MD/PA working relationship

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Sorry for the multiple threads. I just have a lot of questions. I'm probably going to get laughed at and ridiculed for the naivete of this one, but oh well.

What is the general working relationship between MDs and PAs? From the research I've done, I know that there is a certain level of animosity between physicians and mid-level clinicians, but it seems that this animosity is mostly between MDs/DOs and DNPs. I wondered if physicians may have a better working relationship with PAs due to the fact that they're both trained in the medical model. I have this quasi-romantic notion of MD/PA dynamic duos, sort of like a Holmes/Watson relationship. I'm probably totally off.

really depends on the practice dynamic.

30% of docs in my experience hate pa's and all we stand for. they won't talk to us on the phone, etc. some of them are passive aggressive about it and some are just downright jerks. one doc on the board of a hospital I work at just tried to pass a rule that "no pa's can do ultrasound". fortunately for us the pa who applied for these privileges has a prior 4 yr u/s degree. when he presented this at the medical staff mtg along with testimony from our ed chief that his skills were better than any of the er docs who do u/s the first doc looked like a total idiot.
many of these pa haters frequent sdn.
30% of docs love us and think we are better than sliced bread. we take call for them, do their early am rounds, admit and discharge their pts and make them loads of money.
40% of docs don't care one way of the other and put up with us as long as we don't rock the boat or do anything blatantly stupid.
there are pro-np docs and haters out there as well.
there are lots of "dynamic duo" pa/md partnerships out there. many of these are surgical practices or rural practices in which the pa and doc have worked together for years and the doc wouldn't replace the pa with another doc if they could.
see www.aapa.org for pa info and www.physicianassistantforum.com for a pa specific forum with > 20,000 pa's vs the 5 pa's who post here.

One day when I was a resident, my program director was my attending. A call went out to a consultant service, and the callback came from a PA. My PD was aghast - she felt that a doc deserves a doc. Period. I, however, am not so sanguine. As long as the person on the other end of the line knows about what s/he is talking, it's all good. If not, then there will be fireworks.

The animosity you describe is largely limited to SDN. The internet allows people to post long angry rants without ever having to actually face the people they're bashing. In the real world, pretty much everyone is too damn busy to walk around with a giant chip on their shoulder.

In practice the MDs that work with my group don't know which of us are PAs, which of us are NPs and wouldn't care or remember if you told them. We get along wonderfully. We consult all sorts of folks in the hospital to see our patients and if anyone is fuming about the indignity of having to speak to an advanced practice provider, they hide it incredibly well.

Please don't take the atmosphere at SDN as an indication for how PAs and NPs work with MDs. If my workplace was like SDN I'd be dodging sniper fire as I came in to work most days.

Originally Posted by technocrat626

Sorry for the multiple threads. I just have a lot of questions. I'm probably going to get laughed at and ridiculed for the naivete of this one, but oh well.

What is the general working relationship between MDs and PAs? From the research I've done, I know that there is a certain level of animosity between physicians and mid-level clinicians, but it seems that this animosity is mostly between MDs/DOs and DNPs. I wondered if physicians may have a better working relationship with PAs due to the fact that they're both trained in the medical model. I have this quasi-romantic notion of MD/PA dynamic duos, sort of like a Holmes/Watson relationship. I'm probably totally off.

yea...seems to be much more tension with docs who aren't socialized to PAs, and don't understand what they can do, and what they can't do. i trained in the texas medical center as a PA student, and never felt mistreated or disrespected by any physician (although these were all in teaching hospitals).

here are some links that i saved from emedpa that i really liked that show the MD-PA relationship in a positive light (unlike what you see a lot on SDN!)

http://www.annemergmed.com/article/S...129-6/fulltext

http://www.mdanderson.org/publicatio...er-cancer.html

From what I have seen in the healthcare field (mostly military) there was little to no sniper fire aimed at PA/NPs in the workplace. Perhaps SDN is just a more anonymous place for docs to vent their resentment. Either way I have noticed nothing but healthy collaboration.

I agree. I have had one ED physician be rude to me because he didn't like the fact that I was transferring a patient to them. We aren't prepared to treat asthmatic emergencies in the family practice clinic, so off to the ED they go. I really, really doubt he would have spoken to another physician as brusquely as he did me, but perhaps he would have. Perhaps he was just told his mother died, or that his car had been stolen, or he had 6 months to live himself. Perhaps he hates advanced practice providers. Perhaps he hates asthmatics. Perhaps he is just an *******, I have no idea.

Other than that single fracas, all of my other interactions have been positive. I get compliments and appreciation daily from my physician colleagues.

Originally Posted by ChillyRN

I agree. I have had one ED physician be rude to me because he didn't like the fact that I was transferring a patient to them. We aren't prepared to treat asthmatic emergencies in the family practice clinic, so off to the ED they go. I really, really doubt he would have spoken to another physician as brusquely as he did me, but perhaps he would have. Perhaps he was just told his mother died, or that his car had been stolen, or he had 6 months to live himself. Perhaps he hates advanced practice providers. Perhaps he hates asthmatics. Perhaps he is just an *******, I have no idea.

Other than that single fracas, all of my other interactions have been positive. I get compliments and appreciation daily from my physician colleagues.

Working in Canada, I have a limited exposure to NP's.

I have not been impressed thus far in my interactions.

I get a consult from an NP on a patient ( who actually happens to be an RPN ).
According to the NP, the patient is a "very reasonable opioid patient."

She was not.

After having spent an hour with the consult, it became very clear of the following:

1. The NP had not read the previous pain consultant's recommendations.
2. The NP was not being careful in regards to monitoring and managing the patient's medications.
In particular i) the patient's opioids had escalated by a factor of 700 % since last seen by the previous
pain consultant, and ii) she was coming in very early for these opioids.

I got more and more pissed off as I read through the notes.

Apollyon makes an excellent point: it's awfully helpful to know what you're doing. Things have a way of blowing up in your face when they don't.

Originally Posted by ghost dog

Working in Canada, I have a limited exposure to NP's.

I have not been impressed thus far in my interactions.

I get a consult from an NP on a patient ( who actually happens to be an RPN ).
According to the NP, the patient is a "very reasonable opioid patient."

She was not.

After having spent an hour with the consult, it became very clear of the following:

1. The NP had not read the previous pain consultant's recommendations.
2. The NP was not being careful in regards to monitoring and managing the patient's medications.
In particular i) the patient's opioids had escalated by a factor of 700 % since last seen by the previous
pain consultant, and ii) she was coming in very early for these opioids.

I got more and more pissed off as I read through the notes.

Apollyon makes an excellent point: it's awfully helpful to know what you're doing. Things have a way of blowing up in your face when they don't.

Once again, ghost dog, your anecdote-ridden posts always provide valuable contributions to the discussion at hand. Keep up the good work.

If you want a realistic answer go and ask a real P.A. I personally know one and she loves the doctor she works under.

SDN is full of trolls.

Originally Posted by iqe2010

If you want a realistic answer go and ask a real P.A.
SDN is full of trolls.

yup, good advice here.

Yup, agree. I have never seem the hostility and insecurity in evidence here mirrored in the 3D world. You will get your best information from people you speak to and dynamics you observe.

Originally Posted by ChillyRN

Yup, agree. I have never seem the hostility and insecurity in evidence here mirrored in the 3D world. You will get your best information from people you speak to and dynamics you observe.

You think this sub-forum is bad? Try the allo pre-med sub forum...

I wouldn't have any information or support to offer them, so I don't go to that forum.