Renaming of Physician Assistants to Physician Associates

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http://www.jaapa.com/issues/j2008110...unding1108.htm

fter more than 3 decades as a proud member of the PA profession, and as one who has focused on patient care exclusively during that entire time, I feel able to speak with some clarity about what has always been the most sensitive of subjects: our profession’s title—physician assistant. And as I get ever closer to that age of Medicare eligibility, I feel able to face the inevitable firestorm that always seems to rain down on those of us who feel that this is an issue yet to be happily resolved. The specter of the “clinical doctorate” has come to the fore, and now it’s time. Not time to discuss who we are or what we’re made of, where we came from, and what we are capa-ble of–our physician mentors and our patients pretty much know all that. We need now to discuss a title that will at last reflect the reality of where we fit into the scheme of health care delivery here and increasingly around the world. And physician assistant “ain’t it!”

Maybe in the early 1970s, PAs mostly assisted their physician employers, supervisors, and mentors directly, by extending their eyes, ears, and hands. And maybe in the early days of every new PA’s career, he or she is truly an assistant. But time marches on, and the medical world and health care delivery have evolved. We have evolved with them. Our title has not. It no longer is a helpful descriptive of our role.

Tell the military PA, crouching in the sand, sticking a chest tube into a colleague wounded by an IED (improvised explosive device), that he or she is an assistant. Explain to the family of a hospital emergency department patient that their daughter’s gaping laceration is being repaired by a physician assistant—that no doctor is on duty just then. Listen anonymously, as I have, to a patient telling his friend that yes, his shoulder had been dislocated during the game, but the orthopedic surgeon sent in his assistant to reduce it. “She did a great job, though.” Even after 30-plus years, I still occasionally encounter the returning patient who looks at my name badge and says incredulously, “You’re still an assistant? You should have graduated to a full MD by now!” And I launch into the explanation I learned by rote during my first weeks of PA school. It was a good one then, but now it feels like I’m trying to convince myself.

So, what is the answer to this dilemma? How should we deal with it?

Some would say that we just need to do a better job of public education: if we explain ourselves to enough people often enough, using the right media, patients will come to understand that we’re not physicians. But will they really, especially in the era of the paper chase?

Many PAs have doctorates: a hard-earned and well-deserved PhD or DSc, EdD, DrPH, DPsy, DPT, or PharmD. Some even have an ND, or perhaps a DC. They are doctors, although they are not physicians. They practice as PAs. Should they be called doctor?

There are always those in our own profession who will predictably fire back with. “If you want to be called doctor, go to medical school!” (I didn’t and still don’t.) Okay, I get it. But how about a title that more accurately describes what we actually do? Or where we fit in? Is a title like that such a stretch?

I think not … but, I hasten to add, I’m not sure what that title should be. I do know that it shouldn’t contain the word assistant. Perhaps associate physician, sort of like an associate professor. Or physician associate, as in one who works in association with a physician while not actually being one.

And who gets to decide the title, even if we find one that we can agree on? Is it the individual states? The NCCPA? The AAPA? The NBME?

I have no magic answer. I just know that as more and more of us get doctorates—clinical or otherwise—I never want to hear one of my PA colleagues say to a confused and perhaps scared patient, “Yes, I am Dr. X, but I am not a physician. I’m a PA, a physician assistant. But, it’s okay to call me doctor because I am one … just not a medical doctor … I’m a doctor of physician assistant science. And this is my esteemed colleague, Dr. Y, who is a nurse practitioner. No, she’s not a physician either, but she is a doctor of nursing science, so you may refer to her as doctor if you wish. How may we help you today?” JAAPA

If you are functioning as a PA, you are a PA. If you are functioning as a DC, then you are a chiropractor, and you can introduce yourself as such. Fortunately or unfortunately, everyone who signed up for PA school knew that the end result was becoming a PA. I'm a firm believer in the idea that we should essentially expidite the ability to get an MD when one has already completed a PA program, and perhaps we should stop seperating out these two programs entirely, allowing physicians to forego residency and function as a PA without one. Then increase enrollment in medical school to compensate.
What you seem to have is a great deal of is buyer's remorse.

The problem is that there is no logical space along a gradient between PA and physician. Inventing a fake name or a doctorate of PA degree makes no sense. By that logic, the PA doctoral degree would become an even longer (and less efficient) schooling process than just getting an MD. I'm all for better transitional training opportunities, but calling oneself doctor in a clinical setting without completing medical school is frankly misleading and holds no benefit to the patient beyond the ego of the provider. Patients do not understand what a PA is now half of the time. Changing the name again will cause a lot of confusion.

Originally Posted by shahalam

Tell the military PA, crouching in the sand, sticking a chest tube into a colleague wounded by an IED (improvised explosive device), that he or she is an assistant.

My corpsmen do this too. I suppose I ought to call them physician associates?

Originally Posted by shahalam

Listen anonymously, as I have, to a patient telling his friend that yes, his shoulder had been dislocated during the game, but the orthopedic surgeon sent in his assistant to reduce it. “She did a great job, though.”

I guess I don't get why this is a bad thing.

Originally Posted by shahalam

Even after 30-plus years, I still occasionally encounter the returning patient who looks at my name badge and says incredulously, “You’re still an assistant? You should have graduated to a full MD by now!” And I launch into the explanation I learned by rote during my first weeks of PA school. It was a good one then, but now it feels like I’m trying to convince myself.

What is he trying to convince himself of here? Does he just feel disrespected? If he's conveying accurate information and educating a patient about the nature of his background and work, I don't get what the problem is.

Originally Posted by shahalam

But how about a title that more accurately describes what we actually do? Or where we fit in? Is a title like that such a stretch?

That's pretty reasonable.

Originally Posted by shahalam

Perhaps associate physician, sort of like an associate professor.

Associate professors are still professors. PA's aren't physicians. It's an adjective/noun issue. As long as the noun in correct, it's reasonable. I smash med students who refer to themselves as "Student Doctor X". The last thing we need is our best mid-level colleagues falling into the same dishonesty that marks the DNPs.

Originally Posted by shahalam

Or physician associate, as in one who works in association with a physician while not actually being one.

I like that.

Originally Posted by shahalam

And who gets to decide the title, even if we find one that we can agree on? Is it the individual states? The NCCPA? The AAPA? The NBME?

Don't PAs have a national association? Just change the fricking name. If the nurses can invent new titles, I don't see why the PAs can't.

Originally Posted by shahalam

I never want to hear one of my PA colleagues say to a confused and perhaps scared patient, “Yes, I am Dr. X, but I am not a physician. I’m a PA, a physician assistant. But, it’s okay to call me doctor because I am one … just not a medical doctor … I’m a doctor of physician assistant science. And this is my esteemed colleague, Dr. Y, who is a nurse practitioner. No, she’s not a physician either, but she is a doctor of nursing science, so you may refer to her as doctor if you wish. How may we help you today?”

Someone explain this statement to me. Is he saying they shouldn't refer to themselves as "Doctors". Or is he saying they should be able to call themselves "Doctors" and everyone should understand what they mean without explanation?

a bit of a hx lesson here....the ORIGINAL name of the profession was physician associate and it was changed to physician assistant at the urging of the ama.
I am a long time proponent of the term physician associate as it keeps the "pa " initials and more adequately conveys what we do. only in surgery does a pa "assist" a physician.
many hospitals allow pa's in connecticut to use the term physician associate as the pa program at yale is designated a "physician associate" program(ditto stanford) although they follow the same curriculum as other pa programs and take the same board exam.

The word associate implies more equality. It has the conotation that a PA is on par with an MD/DO/MBBS. The training is not on par. If I hire a PA for my future primary care practice I won't be consulting with them as a professional equal, but dictating what I want them to do to make my life and practice run more efficiently - which is the job of an assistant.

...

Originally Posted by Spleen

The word associate implies more equality. It has the conotation that a PA is on par with an MD/DO/MBBS. The training is not on par. If I hire a PA for my future primary care practice I won't be consulting with them as a professional equal, but dictating what I want them to do to make my life and practice run more efficiently - which is the job of an assistant.

you will find if you work in medicine long enough that everyone knows something you don't know about something and can be a valuable consult. younger physicians in my group consult the older pa's all the time(mostly regarding primary care issues as we are forced through our recertification requirements to know primary care regardless of what specialty we work in) and we consult them regarding difficult or unusual em pts.
you would be amazed how many new em docs don't know how to treat really simple primary care problems like bv, cat bites, or om or suture oddly shaped lacs because they focused on the care of truly acute pts when they were residents.
it is possible to have a collegial relationship with anyone you work with be they physician, pa/np, rn, resp therapist, etc whether or not they are your "equals". I am much older than many of the docs I work with and they recognize that my experience may have exposed me to things that they have never seen so they do ask me to evaluate their pts on a fairly regular basis for a second opinion and I consult them as well when I see something new. that's how you expand your knowledge base. if you only allow yourself to be taught by physicians you will miss out on a lot of valuable teaching over the years.

I'm sure that with enough years of experience and also depending on the circumstances surrounding the employment of PAs ( Not all PAs can be as astute as those in the military) there will be some PAs who will shine brighter than their colleagues and even more so than their physician employers (and do so to their own detriment). However this does not constitute grounds for equality and reciprocity in terms of patient care hierarchy.
There is no such thing as a Doctor of Physician Assistant Sciences. By that time, with the amount of schooling already invested, the poor sucker should've invested all his efforts into medical school and become the employer of PAs in less time.
Anyone who wants to truly be a PA should know that they are working in the employ and by proxy, under the license and name of a physician at all times. If you want more than that, then skip PA school and go to medical school. If you are comfortable with the fact that you will be an eternal "resident" per se all because it was a shorter course of school and you do "essentially the same thing" as a doctor, then please do not gripe later over the fact that your every decision is subject to supervision of a doctor and that you will seldom ever make as much or more than a physician. (But that's the biggest selling point of you people. You're a cheaper unit for your intended purposes. That's it.)
My 2 cents. Flame on.

no flaming, just a little fyi.
baylor graduated its first class of DScPA (dr of pa studies, emergency medicine ) last yr. currently the program is only open to pa's on active duty.

Originally Posted by emedpa

no flaming, just a little fyi.
baylor graduated its first class of dpas (dr of pa studies, emergency medicine ) last yr. currently the program is only open to pa's on active duty.

What the hell is that?

http://physician-assistant.advancewe...aspx?CC=101913

again...i'm having a little difficulty in understanding the utility of a doctorate in physician assistant sciences. Unless it's for academic purposes, are they no longer PA-C after their name or is it PA-D? It still seems like a long hard fought road just to end up in a second tier position to physicians. So are they PAs with Doctorate degrees or does this entail additional rights, priveleges, and pretty much everything a doctor has minus the DO/MD at the end of their name?

Originally Posted by LeemerDO

again...i'm having a little difficulty in understanding the utility of a doctorate in physician assistant sciences. Unless it's for academic purposes, are they no longer PA-C after their name or is it PA-D? It still seems like a long hard fought road just to end up in a second tier position to physicians. So are they PAs with Doctorate degrees or does this entail additional rights, priveleges, and pretty much everything a doctor has minus the DO/MD at the end of their name?

this program grants a doctorate which folks can list as PA-C(the c just means a pa has passed the natl board exam and is Certified), DScPA. these grads are only addressed as "doctor" ouside of a clinical setting, for example when lecturing.that is a core principle of the program.
it is extra clinical training and in the right setting it would allow extra clinical privileges as the program is based on a residency model so extra skills that are documented could be approved by individual facilities just like for docs(md/do) with specific specialty training. this does not do away with a supervisory requirement which is required for all pa's regardless of degree or setting. that supervision can be very flexible such as md available by phone for consults and not present while the pa works.. the impetus for this program was to help pa's in the military achieve higher rank which requires a doctorate degree in your profession after a certain level.several other military DScPA programs are in the works. I spoke to the director of this program at a conference last april and asked if civilians would ever be admitted and his answer was" no way in hell".
there are very few high ranking pa's in the armed services right now and that will start to change as grads of this and similar programs become eligible for promotion to commands formerly held by nurses with doctorates and others with doctorate level degrees.
previously folks who completed these residencies only got a certificate but if you do 80 hrs/week for 2 yrs and complete a doctoral level thesis or project after already having a masters degree what is the obvious next degree to award? a grad of one of these programs would typically have around 8 yrs of college level course work( 4 for bs, 2 for ms, 2 for residency). in many other fields that grants a doctorate degree so why should it be different for pa's?

well it's not like we really agree with the other fields of health care deserving a doctorate degree either (DNP, DPT, and the like), especially since those degrees have been out for little more than a decade. The doctor title in this case, merely a means to get higher rank, serves little more than additional wall spaghetti for those who pursue it. It essentially cheapens the definition and meaning of a doctoral degree, and further blurs the line between physician and PA.

Originally Posted by LeemerDO

well it's not like we really agree with the other fields of health care deserving a doctorate degree either (DNP, DPT, and the like), especially since those degrees have been out for little more than a decade. The doctor title in this case, merely a means to get higher rank, serves little more than additional wall spaghetti for those who pursue it. It essentially cheapens the definition and meaning of a doctoral degree, and further blurs the line between physician and PA.

actually by other clinical doctorates I meant pharmd, dpm, dds, etc not dnp, aud, dpt.
I don't think 8 yrs of college study for a doctorate cheapens the meaning of doctoral degree as it imparts new clinical skills and provides an avenue for greater autonomy within the pa/md relationship while still maintaining oversight.
this isn't an online program like a dnp or dpt as it requires significant commitment of time in a clinical setting to complete:
II. CURRICULUM:

The program of instruction is modeled after the emergency medicine curriculum developed by the American College of Emergency Physicians, and places emphasis on the skills required of military emergency medicine physician assistants.

A. The Didactic portion consists of the following:

1. An introduction to emergency medicine consisting of lectures and reviews, structured to allow each EMPA student to make a smooth transition into the program.
2. Weekly lectures, presented by EM, EMPA staff and guest lecturers.
3. Grand rounds, morning reports, trauma conferences, case presentations, radiology reviews and participation in emergency medicine research.
4. Academic clinical evaluation through monthly exams on required readings, Midterm and examinations, case presentations, continuing evaluation of skills during each rotation and chart review.

B. The Clinical curriculum consists of the following:
EM 500 Introduction to Emergency Medicine 4 weeks
EM 501 Introduction to Emergency Medicine 4 weeks
EM 502 Introduction to Emergency Medicine 4 weeks
EM 503 Emergency Medicine & Anesthesia 4 weeks
EM 504 Emergency Medicine, EMS & Law 4 weeks
EM 505 Emergency Medicine & Toxology 4 weeks
EM 506 Emergency Medicine & Neurology/Neurosurgery 4 weeks
EM 507 Pediatrics 4 weeks
EM 508 OB/GYN 4 weeks
EM 509 Critical Care/Cardiology 2 weeks
EM 510 Trauma Surgery/SICU 4 weeks
EM 511 OMF/EENT Disorders 2 weeks
EM 512 Orthopedics 2 weeks
EM 513 Radiology 2 weeks

Many PAs have doctorates: a hard-earned and well-deserved PhD or DSc, EdD, DrPH, DPsy, DPT, or PharmD. Some even have an ND, or perhaps a DC. They are doctors, although they are not physicians. They practice as PAs. Should they be called doctor?

This is easily the weakest argument in the passage. Suppose the guy who pushes wheelchairs all day happens to have a PhD in English Lit. Should patients call him "doctor" in a clinical setting?

Also unmentioned is the true reason why PAs feel compelled to seek a clinical doctorate: competition from DNPs. In the minds of most people, PA has always been the same as NP or at least pretty damn close. If the DNPs insist on called doctor (after a laughable training that barely touches on medicine and focuses on "theory of leadership", I might add), it is entirely understandable if PAs feel forced to seek their own doctorate simply to achieve parity. This on top of other ridiculous made-up "doctorates" such as the PharmD, DPT, etc etc etc.

So while the passage cited does not always make a strong case, I understand completely why PAs seek a clinical doctorate degree. They resisted it longer than anyone else but even they must bend to the reality of degree inflation. Finally, I should note that while in my limited med-school experience I have already met my share of completely incompetent NPs... I have yet to meet an incompetent PA.

PA's are cool. Physician Associate would work.

Originally Posted by emedpa

actually by other clinical doctorates I meant pharmd, dpm, dds, etc not dnp, aud, dpt.
I don't think 8 yrs of college study for a doctorate cheapens the meaning of doctoral degree as it imparts new clinical skills and provides an avenue for greater autonomy within the pa/md relationship while still maintaining oversight.
this isn't an online program like a dnp or dpt as it requires significant commitment of time in a clinical setting to complete:
II. CURRICULUM:

The program of instruction is modeled after the emergency medicine curriculum developed by the American College of Emergency Physicians, and places emphasis on the skills required of military emergency medicine physician assistants.

A. The Didactic portion consists of the following:

1. An introduction to emergency medicine consisting of lectures and reviews, structured to allow each EMPA student to make a smooth transition into the program.
2. Weekly lectures, presented by EM, EMPA staff and guest lecturers.
3. Grand rounds, morning reports, trauma conferences, case presentations, radiology reviews and participation in emergency medicine research.
4. Academic clinical evaluation through monthly exams on required readings, Midterm and examinations, case presentations, continuing evaluation of skills during each rotation and chart review.

B. The Clinical curriculum consists of the following:
EM 500 Introduction to Emergency Medicine 4 weeks
EM 501 Introduction to Emergency Medicine 4 weeks
EM 502 Introduction to Emergency Medicine 4 weeks
EM 503 Emergency Medicine & Anesthesia 4 weeks
EM 504 Emergency Medicine, EMS & Law 4 weeks
EM 505 Emergency Medicine & Toxology 4 weeks
EM 506 Emergency Medicine & Neurology/Neurosurgery 4 weeks
EM 507 Pediatrics 4 weeks
EM 508 OB/GYN 4 weeks
EM 509 Critical Care/Cardiology 2 weeks
EM 510 Trauma Surgery/SICU 4 weeks
EM 511 OMF/EENT Disorders 2 weeks
EM 512 Orthopedics 2 weeks
EM 513 Radiology 2 weeks

I will say that the curriculum looks a lot more robust than the DNP curricula I've seen posted. No PA theory or similar soft classes. I also appreciate that PA's have specified that they will not be called doctor in the clinical setting. Still, it's a "doctorate" level degree in 1 year. In my opinion, if this is really to help military PA's get promotions, the military rules should be changed rather than making a doctorate in PA. Let's be honest, there is already a clinical doctorate-level degree for PA's and RN's for that matter. It's called the MD.

Originally Posted by cpants

I will say that the curriculum looks a lot more robust than the DNP curricula I've seen posted. No PA theory or similar soft classes. I also appreciate that PA's have specified that they will not be called doctor in the clinical setting. Still, it's a "doctorate" level degree in 1 year.

it's actually 18 months after an ms when you include the thesis or project work which is started at the beginning of the residency.
hopkins also has a similar residency(18 mo) for em pa's right now but it's not tied to a degree and there are a few others out there that give an ms. I know of at least 1 civilian DScPA residency in the works right now at a major academic medical center.
for other residencies for pa's see www.appap.org

Most PA's I've worked with introduce themselves as "PA" rather than Physician Assistant. If PA's want to lobby for a name change to "Physician Associate", it seems like a waste of effort and money to me when there are bigger fish to fry.

When the NP programs all convert to DNP's, the PA's will be at a significant advantage. Less schooling and less debt for the same job as a DNP means that being a PA will be the preferred route to being a midlevel. If the actions of the AMA is any indication, physicians will never recognize the DNP as equivalent or even close to being one. The DNP is still a midlevel.

Additionally, if PA's want to move to a doctoral level, then all PA schools should convert themselves to MD schools and MD's who haven't done residencies should be become the new standard for a midlevel.

I believe that it was a mistake the medical profession to make NP's and PA's into midlevels. Midlevels should have always been MD's who haven't done residencies.

Originally Posted by Taurus

Most PA's I've worked with introduce themselves as "PA" rather than Physician Assistant. If PA's want to lobby for a name change to "Physician Associate", it seems like a waste of effort and money to me when there are bigger fish to fry.

When the NP programs all convert to DNP's, the PA's will be at a significant advantage. Less schooling and less debt for the same job as a DNP means that being a PA will be the preferred route to being a midlevel. If the actions of the AMA is any indication, physicians will never recognize the DNP as equivalent or even close to being one. The DNP is still a midlevel.

Additionally, if PA's want to move to a doctoral level, then all PA schools should convert themselves to MD schools and MD's who haven't done residencies should be become the new standard for a midlevel.

I believe that it was a mistake the medical profession to make NP's and PA's into midlevels. Midlevels should have always been MD's who haven't done residencies.

Let's see, four years undergrad plus two years PA school + 18 months of this "doctorate" thing they consider "Residency" they'll probably be just as good as a fourth year medical student, time wise. Still not as much schooling as doctors, and that's without residency.

Gee, I wish I could get another doctorate degree after residency training. That would be cool, but no, after this, we get Board Certification.

Kinda sounds backwards when you think about it.

Originally Posted by Taurus

Most PA's I've worked with introduce themselves as "PA" rather than Physician Assistant. If PA's want to lobby for a name change to "Physician Associate", it seems like a waste of effort and money to me when there are bigger fish to fry.

When the NP programs all convert to DNP's, the PA's will be at a significant advantage. Less schooling and less debt for the same job as a DNP means that being a PA will be the preferred route to being a midlevel. If the actions of the AMA is any indication, physicians will never recognize the DNP as equivalent or even close to being one. The DNP is still a midlevel.

Additionally, if PA's want to move to a doctoral level, then all PA schools should convert themselves to MD schools and MD's who haven't done residencies should be become the new standard for a midlevel.

I believe that it was a mistake the medical profession to make NP's and PA's into midlevels. Midlevels should have always been MD's who haven't done residencies.

I've always agreed with that. At the very least, an accelerated route to an MD after obtaining a PA as long as all other requirements are met would make more sense than inventing an inferior doctorate to the MD that takes a cumulative amount of time almost equal to that required to get an MD. The difference between a mid-level and a physician should be a residency. This also begs the backwards question of why MDs without residency can't legally function as a mid-level now, even though they actually have more cumulative training.

Originally Posted by Miami_med

This also begs the backwards question of why MDs without residency can't legally function as a mid-level now, even though they actually have more cumulative training.

In order to change the status quo, I think we need to shift the bottle-neck in medical education. Right now, the bottle-neck is being accepted to medical school. If you go to a US MD or DO program, you are more or less guaranteed a residency position. We need to change it so that the bottle-neck is getting into a residency so that only the brightest and best can get into one. Anyone who doesn't get a residency then becomes a midlevel. With MD class sizes increasing, more MD and DO programs opening, and more for-profit DO programs like RVU opening, then this may actually happen where we have more medical school grads than residency positions. If that happens, then I think that the AMA and lawmakers will be forced to allow MD's who haven't done residencies to function as midlevels. Hopefully, it will become the standard.

So wait...you get into med school, get loaded with 200K+ debt, and DON'T get a guaranteed for a residency and eventually a job after you are done? And to sucker punch the guy, he's now a mid level who's making way below 100K per year? How is he going to pay off that debt still expect to have a family?

Originally Posted by psy

So wait...you get into med school, get loaded with 200K+ debt, and DON'T get a guaranteed for a residency and eventually a job after you are done? And to sucker punch the guy, he's now a mid level who's making way below 100K per year? How is he going to pay off that debt still expect to have a family?

#1) Student loan debt is a different problem, that should be addressed simultaneously. Of course, the new DscPA or whatever the heck it's called would be almost as long, and without subsidy, likely as expensive.

#2) What makes you think that mid-levels make way less than 100k/year? Virtually all make more than $45k/year, the magic residency number.

So who will be subsidizing the student loan debt to help lower it? Currently we have a physician shortage in this country. The proposal by Taurus would make it worse unless midlvl education was somehow improved to physician standards. If so, then shouldn't they just be called physicians rather than midlevel?

Originally Posted by psy

So who will be subsidizing the student loan debt to help lower it? Currently we have a physician shortage in this country. The proposal by Taurus would make it worse unless midlvl education was somehow improved to physician standards. If so, then shouldn't they just be called physicians rather than midlevel?

Increased school sizes and more schools opening aren't my proposal. It's happening already. Because residency slots aren't increasing, I believe we will reach a point where there are more grads than residencies at some point. If that happens, then these unfortunate grads need a way to earn an income so that they can pay down their huge debts.

Debt size is something that unfortunately most schools don't think too much of. Why else would the pharm's set off this arms race by going to the pharmd? PharmD's do the same job that somebody with a BS in pharm did and get paid the same. While the schools are thinking of making a BS a prereq, pharm's are now are facing decreased employment prospects and even layoffs. Why did the PT's go to the DPT? Why did the occupational therapists go to an OTD (I kid you not)? Why are the NP's now going to the DNP? They will all do the same thing at the doctoral level compared to the BS or MS levels. It's absolutely ridiculous. As long as you have a student who is willing to pay the tuition with loan money, these schools and professions will keep pushing these worthless doctorate degrees.

It seems to be an American thing for everyone to have a doctorate. If you are from England the doc's "only" have a bachelors degree in medicine-MBBS and they are just as good as an American docs. I think the PA profession should avoid this doctorate rat race so they won't look like some of these foolish NP's.

I very much agree with what Taurus and Miami Med are saying.

Taurus, have you ever informed the AMA of your opinion on the issue? I mean it makes sense, a medical school graduate should be able to function as a midlevel if they do not do residency. Also the student loan and this midlevel issue should be simultaneously corrected.

Originally Posted by Taurus

Increased school sizes and more schools opening aren't my proposal. It's happening already. Because residency slots aren't increasing, I believe we will reach a point where there are more grads than residencies at some point. If that happens, then these unfortunate grads need a way to earn an income so that they can pay down their huge debts.

Debt size is something that unfortunately most schools don't think too much of. Why else would the pharm's set off this arms race by going to the pharmd? PharmD's do the same job that somebody with a BS in pharm did and get paid the same. While the schools are thinking of making a BS a prereq, pharm's are now are facing decreased employment prospects and even layoffs. Why did the PT's go to the DPT? Why did the occupational therapists go to an OTD (I kid you not)? Why are the NP's now going to the DNP? They will all do the same thing at the doctoral level compared to the BS or MS levels. It's absolutely ridiculous. As long as you have a student who is willing to pay the tuition with loan money, these schools and professions will keep pushing these worthless doctorate degrees.

Because their goal is to gain the same scope of practice and privileges as MD's. Read some of the literature out of the nursing schools. In some cases they even claim their degree will be better than the MD/DO.

Originally Posted by badasshairday

Taurus, have you ever informed the AMA of your opinion on the issue? I mean it makes sense, a medical school graduate should be able to function as a midlevel if they do not do residency. Also the student loan and this midlevel issue should be simultaneously corrected.

I wish it were so simple as to send a note to the AMA and then see results. These groups tend to have their heads stuck in the sand too much. Remember that it took a threat from Congress to pass a law to cap residency hours before the ACGME capped weekly hours at 80. How much sense is there to cap driving hours for truck drivers at 10 hours a day but to allow a surgeon operate without having slept for more than 30 hours?

50 years ago when the NP and PA groups were first being created, residency was very different than it is now. It could be as short as 1 year long. A general practitioner could be licensed and start practicing medicine just after finishing internship. So back then, it didn't make sense to have MD's who didn't do residency into midlevels. Nurses also were not lobbying states to allow them to prescribe and work without physician oversight. However, today is different. You can't gain hospital privileges and insurance companies won't reimburse you if you do not complete a residency and become board certified. More than 20 states allow NP's to diagnose, treat, and prescribe without physician supervision.

Medicine is under siege from every healthcare-related group who thinks that they can practice medicine with a few classes. The NP's, PA's, even the pharm's want a piece of the action. The midlevel groups that physicians once trusted to assist them are stabbing them in the back. These groups are using lies and propaganda to convince patients that they are qualified when they are not. The DNP is a joke. How can anyone with a clear conscience introduce themselves as "doctor" when they did their DNP online and spent just 1000 hours in clinical training? These groups are trying to erase history and try to convince the public that the word "doctor" no longer has to mean physician. They want the patient to believe that it can now mean "DNP", "ND", "Pharmd", "DPT", "chiroprictor", etc.

I believe that the AMA needs to recognize that times are changing and that they need to adapt. I believe that the AMA should promote the idea that the most qualified midlevels are MD/DO's who haven't done residency. If these midlevels want further training and to work autonomously, they can complete a residency and become attendings. I hope that the increased class sizes and more schools opening are the first steps in that direction. Once we reach a point where we have more grads than residency positions, then the AMA will be in a position to make that vision possible.

Remember that physicians are the primary employers of NP's and PA's. If we collectively say that we will not sell out our profession and keep our Hippocratic Oath to not let harm befall our patients, then we should preferentially hire the most qualified midlevels available, hopefully that will be non-residency MD/DO's.

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First of all, to me "physician associates" for PAs is a bastardization of the English language since it implies more of an MD physicians group practice than PAs. If you do a Google search on "physician associates" many of the results will be names of private MD practices. People who are associates of a firm generally have the same academic degree as the partner. For example the associates in "Attorney and Associates" refers to the JD associates who are working to become partners, not paralegals. Similarly, a research associate (mostly postdocs) has typically the same PhD as the PI.

Secondly, language evolves not just for one group. If everyone and their egos who see a patient are going to call themselves "doctors" and "physician associates," then medical doctors will gradually have another name that people will call out for. So long as the substance of a medical doctor's training does not degrade, people will recognize substance over BS.

Call yourself whatever you please. Frankly, I think our system has bigger problems to worry about. I'm going to be an MD. So what? I'm already over the supposed "thrill" of having people call me "Dr." Honestly, I never really had that thrill. If that's the only reason somebody is in medicine, to be called a certain title, whether they are an MD, PA, NP, or whatever, I bet they aren't too great at what they do, since their focus is misdirected. I fail to see how "Physician Assistant" is any different from "Physician Associate." The difference in connotation is so mild as to be laughable that anybody would want to have a major movement to change the name, in my opinion. What is this obsession in medicine with ranks, titles, subordination, pecking orders, salaries, prestige, etc? Does anybody spend any time thinking about the freaking patient anymore instead of themselves?

Originally Posted by shahalam

http://www.jaapa.com/issues/j2008110...unding1108.htm

fter more than 3 decades as a proud member of the PA profession, and as one who has focused on patient care exclusively during that entire time, I feel able to speak with some clarity about what has always been the most sensitive of subjects: our profession’s title—physician assistant. And as I get ever closer to that age of Medicare eligibility, I feel able to face the inevitable firestorm that always seems to rain down on those of us who feel that this is an issue yet to be happily resolved. The specter of the “clinical doctorate” has come to the fore, and now it’s time. Not time to discuss who we are or what we’re made of, where we came from, and what we are capa-ble of–our physician mentors and our patients pretty much know all that. We need now to discuss a title that will at last reflect the reality of where we fit into the scheme of health care delivery here and increasingly around the world. And physician assistant “ain’t it!”

Maybe in the early 1970s, PAs mostly assisted their physician employers, supervisors, and mentors directly, by extending their eyes, ears, and hands. And maybe in the early days of every new PA’s career, he or she is truly an assistant. But time marches on, and the medical world and health care delivery have evolved. We have evolved with them. Our title has not. It no longer is a helpful descriptive of our role.

Tell the military PA, crouching in the sand, sticking a chest tube into a colleague wounded by an IED (improvised explosive device), that he or she is an assistant. Explain to the family of a hospital emergency department patient that their daughter’s gaping laceration is being repaired by a physician assistant—that no doctor is on duty just then. Listen anonymously, as I have, to a patient telling his friend that yes, his shoulder had been dislocated during the game, but the orthopedic surgeon sent in his assistant to reduce it. “She did a great job, though.” Even after 30-plus years, I still occasionally encounter the returning patient who looks at my name badge and says incredulously, “You’re still an assistant? You should have graduated to a full MD by now!” And I launch into the explanation I learned by rote during my first weeks of PA school. It was a good one then, but now it feels like I’m trying to convince myself.

So, what is the answer to this dilemma? How should we deal with it?

Some would say that we just need to do a better job of public education: if we explain ourselves to enough people often enough, using the right media, patients will come to understand that we’re not physicians. But will they really, especially in the era of the paper chase?

Many PAs have doctorates: a hard-earned and well-deserved PhD or DSc, EdD, DrPH, DPsy, DPT, or PharmD. Some even have an ND, or perhaps a DC. They are doctors, although they are not physicians. They practice as PAs. Should they be called doctor?

There are always those in our own profession who will predictably fire back with. “If you want to be called doctor, go to medical school!” (I didn’t and still don’t.) Okay, I get it. But how about a title that more accurately describes what we actually do? Or where we fit in? Is a title like that such a stretch?

I think not … but, I hasten to add, I’m not sure what that title should be. I do know that it shouldn’t contain the word assistant. Perhaps associate physician, sort of like an associate professor. Or physician associate, as in one who works in association with a physician while not actually being one.

And who gets to decide the title, even if we find one that we can agree on? Is it the individual states? The NCCPA? The AAPA? The NBME?

I have no magic answer. I just know that as more and more of us get doctorates—clinical or otherwise—I never want to hear one of my PA colleagues say to a confused and perhaps scared patient, “Yes, I am Dr. X, but I am not a physician. I’m a PA, a physician assistant. But, it’s okay to call me doctor because I am one … just not a medical doctor … I’m a doctor of physician assistant science. And this is my esteemed colleague, Dr. Y, who is a nurse practitioner. No, she’s not a physician either, but she is a doctor of nursing science, so you may refer to her as doctor if you wish. How may we help you today?” JAAPA

Proud? Good. You should be proud to be a physician's assistant. It's a great field.

Since when are we proud because we're called "Dr." or any other title? Pride comes from within.

You earn respect. It doesn't come in a title.

To the OP - your issues are all valid.

The bottom line is that PA is a terrible name - it's too diminutive for what you do. Assistant should not be in the name because people think it's related to an MA, a nurse, or it's the precursor to getting 'the full MD'. That said, let's not confuse the public by calling it a physician associate either. That name is almost as retarded. We need to raise your title up without bringing our MD title down (I only mean that in a nice way, because your two years will never be what our 7-10 are - otherwise what the hell is the incentive to go through the **** we do).

I think we need to use 'medic' - using a name truer to the origin of the PA profession. You really are like a mini doc and the name needs to go away from something that sounds like a secretary or a lacky.

I don't know. I'd rather be called a PA than a medic. Sounds like an EMT or something. I don't think society looks down on PAs at all. I don't know where all this stuff comes from on these threads.

Anyone see any familiarity...?

How about "ASSOCIATE to the Regional Manager?"

Originally Posted by Coastie

Proud? Good. You should be proud to be a physician's assistant. It's a great field.

It's an even better field when you call it by it's correct name:
physician assistant.
no 's.
one physician assistant
two physician assistants.
never 's.

Originally Posted by abefromann

I think we need to use 'medic' - using a name truer to the origin of the PA profession. You really are like a mini doc and the name needs to go away from something that sounds like a secretary or a lacky.

medic is what many of us(myself included ) were before pa school so that won't do.
in canada they are "clinical associates" which I think works ok. no "assistant" in the title to make pa's happy. no "physician" in the title to make docs happy.

"no "assistant" in the title to make pa's happy. no "physician" in the title to make docs happy."

Seems fair. From the patient's perspective, "assistant" implies too low a level of care. My GF (PA) is constantly annoyed when she takes trauma ortho call and after they splint or cast or whatever the patient demands to see a doctor. 'But the doctor is sleeping at home'. And conversely I've come across many people that ask my GF "well, why would I need a doctor, then?" That is a bit annoying. I guess my med school and residency years were a complete waste, huh? I basically have to shut my mouth and say, 'well, there are some things that their program doesn't cover...'

it just seems like the public doesn't know much about the differences among health care providers - not surprisingly. i, for instance, know nothing about what it is really like to practice law, though I've seen innumerable 'law and order' and 'night court' episodes.

Why do mid-levels have a problem just being who they are? Never understood that one. If you're at KMart and you bump into the assistant manager, it's clear he isn't the manager. He's the assistant manager. If you ask to see the manager, and the assistant manager shows up, you might clarify that you want to see THE manager. PAs are not physicians. They are physician assistants. If they don't like that, they shouldn't take the job. Just like somebody shouldn't take the job of assistant manager if it's going to offend them when somebody doesn't consider them THE manager.

Originally Posted by RGMSU

Why do mid-levels have a problem just being who they are? Never understood that one. If you're at KMart and you bump into the assistant manager, it's clear he isn't the manager. He's the assistant manager. If you ask to see the manager, and the assistant manager shows up, you might clarify that you want to see THE manager. PAs are not physicians. They are physician assistants. If they don't like that, they shouldn't take the job. Just like somebody shouldn't take the job of assistant manager if it's going to offend them when somebody doesn't consider them THE manager.

most of us took the job for the scope of practice, not the name. we would still do this job if we were called goonies. our national association would be NAG(the natl association of goonies). those with a doctorate would be DoGS( Dr. of Goonie Studies).....NO WAIT, DOGS SOUNDS LIKE DOCS, CAN'T HAVE THAT....
do I like the name? no.
can I live with it? sure.
would I vote for a change? you bet.
advanced practice clinician
physician associate
clinical associate
affiliated clinician
take your pick....
until then I'll keep introducing myself as a P.A.

Hah, and what's the point of the name change other than to try to alter scope of practice to inch closer to being a pseudo-physician? None of those names really sound like an improvement to me, but whatever floats you guys' boats. You might consider that many patients have just become accustomed to what a "PA" means before you go changing things up and confusing them again.

Originally Posted by RGMSU

Hah, and what's the point of the name change other than to try to alter scope of practice to inch closer to being a pseudo-physician? None of those names really sound like an improvement to me, but whatever floats you guys' boats. You might consider that many patients have just become accustomed to what a "PA" means before you go changing things up and confusing them again.

No one knows what a pa is.
we are invisible.
our natl organization refuses to spend any money on pr.

Originally Posted by emedpa

No one knows what a pa is.
we are invisible.
our natl organization refuses to spend any money on pr.

What I'm saying is a lot of this stuff is in you guys' heads. I have never heard anybody who went to a PA as a PATIENT and didn't understand who they had just seen. I also haven't heard many of them who were dissatisfied with the service they received. Where you folks get the idea that you're downtrodden, disrespected, and whatnot I'll never know. That's why I'm surprised when there's talk of changing names and similar bs. I hear many more people confused about what a DO is than a PA. I don't hear DO's talking about a name change.