Physician assistant not associate: Reasons against a name change

In reference to the seemingly “simple” name change being proposed for Physician Assistants to Physician Associates, I take great exception to the commentary offered by Dr. Zilberberg in her recent article entitled, Physician assistant name change rubs doctors the wrong way.

She states: “Physicians have been only too successful at becoming the final word in health, at the exclusion of all others.”

Physicians are the highest and most extensively trained group of individuals who care for people daily. It is a massive mistake, in my opinion, to imply, through a simple name change, that physicians and their assistants have levels of expertise which approach each other.

The reason why physicians have become the “final word in health” is that their training and level of expertise rightly put them in the position to do so. Today’s world of disinformation and misinformation, with rampant inaccuracies virally reproduced throughout the Web, make the role of physicians ever more important. Dissemination of accurate, fact-based information is crucial to appropriately care for people. For this reason, any blurring of the lines between highly trained medical doctors and their assistant personnel is dangerous.

Physician assistants, nurses, emergency medical technologists, technicians, etc are crucial components of our health care system and I am the first person to acknowledge and thank each and every one of them for their contributions. But I also am acutely aware that the “buck stops here.” Although there is of course liability with every profession, no other profession is so scrutinized and at risk than that of physicians.

Depending on the person and their medical goals, each physician is required to complete a 4 year college degree, a 4 year medical school training period, a 1 year medical or surgical internship, 3-5 years of residency training and 1-3 years of fellowship training. While not everyone undergoes fellowship training, every medical doctor is required to complete at least 3 years of residency. So, at a minimum, medical training to become a physician takes 11 years.

Contrast the training requirements for a person to become a physician with that of one wishing to become a physician assistant. A Physician Assistant must undergo 2 years of training. That’s it. College is optional, as stated: “Most applicants have a college degree and some health-related work experience.”

Dr. Zilberberg comments that physicians are concerned about “a power grab that this proposed name change has engendered.” Power has nothing to do with it. My continuing concern has been and always will be that there is no ambiguity for my patients. When a person comes to see me, I want them to understand that they are communicating with someone whose background, training and experience have brought them to the chair before them through proper channels and with appropriate testing and Board certifications.

I can state unequivocally that my Medical Board exams were arduous journeys that I was required to undertake in order to demonstrate my ability to care for patients. My Continuing Medical Education and Maintenance of Certification efforts certify my continued ability to care for my patients at the highest levels. To imply or state anything else regarding a name change is inaccurate and faulty.

The “perceived elevation in the status of the PAs relative to that of the MDs should not in any way make the MD profession diminish in its or the public’s view.” With this comment, Dr. Zilberberg again misses the point. As a physician, I am not threatened by whether “PA” stands for “Physician Assistant” or “Physician Associate.” They will probably still be called, simply, PAs by the majority of people.

But it is the understanding by the non-medical individual that is more important here. What does the average person understand about medicine and its caretakers? Even my parents and close relatives do not understand the majority of issues that we in the profession discuss and encounter every day.

But there is one part of the commentary that I agree with: “Healthcare is a behemoth, an inefficient and inequitable trough at which there has been a feeding frenzy for too long.”

I will assume that the “feeding frenzy” refers to the massive profits that the insurance industry has enjoyed for years. To work towards malpractice liability reform and insurance portability would truly be wonderful improvements to our health care system.

Malpractice liability reform will one day come, but I think first lawyers will have been outlawed and the gold standard will have been re-instated.

And insurance portability has just as likely a chance at occurring, once the insurance companies have been completely shut out of Washington, D.C., by a magnanimous President, whose sole aim in life is to improve the health care system for the common man, at the expense of any efforts at getting re-elected.

I can hope anyway.

Paul J Dorio is an interventional radiologist.

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  • anon

    I have to jump in at the beginning and clarify that, if the author chooses to include undergraduate course work into the number of years it takes to become an M.D., then he should give the same to P.A.s. Their coursework typically requires 2 years after college, for a total of 6 years. It is not a 2 year associates degree. It is a 2 year Masters degree. The training is still half, but I believe every respect should be made for the training that a PA undergoes.

  • PA with a doctorate

    Dr. Dorio makes a valid point regarding the difference in duration of training between a PA and a physician. I can’t imagine that any PA would argue that the education and training of a physician is superior to that of a PA. Having acknowledged that, his statement regarding the current status of PA education misses the mark – 88% of the currently accredited programs grant a master’s degree upon completion, the remaining programs will have to grant at least a master’s degree by 2020. College is most assuredly NOT optional. Most programs are 2.5 years long and the duration of training has been creeping toward the 3 year mark for some time. Again, this is not an attempt to argue equivalence, but it’s the education of a PA is not nearly as weak as Dr. Robio states.

  • Paul Dorio

    I appreciate the comments made which clarify and amplify my comment that college education and degree is essentially mandatory for a P.A.

    Basically, my main point, which hasn’t, it seems, been too controversial, is that patients need and deserve clarity of thought and less ambiguity. If every P.A., R.N., M.D., D.O., etc., clearly identify themselves and make sure their patient understands their roles in the care delivery process, then mistakes and misunderstandings may be minimized.

  • Neil Lall

    Thank you for your response Dr. Dorio. I was actually quite distraught by Dr. Zilberberg’s article for these same reasons. I really do think that the term “Physician Associate” could be very misleading to the lay public. And as much as Dr. Lorio stresses the difference in formal test-based education, there is also a huge difference in terms of clinical hours required to obtain each of these titles (I don’t remember the exact figures off the top of my head, but I know it’s a pretty decent gap).

  • Gohkesh

    Physician associate is what I call my colleague who rounds on my patients for me when I am out of town. The word associate implies an equal level of knowledge and comfort in dealing with what I as a physician do. I cannot say that my PA is at that level just yet.

  • Eric Smith MMS, PA-C

    The comments by ANON above are absolutely correct. The national organization for the PA profession, the AAPA, has endorsed the Masters Degree as the basic clinical degree of the Physician Assistant. The very few programs still at a Bachelors level are in the process of changing to a Masters level, and this will actually be done much sooner than 2020.

    That being said, Dr. Dorio makes an important point that we cannot all forget. While PAs and NPs contribute valuably to the healthcare team, we all must not forget that this is a TEAM and that team is and should be led by the physicians. I am a physician assistant in family practice and I am proud of the relationship I have with my supervising physician. Most PAs are. There is no competition between our professions, because when there is no physician, there is no physician assistant. We must all remember, physicians founded our profession.

    As far as the physician associate debate, this is a movement by a group of PAs who are simply frustrated with the fact that the PA name leads to ignorant assumptions that we are at the education level of medical assistants. And this goes beyond patient confusion, it is a confusion reflected even by some actual physicians, legislators and even hospital groups. The name change movement was in no way created to attempt to make PAs look equivalent to physicians. THAT BEING SAID, it is also important to know that the national physician assistant organization, the AAPA, has NOT endorsed such a name change and in past house of delegate discussions, the consensus was that such a name change was not appropriate. While I understand the frustration felt by many PAs, I am not in support of dumping the resources of our profession into this issue. With the changing face of healthcare delivery and the need now more than ever for PAs and physicians to work together for the betterment of our patients, I believe we need to focus on issues that are more pertinent today, like improving Medicare/Medicaid reimbursement for services, encouraging more practitioners to go into primary care, and encouraging the Medical Home model of healthcare delivery.

  • heliox

    The B.A. or B.S. for admission to P.A. school is not half as demanding as pre-med nor is the GPA requirement and clearly no requirement as demanding as the MCAT. Poor duped patients would assume Physician Associate is another doctor. Patients often aren’t even told anymore what their practitoner title is. Oh, this proliferation of P.A.s is out of control-physicians have to let them independenly practice while they are not really qualified. Just FYI, look at the requirements for a perfusionist-much more demanding.

  • shay

    MDs need to spend more time supporting PAs instead of thinking it is a competition. PAs in no way, shape or form want to take over the job of MDs. Becuase truth be know if most of us wanted to be MDs we would have gone to med school. Whether or not you want to believe this, most PA students are very much qualified to attend medical school and choose not to. NOT EVERYBODY WANTS TO BE A PHYSICIAN, but thanks to Dr. Eugene Stead, M.D. we are able to participate in the health care of the general population. What MDs need to do is stop lumping NPs and PAs into the role of physician assistants and recognize that the two are seperate professions. MDs please spend your time in making sure that DNPs don’t try to usurp you because they are busy saying is equivalent to the MD which we all know is not true. So MDs please support PAs because as a profession we respect your authority and will continue to work under your supervision. However please recognize that the name “assistant” does demean us in the public’s eyes. The AMA and other MDs can suggest a better name if associate rubs you the wrong way. However associate is better because then the PA acronym would not have to change.

  • shay

    PAs also are required to do 100 hours of CME every two years to keep there board certification and recertification exam every six years. This has been standard in our profession since the beginning.

  • PA with a doctorate

    Heliox – your statement makes no sense whatever. Most “pre-meds” are biology majors who get a BS. Their curriculum is no harder nor any different than any other biology (or chemistry, etc.) majors. No question that the MCAT is a hurdle but it is the same hurdle regardless of your major. Finally, your statement that “physicians have to let them independenly practice while they are not really qualified” is totally divorced from reality. I have taught perfusionists and the requirements are different but not more demanding.

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