work, diagnosis an illness, and formulate a treatment plan?
Arthur Shopenhaver said; “Everyman takes the limits of his own field of vision for the limits of the world.” It was our good fortune that all men are not as short sighted. Many are the pioneer physicians who stood behind the new concept of PAs and were willing to stand up in their hospitals, medical societies and in the halls of government to state that these well trained , compassionate clinicians were able to perform many of the tasks that were normally done by the physician. They had no fear of reprisal, as they were earnestly seeking to fill a gap in health care, and the end result justified the means of getting there. Dr. John Kirklin was one of these physicians and was responsible for the “surgical physician assistant.” Dr. Francis Mc Gill, an OB/GYN, also believed in these new professionals and taught them the essentials of his specialty, as well as the peri-operative role. Such people have broken the proverbial mold, for they had the courage of their convictions and followed their imaginations. Some were criticized, some were laughed at and scorned, yet they held fast to their ideals. They were unshakeable, immovable, and stubborn enough to not let go of an idea and we became the recipients of their efforts.
Today another group of people with vision have committed to following an idea. One that is catchy. What started as a small, grass-roots effort has grown to a drive involving six thousand like-minded professionals hoping to accomplish a goal. They realize we are a much more sophisticated group of people with far more education and a groundswell of colleagues who have proven our worthiness as medical practitioners. A collective entity that has proven we are much more than assistants. The goal is changing the title of our profession back to its name at birth: Physician Associate. The name our founding father felt best suited our role, but one that was changed at the outcry of a great many physicians who felt the title misrepresented our ability and worth, something we have time and again, resoundingly, proven wrong.
Some of the original grass-roots members and all of the 6,000 colleagues who have since joined the cry for change were recently called “anarchists” by one of the editorial board members at JAAPA. A former professor and Dean, a well-respected compatriot of ours, was accused by some of his friends and colleagues of drinking the same Kool Aid that they drank in Ghana. Some of those against the name change are marginalized, indeed. What the naysayers fail to realize, however, is that those of us joined in this battle will not go away. We will not stand still. We will multiply like so many bacteria on a Petrie dish and we will overcome whatever obstacles present themselves.
People and organizations often make errors. A Western Union internal memo once referred to the phone as one with shortcomings and no practical use. Thomas Watson, Chairman of IBM in 1943, inferred that the world would never need more than a handful of computers. Ken Olsen, President, Founder and Chair of Digital Equipment Corporation echoed that same sentiment. These men and organizations were leaders, but had lost their ability to see beyond today. Our heroes are those that believed in us as a profession and watched us become 85,000 strong. Our visionaries are those that can see that the present name no longer fits this profession, that in fact it is one that does us great harm. Many of the great leaders who have aided this profession in its growth have lost their ability to believe beyond today and have succumbed to fears and rhetoric that say this change of names is impossible. Nothing is impossible if you have the will and the commitment to ask for it, demand it and help finance it. I see a rainbow in our future and sincerely hope that I will be there to see its glory.
Bob Blumm
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 300 plus articles and is a sought out conference speaker throughout the United States.
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.
RECOMMEND THIS ARTICLE
You must be logged in
to recommend articles
|
 |
|
|
| J. Luther PA-C (Vancouver, WA) |
on 05 Oct 2011 at 3:19 pm |
|
| Nicely worded! Going back to our original title is a must for our profession. It's long overdue. It's what's needed to move us forward and will make educating lawmakers and the public about who we are and what we do just a little easier in the future. |
|
| Bob Blumm (LI, NY) |
on 04 Oct 2011 at 8:49 pm |
|
Thanks for your comments Bill as you know that I both appreciate and honor your service to our profession. It's nice to know that the "thinkers" in our profession , have both an opinion and the integrity to place it in print. On behalf of this new group of PAs that desire change, I applaud you.
Bob |
|
| Bill Stanhope (Atlanta GA) |
on 04 Oct 2011 at 12:01 pm |
|
I certainly applaud your thoughtful editorial completely agree with your premise that
many of the professions pioneers and leaders including doctors Stead, Meyers, and Silver, Estes, Smith, Todd and Hamburg would find some elements of the contemporary status quo to be unacceptable. The question of course is which are those elements would be unacceptable, which would be lauded and what advice would those early physician advocates offer.
I have no doubt that if we could have them all around the dinner table a most lively discussion would ensue. I imagine that that discussion would reveal a divergence of opinion around nomenclature, roles and appropriate entry levels of education and would take us no closer to us universal agreement that it did 40 years ago.
associate program.
I completely agree with the position that you are taking around the compelling need to explore the concept of supervision and thus find an alternative way to understand and articulate the complex relationships which exist within the community which provides hands-on definitive health and medical care services. I believe that from that undertaking appropriate nomenclature would become clear to all involved. I am deeply distressed that the contemporary spokespeople (AAPA elected officials) have not made this a first order of priority. Like other elements of our society our profession is crippled by an overabundance of politicians and a distressing paucity of statesmen.
Bill Stanhope, PA
Founding President AAPA |
|
|
|
|
| |
|
|
 |
 |
|
 |
 |
 |
|
