Tuesday, April 20, 2010

PAs can suck my d#@$$$

This just chaps my ass!!!!And that's a BIG job!!!

I hope this link comes thru...The site is Sermo,a medical blog had this post yesterday...

And if that don't work just look up Sermo site and it's under Ethical Postings..

PA's need a high colonic on the way out the door!!

68 comments:

  1. H the IH (who has a Ph.D., but doesn't want to be called "Doctor")11:58 AM, April 20, 2010

    OF - why is this griping your wagger? I have worked with (both as a patient and professionally) a number of PAs and found them to be quite a professional bunch. Most importantly, they understood what they didn't know and would immediately consult with their supervising Doc if they needed to.

    In other words, they seemed to be more of an "associate" than an "assistant." And does it really matter? If so - why?

    The one that spins me a little are the RNs who have Ph.D.s and want to be called "Doctor." Where I come from (University-o-Midwest) the title "doctor" was reserved for:

    1. In casual, non academic conversation - physician only.
    2. On campus - any professor/non-graduate student teacher.
    3. In the docket/depo for Expert Witnessing - any Ph.D./M.D. type.

    A Ph.D. type, outside of academics or experting would never expect to be called "doctor."

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  2. I get why it chaps your ass you old-school dog. It chaps my ass for a different reason... for all I care they can call themselves Kings of the Known Universe... don't care. But, under O-care, and within ten years, PAs and probably NPs will be independently practicing in ERs and hospitals and clinics. Docs will stick at the large centers and their relevancy will decrease. For a while our jobs will be to unfuck a lot of medical silliness, but then what? In my little slice of heaven there are two PAs who practice in independent offices and they send their charts 100 miles down the road for review by a 'doc' within a month. There is also a chiropractor 'practicing' in one of the rural ERs not too far from me. I'm not kidding you. From the forest itself comes the handle for the axe.

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  3. If I ever have a chiropractor try to treat me in the ER, I might just throw a fit.

    On another note, don't hate me OF, but I'm tossing around the idea of PA school. I'd do medical school, but it wouldn't be nice to my kids and I'm holding out for Obama to make education a right so I can go on your nickel.

    I've got about 13 classes before getting my Zoo/Ent degree finished up :-) Can you tell I'm excited?

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  4. Dont be hatin' on the Chiros Amy, there more useful than a Shrink or Neurologist....Cardiothoracic PA's the way to go, you get to crack more chests than Jeffrey Dahmer, Ted Bundy, and the BTK killer combined, dissect out saphenous veins, radial arteries, do most of the work on CABGs, while the MD takes the brunt of the malpractice exposure..Sure you might have to pencil whip a ton of H&Ps inbetween cases, but every specialties got its cross to bear...
    13 Classes??? thats like a whole year...

    Frank

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  5. Here is my deal....I used to work with 911doc and I work with alot of PA's and NP's in the ED. They do alot on their own but they ARE assisting the MD in most aspects. If they want to go and say that they are an "associate" of the physician, then I think maybe RN's should change our name to something like that too because we are "associate" of the MD's as well. I totally get where you are coming from, you go thru a shit-ton more school and training to get where you are, as a PA they do as much school as I did as an RN! YOU are the one respoinsible for them so they DO assist you.....these 50 people just need to get over themselves, if they dont want to be an "assistant" then they should have put the time into being an MD.

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  6. Dear Brayden's Mom,

    Whazzzuuuup? How's your little man? Your post made me want to add this... I have worked side by side with many PAs in a few ERs... One's that can't hang do nit last, those that can can treat me or any of my family.

    I also think that the reality of O-care will force us, shortly, to call them "Physician Apprentice". Mark these words.

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  7. Guys you are making my case and I got all the LUV4U..
    Brayden's Mom. This is my opinion but there is a HELl of a lot of difference between "assistant" and "associate" I'm fighting it now from my administration who wants to have an "assoc" not an "asst" whatcha-ma-call-it..
    To me an associate is some one who is as COMPLETELY as responsible for the output/product as me. But that ain't the way it happens in academic medicine..The "assoc" always lays in wait for the Big Dog to go DOWN and then they get the position..Despite the fact that an "assoc" should be equally as culpable for whatever the problem may be..
    That's what happens in the real world. I'm sorry if you don't live in it..
    I luv u B's mom..really You're up front..just listen to the experience here-in..OF

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  8. hey OF,

    you should have told me you were fighting with clipboard people... now I feel ya brah! agree with the fact that words mean things but we live in Orwellian times. eventually all that is understood is a punch in the face...I call it "non-verbal instruction".

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  9. C-C-C-C-C-C- aint we all just g-g-g-g-g-g- et along...
    Divide & Conquer, same strategy the damned Yankees used to win the Wah of Northern Aggresssion...Thats there plan, get the RNs fighting the MDs, DOs fighting the Chiros, PAs fighting the NPs, while the Northern Devils burn down Atlanta and steal our slaves...
    You wanta pick cotton the rest of your lives, be my guest...Dont argue...ORGANIZE!
    and I ain't talkin no AMA organization, I want a group that'll make the KGB look like Greenpeace, the Teamsters look like a girlscout troop, you get the idea...
    When even the President(Peace be upon Him) has to cross a picket line to get his lung cancer treated, maybe they'll get the message,

    Frank

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  10. You go, Farty!

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  11. Have you read recently that NP's want to be called....DOCTOR. After all...chiropracters and PHD's are called doctors...so they think they should be too

    "PAs are held to the same legal and medical standards as physicians.".....In our ER, we have PAs work the fast track. The attendings name is attached to EVERY chart. So if something goes wrong....guess to get's sued??? Of course the doc, even thought we never saw the patient.

    Let them have the titles they want if they don't hang our ass to dry when they fuck up. I don't blame them if I fuck up.

    -ER Doc

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  12. Dear ER doc,
    now you have ruined my evening... NPs? "Doctor?" NPs? in what universe do they live? about 20% of the NPs that have worked in our fast tracks have survived as opposed to about 70% of the PAs. i don't object to them being called 'doctor' as long as it is said sarcastically and while suppressing a laugh. to the two NPs i know and have either recently or currently work with please ignore this rant.

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  13. Thanks for stirring up my PTSD 911....
    "Being called "Doctor" said sarcastically while suppressing a laugh"?? That pretty much summed up my whole Med School/Internship/Residency experience...

    after scoring "42" on Physiology Test first year... "Nice work, "DOC-TOR"...

    after missing IV Steven Hawkins could have made... "Nice Stick, "DOC-TOR"

    after putting ETT Tube in Esophagus... "Nice Intubation "DOC-TOR"

    After putting Chest Tube for Iatrogenic Pneumothorax on wrong side...umm noone saw that one...one of the beni's of being on ICU call by yourself...

    Frank

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  14. Anyone who thinks that PA school is somehow the same as nursing school needs to have their head examined. They are completely separate entities and approaches. PA education is overseen by 5 different physician organizations, and is based on the medical model of diagnosis and treatment. Bottom line is, if you don't want to work with a PA (Physician Associate) then don't. Otherwise, take your old-school head out of your wide-load ass and move aside for those who are interested in continuing to get the job done as a team. Oh and, btw, many PAs already do practice independently, albeit still with Physician supervision as that is the model of their work. Maybe you think that PAs are there to bring you your coffee or take a history before you come in, but if that's the case then you need to educate yourself and refrain from commenting until you do.

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  15. A bunch of MDs top of the food chain crying about a name change? Nice....

    BTW how do you docs feel about working along side Doctor Nurse Practitioner Smith? Plan to hire some Doctor nurses for your practice? Let's see how your patients like that lol

    And the only time a PA really "assists" is in surgery when they first assist. If you have your PA carrying thier own patient load, covering your office when youre out golfing or sailing the seven seas, covering your rounds and taking call for your office then they are an associate.

    In a practice AND er a well trained PA not only reduces the load of MDs but can also generate additional profit by increasing the amount of patients that can be seen. A PA can add a few hundred thousand in additional profit to any practice just as a partner MD could only difference is a PA costs less.

    A MA cant do that, an RN cant do that--only a PA or an NP can do that. The sad part is that simply because of the "assistant" attachment to their name people confuse them with medical assistants---all they want is recognition for the what they truly do and that is NOT being a medical assistant.

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  16. And we have a winner!!!Come on out of that closet you faggit PA. "old school head"?? "wide load ass"?? OMG, I am bleeding profusely from those zingers, boy howdy. How long did it take you to get your GED so you could go to, drum roll please, PA school? And just how does one get into PA school? I can see the personal statement now of how you have always wanted to help people, your dad was a PA, you saw a PA save someones life as a small child and never got over it, and, oh yeah, I couldn't get into EMT school much less Medical School!!!
    And you are right, I really did think you were for getting the history before I got there. I'm the fuckin' DOCTOR!!!!
    Now get back under your clipboard until we need to have fun at your expense again..phaggit

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  17. hey douchebag anonymous beginner reader,
    try reading all the comments... try to get your mind around the concept before you go off and make a fool of yourself and give PAs a bad name. the ones i know are a credit to their profession.

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  18. then again, maybe Oldfart wants to kill you. he can, with only his thumb.

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  19. dear 'yourmother',
    yes, i deleted your comment at it was gratuitous and was obviously written without reading the post and comments. go get your own blog.

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  20. ad-hominem, non-sensical attacks will be immediately deleted. hey PAs, either you are being punked by pretenders or you have some in your ranks who should never be allowed near a patient.

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  21. lol oh yea, because someone calls them a "phaggit"? dude, do you realize how STUPID you look? no one gives a shit what you think, trust me.

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  22. "ad-hominem, non-sensical attacks will be immediately deleted"
    "Come on out of that closet you faggit PA." You mean like this?

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  23. no,
    since it's our blog we can do whatever the fuck we want asshole, but trolls, well, we do whatever the fuck we want to them too.

    and anonymous,
    you are wrong, if 'no one gives a shit what [I] think' then why are you writing a response to what i think? now go picket for change in your professional nomenclature so you can get that GIANT FUCKING CHIP OFF YOUR SHOULDERS or go to medical school, but that's like, four years right, and then you have to do like, three or five years of some kind of 'residency' thing and all... that sounds bogus, i'm going to get my PA online.

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  24. Too bad you CANT get your PA degree online... there are a few online programs for ALREADY PRACTICING AND CERTIFIED PAs that received BS degrees for their education. Please do research and look at admissions requirements before you show your stupidity and misinform the public.

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  25. I'm a PA student getting close to graduation in Boston. I hate to see this kind of animosity over the name change situation, and just over PAs in general. I don't think people should lash out over the blog posts comments. I just think that this is simply an attempt by the PA community to return to its original name. Most people really aren't that concerned with this. I am thankful to be able to study and learn in a medical community as strong as Boston. I have only seen teamwork and respect from all parties involved in treating patients. I will say that the only thing I do take offense to, and I am sure that I will be ripped apart for this, is the statements about PA education. I was accepted into a program that had over 1200 applicants and only accepted 40 students. This same program had over 2200 applicants this year with around the same amount accepted. I have a huge respect for physicians, nurses and nurse practitioners. I also know that this educational experience has been extremely difficult and it by no means isn't the same thing as going to school online or becoming a medic etc. Anyhow, I know none of you really care about what I'm saying. I just want to let everyone know that the majority of PAs/PA students are sensible people who could care less what they are called, just as long as we can do a good job for the patients and for each other in the team. We obviously couldn't practice medicine, nor will we ever practice medicine, without being part of a physician/PA team.

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  26. Ah, well, now I understand where this is coming from. I think there is a lot of confusion on this blog about what a PA really is. You all seem to be confusing us with a medical assistant or a clinical assistant, which is completely understandable given our name.

    In reality, the PA degree requires 3 years of INTENSIVE medical training AFTER a bachelor's degree. For those that wish to specialize after graduation, there are residency programs and fellowships. Our educational model is the same one used to "fast track" physicians through medical school during WWII. We are taught and trained by physicians to work with physicians (and the other members of the health care TEAM). We have decided as a profession NOT to give in to "degree creep" and do not have a terminal Doctorate degree, outside of the military. Those of us with doctorate degrees do not refer to ourselves as "Doctor" outside of the academic arena.

    PHYSICIAN ASSOCIATE is our original name, bestowed upon us by our founding father, Eugene Stead, MD at our founding university, Duke University (yes, the one in Durham, NC), and is still the name given to the graduates of one of our original PA schools -- Yale University (yup, we have Ivy League schools, too). Our name was changed to "Physician Assistant" years ago under pressure from the AMA.

    You CANNOT get a PA degree online. You CANNOT get a PA degree from a Caribbean Island. You cannot practice as a PA without being Board Certified and our boards are written with the assistance of such physician organizations as the American Board of Medical Specialties (ABMS) and the American College of Physicians.

    As a profession, we DO NOT nor ever have wanted to practice independently of a physician; we do, however, practice and function much like a junior or senior resident (only we don't call ourselves "Doctor"). So as you can plainly see, the title "assistant" does our profession a disservice -- just look at your own posts. We simply want our old name back, a name that will better reflect what we do, a name that distinguish us from the physician's assistants (medical assistants and clinical assistants).

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  27. I've worked with some good PA's and some good NP's. I practice in an under served area, so we have a fair number of "physician extenders". It chaps my butt when patients call them "doctor". I am very quick to correct them.

    This goofy name change was dreamed up by someone with a serious inferiority complex. Point remains that PA's ASSIST a physician. My partners are my ASSOCIATES.

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  28. i am well aware of the requirements to get a PA degree and that some programs do a little more and present a 'masters of medicine' degree.

    i did not know, for a fact, that you could not get your PA degree online, and was confused, so i do offer my apologies. as a matter of fact, you CAN get your NP online which is why, if you will read my post a few above, i much prefer PAs to NPs out of the box.

    but the point really is, as it is with physicians, can they do it? are they good? erdoc85 is right, an associate is a co-equal, PAs, for all their worth, are not the co-equals with doctors. i don't know why you guys want to go down this road except that it obviously is a chip-on-the-shoulder issue and you've met some docs (and there are lots of 'em) who aren't really that good at what they do. you then make the logical jump to 'there's no difference between what we do', but it is a false jump, especially when you start adding in procedures and critical care and surgery.

    and you can stack up your 2-2.5 years of school after college to our four years and then residency all day long and it will still look like a duck, and quack like a duck.

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  29. assistant (dictionary.com)

    1. a person who assists or gives aid and support; helper.

    2. a person who is subordinate to another in rank, function, etc.; one holding a secondary rank in an office or post: He was assistant to the office manager.

    3. something that aids and supplements another.

    4. a faculty member of a college or university who ranks below an instructor and whose responsibilities usually include grading papers, supervising laboratories, and assisting in teaching.


    VERSUS...


    associate: (dictionary.com)

    1. a person who shares actively in anything as a business, enterprise, or undertaking; partner; colleague; fellow worker: He consulted with his associates before proceeding further.

    2. a companion or comrade: my most intimate associates.

    3. a confederate; an accomplice or ally: criminal associates.

    4. anything usually accompanying or associated with another; an accompaniment or concomitant.

    5. a person who is admitted to a subordinate degree of membership in an association or institution: an associate of the Royal Academy.


    i think aside from the tertiary and quinary definitions of 'associate' that assistant is much more useful and correct. you guys have a huge, huge chip... rodney king bitches.

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  30. As a PA I think the name change is a matter of respect not an attempt to act as a comparable with MD's. While i personally don't believe the name change makes a big difference b/c I will still have to explain what a PA is either way. Besides it makes no difference to me as long as I can provide the most effective care possible to the patient. I in no way believe my knowledge compares to that of an MD and when I am in a clinical situation I don't understand I always ask. I believe this is true with most PA's. The profession is designed so that we provide care in conjunction with doctors not in place of. When the issue of making the PA profession a doctorate degree came up it was out right rejected. So the model continues to be a team approach.

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  31. I do not see how the name change garners any additional respect. The fact that anyone thinks so earns them less in my book.

    Respect is earned.

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  32. Shame on ya'll. We are healthcare PROFESSIONALS!!! Having pride in your work and having a pissing contest are totally different things. If you docs ever want me to listen to a word you say, then you should try acting like a respectful, concerned and responsible adult. No one is "better" than anyone on this blog. There are too many factors that go into peoples decisions on education and career choices for some "high and mighty" to carelessly bash others professions. Please, think before you speak or type. Just as every PA must watch his P's and Q's to uphold the validity and respect of their profession, MD's should do the same. As for as the assistant/associate controversary; I would prefer the asscociate title, but could care less. Under your description, we should bunch together RN's,LVN,NP's,PCT,PA and everyone else into an assistant group,right? Wrong. PA do assist but they do more than what the public would think and thats why the profession is seeking the change. How would you feel if you finished undergrad, med school, residency and speciality and people didn't put up on your pedestal that you now stand on? You would probably scream and cry and wet your pants. Bottom line is we all are intelligent people who have curiousity and a drive to help others. Basically we've used that drive to memorize a bunch of shit and regurgitate it on demand. Let's not act like a bunch of jerks.

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  33. I disagree, 85 & 911. I believe that to a certain extent respect is deserved. That "MD" and "doctor" are terms reserved for a very few people who have completed a path that from the very start is extremely hard both mentally and physically. When you awarded an MD degree and the title "doctor" that goes with it, it does indeed make that person deserving of some magnitude of respect. And an attending physician deserves the respect of an intern or a resident physician, as he has withstood the mental and physical rigors of a path that they have yet to complete.
    And I am speaking of the US medical education only...

    That was until the 90's when medical schools began try to make their school classes look like the population of the general public. Now entering classes have a gender norming make up of about 50-50 men and women and soon it will be a majority of women. And you don't really want to know the rest of it..I guess what PA's call themselves is really not worth the little bit of thought we've given it here..

    This new "healthcare" legislation is but the last arrow into the heart of medicine not the first...

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  34. dear OF,
    i think that erdoc85 and i are not in disagreement with you. sure you get a certain amount of respect (or should) from the medical community or your patient (in the old days) with "MD" alone, but past the first interaction the respect is either built or destroyed based on your actions. thanks for fighting this fight i think you are brave to do it because the PC movement has made this kind of discussion obscene on the public square.

    and as for you anonymous, you are a fool... cont...

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  35. dear cloyingly patronizing 'anonymous' person sort of claiming to be a PA,

    "If you docs ever want me to listen to a word you say, then you should try acting like a respectful, concerned and responsible adult. No one is "better" than anyone on this blog. There are too many factors that go into peoples decisions on education and career choices for some "high and mighty" to carelessly bash others professions. Please, think before you speak or type."

    ACTUALLY, IF YOU ARE A PA, AND YOU ARE WORKING FOR ME, YOU BETTER LISTEN TO WHAT I SAY IN REGARDS TO WORK AND PATIENT CARE OR YOU SHOULD BE FIRED. TRY SAYING THIS TO THE DOC OR DOCS YOU WORK FOR AND SEE HOW YOU WAIT FOR YOUR PINK SLIP.

    BUT, MORE IMPORTANTLY,

    "How would you feel if you finished undergrad, med school, residency and speciality (sp)and people didn't put up on your pedestal that you now stand on? You would probably scream and cry and wet your pants."

    YOU MEAN LIKE BEING MANDATED BY THE GOVERNMENT TO GIVE FREE CARE TO WHOMEVER SHOWS UP ON OUR DOORSTEP AND HAVING THE RECIPIENTS OF THIS FREE CARE TREAT EVERYONE WHO CARES FOR THEM, INCLUDING THE DOCS, LIKE SLAVES?


    BESIDES, NUMB NUTS, BY SAYING THIS YOU CLEARLY DO NOT HAVE US ON ANY KIND OF PEDESTAL. YOU SPEAK AS IF FROM ON HIGH AND CONDEMN US FOR THE SAME THING. SERIOUSLY, YOU ARE A HYPOCRITICAL, ARROGANT FOOL, LOOK IT UP.

    "Bottom line is we all are intelligent people who have curiousity (sp) and a drive to help others. Basically we've used that drive to memorize a bunch of shit and regurgitate it on demand. Let's not act like a bunch of jerks.

    YOUR BOTTOM LINE MAYBE. AFTER SEEING THE WORKINGS OF YOUR VERY EMOTIONAL 'REASONING' ABILITIES I DOUBT YOUR INTELLIGENCE AND YOUR DRIVE TO HELP OTHERS BECAUSE YOU HAVE INFILTRATED THIS LITTLE GUNFIGHT TRYING TO BLUR LINES AND DESTROY MEANING. YOU WANT THE RESPONSIBILITY, RESPECT, AND LIABILITY OF BEING A DOC THEN GO TO MEDICAL SCHOOL AND PRACTICE UNDER THE VERY DIFFERENT ENVIRONMENT THAT BEING THE ONE RESPONSIBLE CREATES.

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  36. PS IF THAT WAS YOU MOM, PLEASE STAY OFF MY BLOG.

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  37. Did you call me 911? HA, wasn't me.

    Amy, do the Cardiothoracic PA gig. Saw 3 open hearts tableside. Too late, but if I could I would. Surgery is the only reason to PA IMHO. But skip the ortho, you'll just spend your time holding some big guy's leg in the air for half the surgery and then end up popping it back in the pelvis once the surgeon gets the hardware in -- totally like popping a barbie doll's leg back in, so you've been there done that, ho hum ya know.

    -SCRN

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  38. I am not a PA. Just a passerby. But, I must say that respect must be earned. I can respect you as a professional because of your completion of a difficult journey that decided to take, but when you name your blog "PA's can suck my dick" I instantly lose all respect for you as a man. Why don't you call it "the people I have to give free health care to that don't give me any respect can suck my dick"? That's the point I'm trying to make. Why bash an entire profession because they want to feel a little more respect than they are given. I agree with opinion that MD should be the DR's in the clinical setting. Noone else. Period. Let's keep it cool and try to make sense of the mess that the US healthcare is in. Whether or not anyone likes it, NP's and PA's are going to crucial in Obamacare. With all due respect 911, how do feel about the role of mid-levels in the forthcoming changes in healthcare?

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  39. And if I were a PA, of course, I would listen to you in a clinical setting but this is a blog. I was talking about listening to you as another human being not a doctor.

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  40. Actually I know alot about not receiving any respect, much less enough respect. I'm a medical microbiologist(med tech). When I tell people that I'm a med tech, they say; "oh, so you draw blood?" or "oh, you drive a ambulance?". We are usually at the bottom of the food chain for some crazy reason. My undergrad curriculum was basically pre-med(organic chem,biochem,physics,genetics,immunology,cell biology, molecular,etc..) and I still get talked down to by LVN's on a daily basis. So, I apologize if I've come off as being coy, but I'm about fed up with the disrespect. Just like every profession, there are some med techs that have "fallen through the cracks", but most of my coworkers are unbelievably intelligent and collaborate daily with physicians,infection control,transplant,etc. I basically would like for the hospital environment to be a more respectful institution, instead of everyone trying to act like they are better and smarter than the next guy. That's it. Plain and simple.

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  41. What an idiotic post. For the record, after becoming a PA, I thought about going back to medical school, I passed my MCAT's, and was accepted into two separate programs. I decided not to go. The title assistant is anachronistic, and outdated. It implies a lack of training, and a person that can complete only a limited number of tasks. As an EM PA, I practice rather independently. One ED I moonlight at, is staffed ONLY by PA's, there is no physician on site. Why? Because the volume is too low to justify a physicians salary. Am I "assisting" anyone? No. But I am not a physician either, and have never claimed to be, however, I feel that with a decade in practice now, that I can handle about 95% of what walks through an ED's doors on my own. NOTE, that is not 100%. Also, to the person bemoaning the liability exposure. This is changing, IF a PA sees a patient, and the physician did not lay hands on, or know about the patient, or the encounter, then they are starting to often be dropped from the suit, leaving the PA exposed alone.

    For me, I am completing my Doctoral, but not in clinical work. I am strongly involved in health policy work on the national level, and am beginning to develop a reputation as a workforce researcher. In those two environments, that title will be used, and helpful, but NEVER in the clinical environment. Speaking of workforce issues, current predictions estimate 212,000 physician openings by 2025 from the BLS, and my friend and colleague Ed Salsberg at AAMC, estimates a shortage of 125,000 physicians by 2025, with a significant percentage being in primary care.

    I would get off of the holier than thou concept however, it does nothing but paint you as an unprofessional, incompetent jerk who is railing against the wind. Perhaps you could give us a list of some cogent reasons WHY you opposed the name change? Then perhaps we could have an adult discussion. Lastly PA's are expanding into all kinds of areas. Susan Edgman Levitan is the Executive Director and founder of the John Stoeckle for Primary Care Innovation, she is also a PA, Catholic Healthcare West, which is one of the largest healthcare systems in the entire country, well, their COO and EVP, Bill Hunt, is a PA...I could go on and on with dozens of other examples, but the point is, that we are no longer some little scut monkey to have in the back of the office, if we ever really were.

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  42. anon. 8:44 and 8:49,
    if you will read the initial comments to this post, and I DID NOT WRITE THIS POST, then you will have your answers, but here they are.

    my ER could not function without it's excellent PAs and NPs. on a personal level, if they want me to call them 'emperor' or 'your higness' then that's what i'll call them, but that, as oldfart knows, is not what this is about...

    if PAs, as a group, want to change to being known as 'associates' then there are two problems...

    1. since words mean things and have consequences, especially and perhaps solely, in this case, the PAs pushing for this already know how they are respected, or not, at work. if they are not respected where they work, changing their titles will not bring them the respect they seek and they know that... so, what this is about, is a cynical bit of incrementalism. it is about positioning themselves to capture the public (non-medical) world's belief that they are "just like doctors" and can therefore make more money and power and begin practicing indepependently. this will amount to misrepresentation and people will suffer because while there are PAs who could absolutely have kicked my ass in medical school or residency training, they did not, because they weren't there, and their on the job training has never included the most intricate or dangerous of medical procedures. for instance, while, at my present facility, the PAs do almost all the suturing and are, therefore, better than most of the docs at doing it, NONE of them intubate or run codes (care for dying patients), and that's the way it is. they are 'just as good' at lacerations, but, by necessity, are not even in the ballpark, for life and death stuff. similarly, while they may be 'just as good' as the cardiac surgeon at harvesting veins from the leg, they can not, and will never be as good, at stopping the beating heart and bypassing diseased vessels. if they want to do it, UNLESS THE RULES ARE CHANGED, then they will have to go to medical school, and this gets me to point two...

    2. as i said in one of my early comments, if i were the PAs i would just go 'all in' and push for a title change to 'physician apprentice' because that's the only way this makes sense. they are positioning themselves, with this little ploy, to step in when O-care kills medicine and docs like me quit (if you are new to the blog it's a running theme... three of the board certified ER docs on this site alone are quitting mid-career because it's just not worth it in any sense any more). in this regard, i hope they win, because they, as a group, are better trained to do independent medicine than the NPs who are trained in the nursing model, and are therefore trained to follow.

    the NPs i work with in the ER and the PAs i work with in the ER are excellent in every way, and, as i said earlier, i would let any of them care for me or my family any day, any time. but that's not what this argument is about.

    and if you doubt that words mean things and have consequences, then simply visit your local 'hood and say the following... 'white power!' clayton bigsby did it, and so should you.

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  43. There are so many parts of the legislation that are illogical. But the promise of health care to everyone with no thought of how to deliver it would be considered malpractice in my profession.

    There are only 3 ways to increase the number of care providers:

    1) import more foreign doctors
    2) mandate increased med school class sizes
    3) increase numbers of non-physician medical professionals & allow them more autonomy to treat & manage patients (PA, NP, RPh, DC, etc).

    I believe all 3 will happen with an increase in mistakes and dissatisfaction.

    I don't consider my worth by 85% of what I do. Indeed, I could delegate that to someone else. I earn my keep by the other 15% and KNOWING THE DIFFERENCE.

    -85

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  44. dear PA who signed your name,

    you can pile up your names and examples of all the neato things that PAs have done in the twenty or thirty years you guys have been arounhd and still not understand i am not arguing with you... but simply because your farts smell like strawberries does not mean that every PAs farts are like yours.

    get the chip off your shoulder because it sounds like it's a big one... and you made a decision NOT to get an MD... seems a little late to be upset about what you are called.

    thanks for covering the ER, get used to it. American this is Obama care, you better hope michael is as super a PA. as he says he is, your life is in his hands, and he is definitely a PHYSICIAN ASSOCIATE. perhaps we should come up with a new abbreviation too?

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  45. dear microbiol. tech,

    thank you for what you do. i hope that it rains unicorns too, and soon. O-care is passed so it should happen shortly.

    in all seriousness, if you are that hung up on how others perceive you and treat you then you are giving them power over you. only you have the power to make yourself 'feel bad' or 'disrespected'.

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  46. Totally agree that respect is earned and not in a title.

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  47. dear bayle,
    i respect that.

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  48. Actually 911, I don't disagree with you, I was rather arguing the OP, which was rather tasteless. I don't believe the title change will accomplish everything. Will it help, probably. Is it some panacea that makes everything right in the world? Not at all. My "chip" has to do with condescending comments by physicians. Such as the one suggesting an increase in errors. Surely, after 40 years of PA's in practice, we would see a higher malpractice rate on common medical mistakes, right? We would see lower patient satisfaction surveys (not that they are worth much, but still in the bigger picture) across the board with PA's right? Surely, the AMA would have reams of data proving conclusively that PA's provide inferior and substandard care, right? The fact is none of that exists.

    In my health policy role, I was at a Symposium last year on Health Care Education Reform. All the big players were there, heads of AMA, AANC, AAMC, etc.etc.etc. One of the common themes coming out of this meeting, was to tear down the silos in medical education. Nursing and Medical students should take SOME of the same courses....Medical students should be graded not only individually, but a large part of their grade should be based on how the TEAM performed. Oh, and they also discussed shortening medical school, to a 3 year format.
    The Dean of Emory's medical school, talked about changing the way medical care is delivered, and now longer should it be in a heirarchal structure, but rather, it should be in a circular, team concept, where each member of the team is equal, and at certain times, each member may be best suited to be the leader, and it may not always be the physician.

    THIS WAS OTHER PHYSICIANS, and the leaders in the medical academic community saying this. I was merely a participant.

    I do more than merely suture in my ER, and have done more LP's than I care to count, have intubated on many occasions, participated in level one traumas, and codes, and even ran some codes at smaller hospitals...but guess what, that still doesn't make me a physician. But, I would say, that I'm not just an "assistant" either.

    BTW, procedures are nice, I taught an MS IV how to use the ocular burr the other night, but knowing WHY, and WHEN to do the procedure is a million times more important. YMMV.

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  49. Oh, and lastly, I would just add, that Dr Eugene Stead, the founder of the PA profession in 1965, initially WANTED us called physician associates. The AMA opposed it at the time, and having no money, no graduates (yet), and no political power, we compromised at that time. Yale's PA program STILL calls their graduate PA's Physician Associate, and the Yale-New Haven Hospital does as well. We just want to return to our roots. It was intended to be the intial name of our profession, and 43 years after the first five PA's graduated, we want to return.

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  50. Call yourself what you wish. No offense intended, but by definition you will still be my assistant. But I do appreciate what you do.

    I feel certain that the roots of this name change involve an attempt to put the PA on a more equal (thus associate) footing with physicians, whether you realize or acknowledge this or not. Why else is this ridiculous notion just now becomming an issue after 43 years? Coincidence??

    Though your respect with most health care workers will be earned and is not inherent in a silly title change, sadly I believe this to be irrelevant. If the healthcare debate taught us anything, it taught us that in our current culture, people will listen and respond to "feel good" and "emotional" arguments while ignoring all logic, reason, and forethought.

    Have heart. Us cranky Docs on here might never call you our "associates", but I strongly suspect that healthcare reform will have more and more patients calling you "doctor".

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  51. Er Doc, the impetus behind this has nothing to with respect from physicians, that is either earned or not, and for the most part, I could care less what they think. What my patients think is infinitely more important. I believe that I have already earned the respect of the phsycians I work with. I am frequently called a "colleague" to patients from the attendings, and senior residents have, on more than one occasion, told me that I function at the level of a senior resident, if not a junior attending. Does that make me a physician? Nope, but I'm sure as hell not someone's "assistant". And the name change is not a "new" issue, it has been visited about every 6-10 years in our profession since it's inception, not new at all.

    Even in my role in health policy, I once had a meeting on the hill with a congressman, who opened the meeting by stating "If you are a physician('s) assistant (got it wrong right from the start) WHY am I seeing you, and not your physician?" Needless to say, education was in order.

    911, words DO matter, titles matter, and just being an MD does not grant you respect. There is variation in the physician profession, just as any other. I know PA's I would trust implicitly with my daughters life, and I know MD's I wouldn't trust to treat my dog. Like, I would kick them out of the room if they were assigned to my family.....AND VICE VERSA, I also know PA's who I wouldn't trust to treat anything, and MD's who I wouldn't hesitate to let treat my family.

    In Minnesota, we finally got rid of that annoying title "Supervisory" agreement, and have now drafted up a "Delegation" agreement. Still not what it should be, Collaboration, but it's a start.

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  52. I don't know why any Physician Assistants here are offended. These doctors (if they even are ones) are like spoiled children deserving of time out for not having basic manners. Nobody with intelligence would really care about what they say because their boorish, immature demeanor forfeits their right to contribute to the conversation about mid-level practice that is currently going on in the medical community.

    Now you see my post. In a few minutes, you won't. It will probably be deleted by the moderators who cannot stand to see anybody point out their god complexes.

    "BESIDES, NUMB NUTS, BY SAYING THIS YOU CLEARLY DO NOT HAVE US ON ANY KIND OF PEDESTAL. YOU SPEAK AS IF FROM ON HIGH AND CONDEMN US FOR THE SAME THING. SERIOUSLY, YOU ARE A HYPOCRITICAL, ARROGANT FOOL, LOOK IT UP."

    Of course we don't have you on any kind of pedestal. You don't deserve it. You're not any better than any other human being on the face of this planet, despite you citing your glorious years in college. None of those eight years has taught any of you humility, empathy, beneficence, or any other attribute that makes a great human being. You want a pat on the head for your achievements, do you? Looks like you're the one with the chip on your shoulder. There is no room in professional practice for this kind of bigotry and hatred. Try and be demeaning to PAs. Go ahead. See how many will jump at the chance to be demeaned by you. I hope you all enjoy the lip service respect that your title gives you. That's the only kind of respect you'll ever get.

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  53. dear "anon." 4:39...

    wow, that was a ton of words.

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  54. Anon,

    Can you really read this blog and conclude that we might not be physicians? This says more about your intelligence than it does about ours.

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  55. I read this blog and conclude that if you are physicians, you do not behave like professionals.

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  56. thus speaketh anonymous...
    Q.E.D.

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  57. Wade Holloway, PA-C8:24 PM, April 27, 2010

    To all anonymous posters, if you are going to run down someone you should atleast have enough guts to put your name down if that is really how you feel.

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  58. Thank you Wade! You can be my Associate.

    Bet the Ano-pod who judges our professionalism here merely by blog comments has no clue about our side of medicine, has never witnessed the kind of stuff we write about first hand, and certainly isn't old enough to understand that what people THINK and the way they must BEHAVE professionally are often two completely different things.

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  59. Of course, but I have no problem posting my real name, as I stand by everything I say. I say it on my own blog under my name as well. I would state that the OP is crass and tasteless, there is a way to address your concerns, and to do so in a gentlemanly manner.

    I would only add that I hope our physician colleagues do not think that this represents a change in our practice model. For it does not. We are still DEPENDENT providers, but we practice autonomously, not independently. We would only like to eliminate the confusion that our current name sometimes suggests. I've had patients say, "Oh, so you take blood pressures, and are like a Medical Assistant, right?" Ummm no. I did a conscious sedation yesterday using propofol....I doubt many assistants do that. Does that mean that I am equal to a physician, no...but it does mean that I can perform MANY of the same tasks.

    Respectfully,

    Mike

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  60. Michael, if you read MDOD at all previously you would return only because MDOD is a "quaint" (NOT) destination.

    And now, are you trying to prove you can out-perform any good ICU nurse?!?! Quit while your behind, as they say :o)

    -SCRN

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  61. *yawn* Mike, you can name drop and brag about how politically connected you think you are, but you're still not cool

    If you had ever read this blog, you'd realize that there's not a lot of love for the fools on the Hill or lobbyists.

    You're barking up the wrong tree my friend.

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  62. Excuse me. I hate to interrupt but I just want to say; Hey 911, it was nice seeing you man. And I'm going to be a Nurse Anaesthetist so I can sedate the patient and catch up on some casual reading/gossip and raise and/or lower the surgical table when the MD and/or the Physician (whatever they want to be called) asks me to. Then pray the patient wakes up.

    Let's see how badly I'm bashed. HA.

    P.S. 911, you're my hero and I look forward to another 4 hr football quarter.

    P.S.S. Anonymous, you can come suck my d!@% since you seem have an issue with sucking off OLDFART.

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  63. What a quaint read, I have now finished reading all of the posts on this PA issue and as a practicing PA for 17 years know as we all do that there are jerks in every profession and at every level of life and it seems that I have run into some of both (PAs & docs) on these postings. Honestly I think 911 Doc would be a fun guy to drink beer and smoke a good cigar with. Everyone is allowed their own opinion and if PAs want to enter the fray on a blog moderated by an ER Doc he or she better get ready to take some serious shit. Albeit I should say they should be ready to give it back as well. I haven't met an ER Doc yet or any other Doc I was afraid of, especially over a blog, but how many do I respect, the ones that give good care. The only medical professional I ever met that scared me was an ER NURSE, Jimmie Gaskins from Oklahoma, she kicked a good many ER Docs asses and other medical professionals as well. But I digress... Teeh name change has nothing to do with any of us PAs wanting to change a thing about the way we practice medicine. Wht can't you guys get that through your thick skulls? I don't want the right to practice independently, as I already do. I have never had a Physician stand over my shoulder and tell me what to do, or how to do it, except in school. We do have a collegial relationship. An association with each other as professionals. You can cry about that all you want but "it's only the facts maam" Of course when first out of school there is a learning curve but by the time my med school buddies had finished their residencies and I had drank much more beer than them to their dismay, I had OJT that had placed us on an pretty much an even keel. After all what is residency other than OJT? Get over yourselves Docs and let us do our job and don't fret about what we call ourselves. Most of us don't really give a rats ass about what you think of us personally anyway, but on a professional level, we will continue to yes suck your &##$$2 and let you sign our charts as long as we continue to practice medicine. BTW, why don't you think we aren't sued for the work we do when it is shitty? Boy I wish I didn't have to carry malpractice for 1,000,000 -3,000,000. That would be sweet. We take the heat when we do bad just like you do. Except the statistics show we do bad on a much less frequent scale than you big boys. I know, I know it's cause you do all the big special things in medicine and are therefore subject to more things can go wrong. Just making the point that some here keep missing, that we take the heat for our mistakes. Yea the doc does too, but then he shouldn't have hired on as my super? Oh did I mention that I own my own clinic and the Doc works for me? Oh sorry to go there, will just make somebody cranky. And no their not losers and thsi is the only job they could get so don't try that. Oh I'm sorry I digressed again. We want to change our name back to Associate because were tired of answering the same question a million times from our patients, and building trust with your patient is utmost important. When I tell them to take this medicine so they don't fall over dead, probly not a bad idea for them to take it Lucy. Get my drift
    Loving all Docs
    Also a hiding PA cause of bad things I say and don't want to lose license. Baby needs shoes

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  64. Who gives a damn? If you like your job, why do you care what it's called or what anyone else's job is called? I think anyone who has a problem with this name change issue is probably threatened or unhappy in their own profession (doctor or PA). If you're truly happy with your job as a doctor and don't feel threatened by a midlevel, then you shouldn't give a damn what a nurse or a PA wants to be called. You're still a doctor who went to medical school; nothing can change that. Similarly, if you're truly happy with your job as a PA and don't wish you were a doctor, then you shouldn't care whether you're called an assistant or associate. All you should care about is doing your job.

    And for the people insinuating PAs are idiots who couldn't make it into medical school, I would graciously ask you to reconsider your preconceived notions about this profession. Let's consider this logically, shall we: what gender accounts for the majority of PAs/NPs/nurses?

    Females.

    Now, perhaps you'll conclude that all females are too stupid to make it into medical school. Well, that's your prerogative. However, based upon my own experience and that of other people I know, I would say many very intelligent females choose PA school over medical school due to the length of training involved in becoming a doctor. If we want a family, we have to realistically consider our options- not only do we have somewhat of a time limit on having kids (yes, yes, you can have kids past 35, it's just not recommended) but we're often also expected to be the primary caretakers of our children. The fact of the matter is that you cannot have everything. You can be a doctor and you can have a family. But you cannot be an amazing doctor and an amazing wife and an amazing mother. You have to make tradeoffs. And every female doctor I've talked to has spoken about these tradeoffs: sometimes, the job suffers. Sometimes, your family suffers. Usually, your sanity suffers. But something always has to give.

    Of course, when I ask a male doctor if it's possible to have it all, I'll get the occasional- of course! It's just a matter of hard work and determination. I'm an excellent doctor and very involved with my kids.

    *drum roll*

    Then I ask, "So what does your wife do?"

    *pause, guy looks slightly embarrassed*

    "Uh, she stays at home with the kids..."

    Righttttt.

    FYI, I'm about to graduate from one of the top ten universities in the nation, with a science degree and a high GPA. I worked as an EMT my freshman year of college, I've volunteered extensively with underprivileged children, and I've worked in a biomedical research lab for over 2 years now and have even been awarded a small fellowship to fund my research. I've volunteered in a hospital and I've worked with doctors and PAs.

    And I want to be a PA. I choose to be a PA, knowing I have many other options. I feel it fits best with my future life goals and aspirations. Choosing PA school over medical school does not mean I'm an idiot or that I couldn't get into medical school. It means I don't WANT to go to medical school.

    In fact, I feel as though I would actually have a better chance of getting into a top medical school than I would getting into a top PA school (the most competitive PA schools tend to weight direct patient care experience heavily, which I am lacking in).

    There is no "easy" PA school to get into, just as there is no "easy" medical school to get into (I've looked into both extensively). There are some medical schools that I honestly believe would be much easier to get into than some PA schools. And vice versa, obviously.

    Case in point, to say all PAs are idiots who couldn't hack medical school is an extremely ignorant statement and one I would not expect of someone who considers themselves to be a highly educated individual.

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