Saturday, March 24, 2012


To those who read this on a regular basis - I'm sorry for being so lame as to give you nothing to read.  But here is the latest update.

I have taken a new job working as an urgent care PA.  You might ask what that is...  Then again, you might not.  But I'll tell you anyway.  Urgent care is exactly that - I see patients who walk into the clinic without an appointment and feel they have a minor emergency occurring.  Now, most of this is not actually emergent - a majority if what I see is sinus infections, ear infections in kids, strep throat, etc.  But about 30-40% of my practice is devoted to truly urgent issues: a weekend warrior (that's me!) breaks an ankle while playing flag football in the park; a child has really severe nausea and hasn't been able to keep anything down for over 24 hours and is becoming dehydrated; a dull knife slips...  You get the picture.  Ankle sprains, concussions (without loss of consciousness - that's another story), and the like are welcome in my urgent care.  And sometimes I see much worse stuff, too.  Pneumonia, blood clots in the lungs, heart failure - that kind of thing.  The job is remarkably challenging - I would not have believed myself capable of this pace, but it is remarkably rewarding.  I can take care of 30-40 patients per day and sometimes I'm able to restore them quickly, and naturally the instant gratification is very satisfying. 

So, that's where things are right now professionally.  I'm contemplating another post soon about the first aphorism...  Hopefully it won't be 2-3 months before I get around to it. 

PA Name Change

I think that it is about time I make my stance on this topic known publicly.  But first, a little bit of background for those who don't know what the title of this post is referring to.

In the 1960s the Physician Assistant profession became the brain child of one Eugene Stead, MD.  Dr. Stead believed that servicemen coming back from the war with extensive combat medical experience could be crosstrained for a year in general medicine and then begin working alongside physician colleagues practicing medicine.  His vision was that these men would extend the number of primary care providers available to stem what was at that time just a minor shortage.  He was right, we do a fantastic job of this.  His pilot program began at Duke University, and when these men graduated they were Physician Associates.  Shortly after his pilot graduates began their fledgling careers, these providers were renamed Physician Assistants and we have carried that name ever since.

Fast forward 50 years or so.  We remain in these roles taking care of our patients, practicing medicine and doing excellent work.  Physician Assistants form a crucial part of most medical practices in the nation.  We are almost 90,000 strong (depending on which resource you look at) and we are involved in pretty much every medical specialty.  In family practices and other primary care specialties we are essentially doing the same thing as our physician counterparts, though there are some limitations.  And for the past 20 years or so there has been a lot of discussion about returning to our roots as Physician Associates rather than Assistants.  The feeling among most of my PA colleagues is that the "assistant" moniker no longer represents what we truly do in the medical world anymore.  Initially there was an element of assistant-ship to what we did, but our role and jobs have evolved fairly extensively.  We are no longer assistants, but we are associates to our physician partners, helping to extend the number of patients that can be reached.  We still have some oversight, but it is no longer an apprenticeship or assistant role that we play; we are partners in medical care.

This year the debate is growing even more heated.  Past representatives of the American Academy of PAs have made their opinions know, petitions have circulated, and there may be a resolution in front of our decision making body at the national convention this year to begin the process of changing our name back to that of Physician Associate.  I have to admit that my stance on this is that the title of Physician Assistant is misleading to the people I take care of on a daily basis.  I often get, "What exactly is a Physician Assistant?  I thought you were the people who put the patient in rooms and took their vital signs and stuff."  When I tell people what I do or introduce myself to my patients as a PA, there are often questions and occasional sidelong glances of distrust.  I do feel that our title is misrepresentative.  As such, I support a name change.

The caution is that we as a professional association have to avoid alienating ourselves from the physicians who have always supported us.  Those of us pushing for a name change and the general public as well as our supervising/sponsoring physicians need to understand that we aren't pushing for independent practice or greater scopes of practice or any more leeway than we have now.  We are only trying to emphasize that PAs are much more than assistants - we are providers who diagnose and treat illness.  We have the training and skills to do much more than the assistant title connotes.  That is all.  We need that message relayed to the public and our patients via a name change.  We need it in order to foster greater trust and to cement ourselves in the medical community.  That is all.  The name change will not only benefit us, but will benefit our physician partners as well.  I see it as a win-win.

There are many who oppose the change, and their reasons aren't horrible.  But for the future of the profession and our own growth I am fairly certain we will need to move along in the name change process.  You will continue to hear about this as time goes along, so I hope this gives enough background.   It's a big debate, and I hope that we can partner with our physician and PA colleagues alike to resolve it in a way that benefits us as well as them but overall so that our patients will have a better idea of who we are.