Can't we all just get along?

[levels x3]

PA's and residents seem to be in constant conflict here. Is it just us? Is it everywhere? What's behind it?

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[yaah]

We don't seem to have much of that here. Residents respect some of the PAs more than others, but everybody seems to be fine. I am sure there are a couple of individuals who have personal beefs with others though.

I don't know what's behind it at your place, sometimes it's what is perceived as an inequitable distribution of work or responsibility. Say, for example, if PAs never do cases for certain residents but do for others. Or if PAs refuse to do certain types of cases that residents hate. Or if residents treat the PAs with little respect. Things like that.

 

[LADoc00]

wth lol, is this a wrong forum posting? Yaah mod on it.

 

[Psychopathology]

I'm also interested in everyone's take. In my experience, PAs were extremely helpful and hardworking. They could really make our lives inside of the grossroom easy if they wanted to. They'd be among the last people anyone would want conflict with.

 

[levels x3]

I know what forum I posted in. PA in my question = Pathologist Assistant.

Here it seems to be, as yaah said, a perception of unequal work distribution as the biggest point.

"Constant" conflict is a bit of an exaggeration as well. Things run smoothly a lot of the time, but we have issues develop on a fairly regular basis. I was simply wondering if it's a product of the specific personalities of our PA's and some of our residents, or if there is something inherent to the PA/resident relationship that creates problems everywhere.

 

[LADoc00]

I see...conflict tho? you need to actually quote what the hell you are talking about.

And you need to understand the history behind what pathology assts are, who licensed them and why.

And let me clarify, ANYONE who assists me is technically a P.A. I have lots of PA's. They are great, there is no conflict whatsoever.

I havent experienced conflict in the sense of Yaah's post. If I have a PA who refuses to do something I think is reasonable, they are fired on the spot, gotta love "at will" employment states.

I actually did this not so long ago, called security, got their stuff out of the office and escorted em to the door. Not a biggie. No conflict outside of their own psyche I would guess.

 

[yaah]

Do the PAs have a supervisor? See, here the surg path director is the supervisor of the PAs and there are a bunch of job duties, regulations, etc about what they are supposed to be doing with their time. If necessary, I suppose things like how many cases they gross, how many complicated cases, how much time they take to do it, etc, can be tracked.

If the PAs aren't doing their job you need to bring this up with the supervisor or whoever directs surg path.


p.s. Grammar cop reminds you that "PAs" does not have an apostrophe in it because it is an abbreviation for a plural word (Physician Assistants), not a possessive (Physician Assistant, his/her). To wit: The senior PA's loud voice while dictating irritated the other PAs. Everyone needs a grammar cop in their life.

 

[mlw03]

i could see a potential issue between residents and PAs as follows: experienced PA trains resident in how to gross, but eventually resident will be PA's "boss" and that's a bit awkward. also, because residents look at stuff under the score and PAs rarely do, we're bound to have some different perspectives on the ideal way to gross a certain type of specimen. no one likes being told how to do their job, especially not an experienced PA by a young resident or even young attending. all that said, i see the PA-attending-resident relationships as generally positive and conducive to getting the job done as best as possible.

 

[yaah]

i could see a potential issue between residents and PAs as follows: experienced PA trains resident in how to gross, but eventually resident will be PA's "boss" and that's a bit awkward. also, because residents look at stuff under the score and PAs rarely do, we're bound to have some different perspectives on the ideal way to gross a certain type of specimen. no one likes being told how to do their job, especially not an experienced PA by a young resident or even young attending. all that said, i see the PA-attending-resident relationships as generally positive and conducive to getting the job done as best as possible.

I commend you on your excellent use of apostrophes.


There are a great many PAs who know far more gross pathology than residents do, and residents would be well served to remember this fact. I have seen quite a few PAs who make it a point to look at slides on odd cases that they gross, to see what turns out.

 

[levels x3]

It seems not to be a systemic issue based on this limited sampling. Honestly, I've never run into many problems myself, but as chief this year, everybody else's problems become mine. Perhaps we just have a few conflicting personality types at this time.

I agree that there are many PAs with more gross pathology knowledge and experience than most residents. There is a big difference in perspective though. Case in point; I recently questioned a request from a breast surgeon to have us do an intraoperative touch prep of an excisional biopsy for diagnosis ("tell me if it's cancer!!!"). We don't routinely do frozens or any other intraoperative assessments like that here (other than sentinel nodes), but that's not my point. The PA looked dumbfounded when I questioned this and basically said, "if the surgeon asked for it, you should do it". Um...no, I shouldn't. I work for the patient, not the surgeon.

LA, to be specific, the most recent issue (and most others) dealt with "dumping". A PA thought a resident had dumped work on her. The resident had done no such thing. PAs will dump on us quite frequently, but if there is even a perception, however untrue, of it going the other way, the proverbial _____ hits the fan. And no, though I might have wanted to at various times in the past, I can't fire anybody.

I appreciate the responses though.

 

[djmd]

There are a great many PAs who know far more gross pathology than residents do, and residents would be well served to remember this fact. I have seen quite a few PAs who make it a point to look at slides on odd cases that they gross, to see what turns out.

I fully agree with this... generally in situations where I was have to swap between their having more experience grossing, and me have to be their 'boss' was try to have a conversation about what sections we need...

Most of the best PAs want to know more about the microscopic as it relates to their sections and don't always know the clinical importance...

Some PAs never handle this transition well however... the more concrete thinking types... one way for every case. And heaven forbid you override their training once for a special case, because they will either not do it, or do every case after that like that, and blame you...

 

[raspberry009]

In our institution it's 2-3 PAs to 1 resident at the gross cutting room. They are awesome. Granted, we the residents always cover for them whenever we can to make sure that they don't have anymore than 40 hrs per week, which more often than not ends up going over 40 hrs. But we (the residents) always do little things to make sure that we're greatful for all of their help while they cover for us while we're at conference, like bring food, ect. It makes the environment much easier to cope with when the crap hits and we can't keep up with the work load. But all of our PAs are hard workers, none of them are slackers.

 

[ScopeHound]

Residents and PAs have the same relationship as residents and nurses if you did internal medicine. Some PAs will look at residents as a way to dump cases/work on since you are basically there for cheap labor at 1/2 of their salary. The relationship gradually gets better as you become a senior resident and is totally different once you become a pathologist. As a pathologist, you are their boss so you have the ability to fire them and discipline them, etc... But as a resident you have no power over them since the attending pathologist would much rather get rid of you than the PA because if the PA left, they would have to gross. Its your basic power struggle that every resident encounters in every medical discipline with their respective physician assistants. Just be happy in knowing eventually it will get better and some other sucker will come in and take your place.

 

[green mantis]

At my residency, we only dealt w/ 1 PA. At the other 2 hospitals, residents did all of the grossing. In general, the attendings treated the PA better than the residents. Part of this was because she was a permanent employee. Residents rotated through a couple months at a time during their training & then graduated after 3-4 years.

The PA was able to gross any of the specimens the residents could & was probably faster than most of us. She even cut frozen sections. However, the residents didn't really get to sign out her cases, unless you made a specific effort to do so. There were never any major conflicts.

I thought she was pretty fair when it came to splitting cases. I carried my own weight & didn't push extra work onto her. She knew who the slackers were & didn't cover for them.

In the end, it's all about patient care. PAs are there to help. Treat them w/ respect.


----- Antony

 

[randomlogik]

What types of cases do PAs at your programs gross? At my program they only do placentas, biopsies, and help with cutting frozens.

 

[veo1]

What types of cases do PAs at your programs gross? At my program they only do placentas, biopsies, and help with cutting frozens.

Same at my program. They only do biopsies and help with frozens (sadly we don't really get to look at frozens anyway because of the volume). We consider ourselves lucky if they get around to grossing heart valves for us. Every now and then, if you are nice to them, they will gross a prostate or benign uterus for you. And to top it off, they get paid twice as much as we do! We're just meatcutters. And BTW, I'm at what many have called a 'big name' program.

 

[yaah]

At lots of programs, as well as at many private practice places that don't have residents, PAs gross everything. Scope probably varies from place to place. At my program they have no responsibility for frozens.

 

[mlw03]

here the PAs gross any type of big case, and we have techs to "gross" the biopsies and help accession cases. PAs also cover the frozens. it's the PAs who are the resident's primary teachers when it comes to grossing, both in terms of the proper way to handle particular types of specimens, as well as knowing the proper protocols for our institution. additionally, we're one of the few PA training programs, so we also usually have 1 or 2 PA students in the gross room too, and they, like us residents, progress in terms of case complexity over the academic year. in fact, i've seen teaching go both ways between the PA students and us residents (ie, i've showed PA students their cases under the scope to help them correlate gross and micro, they've helped answer grossing questions for stuff they know better than me); it makes for a very nice working environment when each side appreciates what the other brings to the table towards the common goal of getting the best diagnosis possible to the surgeons.

PAs aren't going anywhere, nor should they. finding a way to coexist will become/is as crucial to us as getting along with the nurses is to the medicine interns.

 

[deschutes]

Residents in our program rotate through four sites. From my observations based on the PAs I've encountered in residency alone (n = 3 + 2 + 1 + 4ish), the nature of the interaction is pretty much down to the individual PA, as well as the individual resident. You can work out the permutations for yourself. As a fourth-year, I can confidently state that I've met PAs I'd never wish on my worst enemy, as well as PAs whom I'd kiss the floor they walk on. (that was grammatically tricky, yaah )

I've had PAs take large specimens from me on a particularly busy frozen day, which was something I never thought I'd see.
I've also had a so-called "head PA" in charge of the gross room save all amputations for residents/fellows to do, not to mention waste no opportunity in putting down residents/fellows in front of attendings.

On the flip side, I've seen junior residents new to a service complain about PAs being lazy. Not surprisingly, said junior residents subsequently get dumped on.

There's all sorts.