Please be kind to me. I am a new forum member seeking both personal and professional clarity on the issue of what constitutes an appropriate role and scope of practice as a mid-level provider. I appreciate the input and the multiple perspectives presented here and I understand this to be a very complex issue, and one with many stakeholders.
To set the context for my comments, let me disclose that I am a doctorally trained psychologist who re-trained in mid-life as a physician assistant. I have been working in a family medicine setting for the three years since my graduation from a medical school affiliated, top-five ranked PA program. I graduated near the top of my class academically and subsequently passed my boards in the top 1% of PAs the year I took the certifying exam. I am in a setting with an exceptionally bright, informed, experienced, and caring supervising physician. And..........I am truly miserable in my new profession.
For many of the reasons already well articulated on this thread, the role of mid-level provider (the profession strongly dislikes that word, by the way) is a very difficult role to assume. I think this particularly true for PAs, as the public at least has some understanding of what a nurse-practitioner is. Physicians as well often either over (or under) estimate the capabilities and appropriate role of their mid-level colleagues (I hope this is not an offensive use of the term). I am entangled every day in the significant discrepancy between my training/experience on the one hand, and what the system of organized medicine expects of me on the other hand. It weighs on me daily.
Borne solely from my experience and three years of personal angst, here is what I have come to believe regarding this quagmire:
1) I am not, and never will be, equal to a physician in training, knowledge, and expertise in the art and science of medicine. This does not mean that I will not grow and advance both my knowledge and skill, and become increasingly competent and valued. But I will never be a physician. I accept this as the consequence of my choices. I did not choose, at my advanced age, to spend 7-8 years in medical training. There would have been insufficient time left to practice to make this a viable pathway.
2) Because of this, I (and others at my level of training) should not be granted autonomy of practice in medicine. Perhaps with some degree of egocentrism, and certainly without full knowledge because I have never trained as a NP, I unequivocably believe that PA training is superior to NP training in rigor and scope. Hence, I even more strongly do not support autonomous practice for NPs.
3) With regard to "truth in advertising," so to speak, of course mid-level providers ahould be identified as such to all: office staff, patients, family members, etc. Recall that I hold a doctorate in a healthcare profession and have been called "Doctor" for more than 20 years in that setting, and additionally in the university where I taught for 17 years. But I am not a "doctor of medicine" in the same way that a DNP is not a doctor of medicine. I would gently point out that medicine does not own the title of "doctor," (e.g., see above regarding academia). However, the potential confusion that would arise in a medical setting for multiple providers to be co-opting the title outweighs, in my opinion, any argument to the contrary. In the practice of medicine, "doctor" has always connoted "physician," and this should not be wantonly altered.
In fact, in my state, mid-levels must be identified as such, on their person, in writing, in size 16 font or greater, at all times. This is clearly stated in the licensing law, and I consequently had "Physician Assistant" embroidered on my white coat. My SP did not require this, and sometimes teases me about my "uniform," but I am both in full compliance and full agreement with the law. Yet, I have seen very, very few other mid-levels in may area conform to the law in this way.
4) In summary, I remain confused and conflicted about where, or if, I fit into the medical machinery as a practicing PA. In many ways, I believe myself to be a caring, compassionate, and relatively competent provider of at least some medical services. I have a particular interest in women's health, and I have recently performed pap test and pelvic exams on many women in my community who, because of embarrassment regarding their size (BMIs in the 40-50 range) and discomfort with my male SP, have neglected their gynecologic care, some for decades.
But again, I am not a physician. I worry daily (perhaps even multiple times per day) about what I know versus what I do not know. My SP is generous in his availability to me, and graciously didn't fire me when I said I did not feel comfortable covering the practice alone, as a new graduate, when he went on his yearly fishing trip. I am truly, truly interested in how others, at various levels of the medical hierarchy, view what my role and my contributions might be, because I have not been able to resolve this on my own, and I may not be in agreement with my own professional lobby.
Thanks in advance for your continued thoughts. I've benefitted already from the views on this thread.
