PAs getting the boot?

[fun8stuff]

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I was shadowing my family doc today and I happened to notice that all the PAs that used to work at the office were gone. He told me that the hospital that oversees and runs their office gave all the PAs in all the diff FP group offices the boot because they were taking money and patients away from docs. Also, a significant number of patients were upset because they could never get in to see an actual doctor.

Has anyone else noticed this in their area? Just wondering... I was really surprised. If this is going to be a new trend, it doesn't look to good for PAs!

 

[Rapid Decomposition]

I work for an endocrinology practice that has two completely swamped doctors (i.e., booked out two months), one each at two different offices. This led them to hire one PA who goes back and forth between offices seeing patients for routine follow up appointments, and they have hired a second PA to start in August.

I guess it probably just depends on the area (and whether the practice is private or not), because by having PAs, the docs I work for are bringing in a little more money for themselves and are able to schedule appointments for patients the next day instead of having to wait two months or double book in an already clogged schedule. Also, few patients have made a fit about seeing the PA instead of the doc, probably partly because they realize the scheduling difficulties and also because the doc is in the office if patients really need to talk to him.

 

[UrSexyLatinDr21]

I agree with Rapid Decomposition. It all depends in the area and type of practice. For example, I live In the San Joaquin Valley ( central california). Many PAs work in here and the number seems to be growing. I guess since here is a rural area, very underserved many MD/DOs arent attracted here, so PAs take their place. I think PAs/NPs are a vital group in health care. Imagine if these group didnt exist, who would be working the underserved areas? Many Physicians are leaving to bigger cities ( more money) and as a result the number of PA/NP is growing.

Eduardo

 

[fun8stuff]

I wasn't trying to argue whether they are a vital part of the healthcare system, which it sounds like they are in the situation that you are in. I was just wondering if what had happened by me happened other places.

 

[southerndoc]

My mom recently scheduled an appointment with a neurologist (she has chronic migraines). She was told she would see the PA, who was a "headache specialist."

I made her call and reschedule the appointment to see the neurologist. If a patient is to see a PA, then he/she needs to have a reduced cost. I had her ask the receptionist if she would pay less for seeing the PA, and the receptionist told her no.

So if you're paying for the MD, then see the MD!

 

[Rapid Decomposition]

I agree that patients should be given some sort of compensation for having to see the PA. I am frankly surprised how okay people often are with seeing PAs in the practice that I work for instead of the docs. PAs are trained to be primary care practitioners, yet they can be hired in any type of specialty practice with no extra required training (at least in Nevada, they can - is this universal? - I guess the implication is he should stop and ask the doctor if he is unsure about something, which he does). The PA told me that he started on his first day knowing little more about endo than he learned in school, and has had to build up his knowledge essentially from scratch.

This seems a little worrisome to me, because I have been following him around occassionally and double checking his notes (which is part of my job, incidentally). For the most part he is usually very good. But, though I'm definitely not qualified to verify medical decisions, I have noticed inconsistencies, diagnoses that don't seem to be justified, etc. in his notes occassionally. I'm afraid he's missing things that the docs might catch - after all, endo is a very intricate specialty. Some endocrine problems require quite a bit of investigation before they become apparent.

Not that PAs are incompetent - especially in a primary care setting, I think they would be roughly equivalent to a doctor. But if I was seeing a specialist I would probably not want to see the PA in his stead, especially if I'm paying the same amount for it.

 

[2badr]

I agree with you all on that fact that is possibly the area and whether or not it is a private practice. My niece had a brain tumor and for follow-up care after my niece's surgery she could never seem to get in to see the doctor. The doctor and the PA would see her but mostly the PA.
I think (or at least in my sister's case) it was more of an issue of who she thought would provide the best care and treatment for the post-surgical care of her daughter.
The cancer center there she tells me is absolutely full of PA's. On the other end of the spectrum is my Mom and Dad who live in a small country town and still have no idea what a PA is. They see our FP for every appointment without fail. I think will ask him (the FP) why he hasn't hired any PA's yet. (Presently he has nurses and administrative staff.)

 

[2badr]

Originally posted by Geek Medic
My mom recently scheduled an appointment with a neurologist (she has chronic migraines). She was told she would see the PA, who was a "headache specialist."

I made her call and reschedule the appointment to see the neurologist. If a patient is to see a PA, then he/she needs to have a reduced cost. I had her ask the receptionist if she would pay less for seeing the PA, and the receptionist told her no.

So if you're paying for the MD, then see the MD!

I think physicians need to understand the patients' and family's concern. The cancer treatment for my family was a very frightening time. We just wanted the best possible care for our loved one. It was not anything personal against the qualifications of the PA.

 

[Doc Ivy]

I think the critical thing is this: Do PA's know when to refer a patient to a MD specialist?
I don't think anyone has a problem seeing a PA for routine follow-up and primary care, but if Pa's can't reliably come up with good differentials for what they are seeing in their patients, then this becomes a dangerous thing---many will fall through the cracks.

 

[denali]

RD,

Aren't the docs where you work reviewing a sample of their PA's notes? Perhaps you could ensure the sample includes those charts with questionable notes?

mdf

 

[Rapid Decomposition]

Originally posted by denali
RD,

Aren't the docs where you work reviewing a sample of their PA's notes? Perhaps you could ensure the sample includes those charts with questionable notes?

mdf

It's been sort of a filter up effect. I audit the notes initially, show any problems to the office manager, and the office manager (who has more medical knowledge than I do incidentally) shows any major problems that she can't fix to the docs.

Of course, all this happens after the patient leaves, so any major problems, though they'll most likely be caught, have to go back and fixed after the patient has already been told something else for a week. Plus the docs are so busy with their own patients that they rarely give the PA their full attention. It's just that there's a couple different cracks for something to fall through - I'm sure it rarely does if ever, but if it did, the docs could be sued for something they didn't do, since they're the responsible party. I don't know, the process doesn't seem as tight and secure as it should be.