Physician assistant name change rubs doctors the wrong way

Much like many other news items, I came upon the one about the proposed name change for Physician Assistants quite by accident: it came to me as an e-mail notification of a new topic being discussed on one of the physician only discussion boards that I am a part of. Apparently, after 40+ years of the profession’s existence, there is a grassroots effort afoot to upgrade the name, and presumably the clout, to Physician Associate.

Well, as you can imagine, while the move is met with praise by the PA profession, the MD profession is seething. Some of the comments that I have seen from my colleagues betray such tremendous pain and suffering as a profession that it threatens my equanimity: I feel organically how lost we are as a profession to be expressing such bile without much thought over what appears to be a relatively innocuous event.

But surprised I am not, and here is why. The medical profession’s victory over all other potential modalities is hard-won and filled with a history of major turf battles and occasional demagoguery. The historically either-or approach of modern-day practice of medicine is responsible for the current landscape of our healthcare. In short, physicians have been only too successful at becoming the final word in health, at the exclusion of all others.

With the allied providers, such as nurse practitioners and PAs, gaining in importance, particularly at this time of great uncertainty about the future of our healthcare “system”, understandably the MDs are reflexively bracing themselves for any and all turf battles. So, the perception of a power grab that this proposed name change has engendered in my hallowed profession is a classic fight-or-flight response, an activation of the survival instinct.

There are several aspects of this response that I find disturbing. At the most basic level, the response betrays such tremendous emotional pain among so many good people that it is all I can do to keep myself from sinking into a depression. And while I feel compassion for them, I am also forced to remind them that, as Eleanor Roosevelt once said, “No one can make you feel inferior without your consent.” Applying the thought to the current situation, how the society may view PAs, whether they are called assistants or associates, should have absolutely no bearing on how physicians are perceived. Simply put, this 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.

The next layer of why this is a dysfunctional response lies in a poor choice of battles that this represents. I once had a boss, whom, despite working for myself currently, I frequently allude to as “the best boss I have ever had.” When I would get hot under the collar, she would pointedly ask me to clarify for myself whether this was an issue to fall on my dagger for, thus teaching me that falling on my dagger too many times would make me politically into Swiss cheese, or, worse yet, dead.

Under the circumstances, do MDs and their organizations really feel that this is an important dagger to fall on? In the current atmosphere of public distrust rightly or wrongly bestowed upon the profession, such indiscriminate issue picking will rightfully appear self-serving.

Finally, for a profession with, on average, a very high intelligence quotient, I am amazed that we are focusing on the minutia instead of looking at the big picture. Healthcare is a behemoth, an inefficient and inequitable trough at which there has been a feeding frenzy for too long. We need to be reining it in to the best of our abilities. And yes, altruism, not unmitigated self-interest should be driving us to do this. Gentleness toward and respect for each other, our communities and our planet should be the values that determine our actions as a profession. I am convinced that these are the values that brought us into medicine.

These are difficult times, made more so by the external forces all ganging up to deprive us of our humanity. Let’s get back to the reasons why we went into medicine; let’s sit quietly and find that lost thread of contentment and pride. Or else, if there is no joy left for you in your practice, resolve to find something else that you can be happy about. And no, it is not easier said than done. It is much more difficult to go through life carrying the baggage of self-imposed misery than to set it down in favor of finding happiness in this brief sojourn that is our life.

Marya Zilberberg is founder and CEO of EviMed Research Group and blogs at Healthcare, etc.

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  • eRobin

    Reminds me of the title fights b/t David/Michael and Gareth/Dwight in the Office. “Assistant Manager” “Assistant to the Manager”. Marya is right – physicians shouldn’t fall on any daggers over this.

  • stargirl65

    An associate is one that has a limited or subordinate position in an organization. The title fits. The problem is that PA’s were originally designed to be of limited education to assist physicians, hence physician assistant. The term physician associate removes the reference to the physician as a supervisor and it opens the door to PA’s practicing on their own. This is the concern.

  • anon

    I haven’t noticed much uproar in the physician community about this. I think most physicians understand and appreciate the desire of a Physician Assistant to distance themselves from a Medical Assistant, which people often confuse.

    Now what will stir up a bit of a frenzy is some of the talk I hear in PA internet forums (mainly among the current students/recent grads) about a doctorate of PA. It’s mainly “keeping up with the Jones’” with NPs being Jones, but seriously… the terminal, doctorate, degree in the Medical Model is the M.D./D.O.

  • Anonymous

    “physician assistant”, “physician associate”, it’s still “PA” – that is what most patients will recognize.

  • docguy

    when i got out of residency and first joined my group I was a associate, not a partner. That’s the problem, physician associate is actually what I was, not a Physician assistant. Why not just leave things as they are? clearly they want the name to reflect more and are unhappy with what it reflects now.

  • http://bittersweetmedicine.com/ Dr Lemmon

    I have no objection to “physician associate” as a title. I don’t understand the concern. FPs and General Internists fear that PAs and NPs will replace us. This is a legitimate concern, but it is not because of their titles. It is because there is no one advocating for us anymore but us. That’s called self promotion and it generally doesn’t go over well. There are many people and organizations (government) advocating for mid levels. They are willing to work for less and are cheaper to train and they follow guidelines and check off boxes as well as any physician (probably better).

  • http://nostrums.blogspot.com Doc D

    Names are sometimes important. The socialists in Europe were losing ground until they reinvented themselves as “social democrats.”

    And sometimes we seem to choose ambiguity over clarity: while some of us are “handicapped,” arguably all of us are “physically challenged.” We adopt the vagueness to take away the sting.

    I guess “assistant” lacks dignity to some. But is my receptionist a physician associate? No, the job description is administrative. Then how about my nurse? Is that person a physician associate? Maybe. They accomplish a lot of the medical care. But I doubt nurses want to be labelled an associate of anybody.

    None of this seems optimal. By contrast, “nurse practitioner” works well, reflecting a dual qualification. Isn’t there a way to acknowledge that PA’s are practitioners without using power-laden words?

  • ninguem

    Soon it will be “Physician Actually”

  • ninguem

    I wonder if doctors should use the older term “physician and surgeon”.

    Might be more of a stretch for the midlevels to appropriate that term. Because yes, that’s precisely what they are trying to do is get hold of the term “doctor”, “physician”, etc., to confuse the public and take the legitimacy of the degree, without earning it.

  • primaryMD

    we all know they’re not doctors.

    Let them call themselves whatever they want.

    they’re still PAs either way.

  • platon20

    PAs are a threat, but they’re not the biggest threat. You guys should be worried about the new “doctor nurse” BS that is piling up. By 2015, all nurse practitioner programs will be mandated “doctorate” degrees, and make no mistake about it, they WILL call themselves “doctor” inside the clinics and hospitals.

    PAs will do the same thing eventually. They’re just a little bit behind the NPs at this time. You thought it was bad with chiropractors and naturopaths calling themselves “doctor” its about to get a whole lot worse.

  • anon

    Yeah, but when that happens, it’ll be like when NPs (and everybody else) started wearing long white coats. You couldn’t tell who was a physician in the hospital any more… Now you just look for the person on the floor NOT wearing a coat and you’ve probably found the physician.

    P.S. When that time comes, will they get a nurse practitioner on the show “The Doctors”?

  • alex

    The government’s primary interest is minimizing cost and maximizing control. From this perspective, if PAs and NPs replaced all MDs, that would be the ideal solution. The only thing preventing this is patient resistance. The solution to this is to blur the lines between them as much as possible so that people don’t know who’s taking care of them. Of COURSE you’ll be seen by a doctor… (of nursing). The person making the decisions on your ICU stay is a fully licensed physician (associate).

    If you asked 50 people whether a physician assistant is a physician, and then asked them whether a physician associate is, I bet you’d get markedly different answers. That’s the entire point of the name change and that’s why it needs to be resisted.

  • docguy

    alex you hit the nail on the head. if you want to be a physician go to medical school and residency, otherwise you are just doing things to confuse the situation.

    Much like the chiropractor in town who is board certified in pain management, apparently the ASA is letting a lot more people in than I was aware.

    stop trying to confuse the public, say what you are…

  • Ed

    The biggest problem I see that doctors have with their staff PA’s is that patients don’t like to see the PA when they have the option of seeing the doctor, even for minor or routine visits (the purpose of the PA) if this gives PAs more clout, the its a win for doctors because the PA will be seeing the patients that the doctor (or practice) wants them to see.

    doctors often make to many enemies out of allies when it comes to health, lets not make that mistake with this small issue.

  • ARC

    Physicians have already embraced the physician assistant and have spent a great deal of time convincing patients that the PA’s care is equal to theirs when appointments are short. My physician’s PA knows me better than I my doctor since my doctor rarely has time for me. The triage done by the medical assistant always lands me with the PA. If this is a turf war, doctors invited the enemy in. This had nothing to do with the government cutting costs, it had to with the doctor cutting costs, using a lower paid employee to do his work and increasing his income. So what’s the difference if the government wants to promote PAs to save money, my care was provided by a PA anyway.

    My sister was diagnosed with a pulmonary embolism by the PA at her doctor’s office, saw a PA in the emergency room, saw two more in the hospital. A doctor finally showed up 14 hours after she was admitted.

  • Frank

    If a chiropractor can call themselves ‘dr’, a PA can use that term. I’d rather seek medical advice from a PA than a chiroquacktor any day. I’d seek it from the school medical assistant before the chiroquack.

  • Kent

    “Gentleness toward and respect for each other, our communities and our planet should be the values that determine our actions as a profession.”

    I’m sorry, but…huh? How ’bout a little “gentleness and respect” from the PA community, who should have better things to do than quibble about their name? Did you ever think about turning this argument around?

  • http://www.pulseuniform.com Penelope

    “No one can make you feel inferior without your consent”

    Very good quote and yet difficult to practice in health care profession. And most likely this year and in the coming years due to the healthcare reform maybe some PA’s will feel inferior even to nurses who were given bigger roles like doctors.

  • Michael Funk, PA-C

    As a Physician Assistant I want doctors to know that the official stance of the AAPA, American Academy of Physician Assisants, is against any name change and against the doctorate degree for non-physician providers. The proposed name change discussed above is on a small thread on a rogue website and is NOT to be confused with the mainstream PA. We are, by training, dependent practitioners. We consider physician supervision a strength of our profession and we embrace the physican supervised team model. Physicians should be in control of medicine, they are the best trained, and NOT any non-physician provider.
    Michael Funk, PA-C, MPH, DFAAPA
    Florida Academy of Physician Assistants
    Past President
    Legislative and Governmental Affairs Committee Chairman

    • http://bittersweetmedicine.com/ Dr Lemmon

      Michael,

      Well said. Well written.

      For what it is worth, I have so far never worked with a poor PA. The one I work with now is obsessive about the details and works late when he has too and never complains or draws attention to himself. He deserves tremendous respect for what he does and I, upon reflection at this time, will try to give him more of that in the future.

      I appreciated your comments.

    • Anonymous

      One small thread on a rogue website? Among the google search results for “physician associate” were a number of physician groups – i.e. “physician associates of (insert city)” – and the “Yale Physician Associate Program”. http://medicine.yale.edu/pa/ Not exactly rogue.

      • Frank

        Actually a google search also brings up a slew of Physician Associate websites, like http://www.physicianassoc.com/, described as “With over 130,000 members, Physician Associates is the largest physician association in the San Gabriel Valley. ”

        If this rogue group of PAs were a bit more creative, they would try to look for a name that doesn’t imply they are a large group of doctors working out of a valley.

  • Lisa Dandrea Lenell

    I just recorded a show on this topic on ReachMD XM160 with Bob Blumm. If you are interested in hearing why the “rogue” PAs feel this is an important move for the PA profession please listen.
    http://www.reachmd.com/xmsegment.aspx?sid=5479
    The mainstream PA is the one working side by side with physicians in every field of medicine. They are also the ones that are logging on to the websites and working together in what they believe to be a very important need for the PA profession.
    Maybe the leaders of the PA organizations should find a little “rouge” inside them to better represent the voices they are not listening to.
    This is not a move for independent practice, just a group of hard working medical professionals that are politely asking to have a title that reflects the job.
    Sincerely,
    Lisa Dandrea Lenell, PA-C, MPAS

  • http://thehappyhospitalist.blogspot.com Happy Hospitalist

    I think physician assistants should change their name to nurse practitioner assistants (NPAs), sincemany states have granted authority and licensure to having NPs practice independently.

    If NPs are equal in capability to MDs, why not have PAs practice under NPs and call them NPA’s?

  • Michael Funk

    The very thought terrifies me!!!
    If you compare the medical training of a PA and an NP you will see who is better trained. In Florida, where I work, an NP only has to have 500 hours of supervised training. A PA has over 2000 and a doctor with residency training has 20,000! Who is better trained and who should be in charge of medical practice?
    Again, I want to emphasize that these other websites, PA Forum for example, are for profit, independently owned and operated sites. They are not associated with the recognized professional organization, the American Academy of Physician Assistants (AAPA). The PA Forum has had this Physician Associate issue running for 14 years, since its inception, and it has gone nowhere.
    PAs need to know that they get respect not from their title but from their professionalism and their ability to play their role on the physician supervised team.
    The Yale PA Program has had the Physician Associate degree program since it’s inception and it is the only one I know about that gives that degree. All others give Physician Assistant degrees.
    You don’t have to worry, this name change is a dead issue.
    Michael Funk, PA-C,MPH, DFAAPA
    Florida Academy of Physician Assistants
    Past President
    Legislative and Governmental Affairs Committee Chairman

  • Dave Mittman, PA

    Guys: This stems from PAs being confused with medical assistants, chiropractic assistants, opthalmic assistants, PT assistants and we can keep the list growing for hours. NO OTHER assistant, NONE can diagnose, treat and prescribe. This is not a move towards independent practice but a move to place the PA profession in a place it belongs, not one of having a name that suggests being in a technician status occupation.
    PHYSICIAN ASSOCIATE was the profession’s original name at many programs and in many state laws years ago.
    We just want to go back to that. Patients are confused by it and it would even be better for the physicians we work with.
    Why so threatened?
    Really Why? We already have physician in our name.
    Would medical associate or clinical associate be better? If so, let us know.
    Dave Mittman, PA

  • Frank Rodino

    It’s interesting that a name change to “Associate” is viewed an “upgrade.” I suppose that’s a subtle way of agreeing that “Assistant” doesn’t do justice to the profession. I am distressed that the author, and others, view this as something new after 40 years. That’s simply not accurate. I entered the “Physician Associate” program at Stony Brook University in 1975. I graduated from the “Physician Assistant” program in 1977 because the Medical Society of the State of New York insisted that the name be changed in 1976. It wasn’t our choice. Many of us just want to return to our original name. Frank Rodino, PA

  • eric holden

    there are several physician associate(5-6?) granting programs — starting with stanford.

  • Michael Funk

    There are still a few programs that give an associates degree, and there were PAs who recieved Physician’s Assistant degrees, as well. In any case, what is important is not our name but that we are not a threat to doctors. We are not like the NPs who want independent practice, want to be called doctor, and claim to be equal to or better than doctors.
    Mike funk, PA-C

  • edd

    In the “old” days there were a number of programs that were “physician associate” programs regardless of the degree they granted. In the mid-70′s when certification and accreditation processes were being refined, the AMA threatened to withdraw their support and participation if the name was not changed. The professional organizations did but not all the programs followed suit. But PA’s suffering from the Rodney Dangerfield syndrome isn’t a surprise given the hatefulness of the comments on the discussion board that Marya quotes. I can’t imagine working around folks with such contempt for their abilities or so threatened by their existence. Marya has provided a thoughtful counterpoint in speaking more of physician insecurities than of PA over-reaching. To the best of my knowledge no PA has suggested independent practice – more than I can say for the nurse practitioner who seeks a MUCH more confusing name – doctor.

  • Dave Mittman, PA

    Also, I might add to edd and all others that this fight has nothing to do with NPs, either positively or negatively.
    NPs have their own problems for sure.
    Two questions:
    -I asked the physicians on here to give us a name that you could live with if you do not like Physician Associate. We think that’s the closest to what we are. Please give me another one. Do you really care? Would medical associate me better. How about Medical Practitioner?
    I want your support.
    - Regarding NPs and the “DNP”. Why take the problem of the doctorate out just on them? ALL pharmacists, PTs, OTs, most psychologists, chiropractors, podiatrists and others are all DOCTORS. So why the animosity towards the nurse that gets this degree and not the others?
    I would especially like to hear from the physicians why it’s not good for nursing but good for all of the other professions?
    Dave

    • anon

      To answer your second question, I think it is because the similarity of job description. Ph.D.s are also called Dr, but it is not in a clinical setting.

      I think the biggest difference is in the usage of the word. If someone walks into a clinic and says I would like to see a doctor, no one will think you may wish to see a pharmacist, PT, OT, or a psychologist. Chiropracters don’t really practice outside their clinic and can call themselves whatever they wish in the confines of their business. However, soon, someone can walk into a clinic and wish to speak to a doctor, and be put with an NP. That’s how it is different from the others.

      • Laurie

        @However, soon, someone can walk into a clinic and wish to speak to a doctor, and be put with an NP. That’s how it is different from the others.

        This already happens. I can’t remember the last time I called my doctor and didn’t get an appointment with an NP or PA, even when I ask for a doctor.

        • stargirl65

          In my office you only see doctors. That is only M.D.s. NO PAs and NO NPs.

    • anon

      The other thing, the really crazy thing, is that the DNP degree is closer to a Ph.D. (on top of the NP degree) than it is a clinical doctorate. From my understanding, the training that an NP gets to become a DNP is research, statistics, and skills in evidence-based critical thinking skills. There isn’t any additional clinical training over the 500 hours of experience they get in the NP program.

      A P.A. could technically do the same, by getting a Ph.D., but calling himself a doctor (in a clinical setting) would be a little asinine and misleading because the Ph.D. does not require extra clinical training. However, the DNPs will be doing just that. So, that is another way that it is different.

  • Michael Funk, PA-C

    In our offices we have 2 doctors (DOs), 4 NPs and 2 PAs. You can see any of the providers you choose, but if you see and NP or PA you also have the doctor supervising the care plan. They may not see the patient every time, unless there is a complex issue that needs their training and expertise, but they know what is happening with each patient. They are able to provide care to a much greater number of patients with this model.
    My activities bring in about $1m to the practice yearly and my compensation is a little more than 1/10 of that. We are all happy with the arrangement and our patients are very happy with their care. We continue to grow month to month.
    This is really a good model to follow, ask our patients!

    • Laurie

      @ but they know what is happening with each patient.

      Filtered through the notes of someone else. This model interfers with the “doctor-patient” relationship. I have found being bounced around the office rather awful. Really, my provider is the EMR, the keeper of information, and it doesn’t really matter which person is sitting in front of me. My EMR is the one that knows me.

      I had a more complicated problem, was seen by a nurse practitioner. I am not sure why she recommended the treatment she did and I wonder whether an MD would have made the same recommendation. When I reviewed my record, it wasn’t accurate and my words were summarized with her interpretation.

      When things started going downhill, I was scheduled with a different NP. Her suggestion was I should schedule an appointment with a doctor. When I reviewed these notes, there were misinterpreations of the notes from original visit. So now I have this doctor, who hasn’t seen me in several years, who doesn’t know anything about me, reviewing a chart that is biased and inaccurate.

      The pain seems to be permanent…I wonder if the appropriate treatment hadn’t been delay whether I would still have this pain. I wish that during this very difficult time, as a adjust to a chronic condition, that I had a caring trusting doctor. Instead I have an EMR and strangers to take care of me.

      • tgottsdo

        sorry you haven’t had a good experience with your medical care. It sounds like you need to see a different practice… or maybe your condition is difficult to diagnose/treat.

        When a doctor or NP or PA is taking your history he isn’t taking dictation… all of what you say is interpreted more or less. Some people are better at summerizing what someone is saying than others. I think it’s a skill that physicians have pounded into them in residency… giving daily bedside reports on rounds and getting curbside consults. In residency, being able to give brief, succinct and accurate reports are literally pounded into you on a daily basis. I’m not sure if PA’s or NP’s get the same treatment. Regardless, even when I see someone who has seen another provider I ask all the same questions and try to come up with my own interpretation… especially if the story makes no sense to me.

  • regular joe

    i’m a pa ….i make 250 i give the md 400….does the name really freakin matter? life is short…take your 3-4 vacations a year….enjoy life my friends…

  • mike

    As someone else pointed out, our name was Physician Associate. We’re just going back to what it was originally.

    In regards to the PA who said they bring $1 million in to the practice and only get 1/10th, that is a major reason why PAs need to start fighting for more clout. It’s also why NPs fight so hard for independent practice (and they are getting it, and will eventually get it everywhere). They have a phrase called “equal pay for equal services.” Now, I don’t believe we should be reimbursed as PAs at the levels of doctors, but I think it’s ridiculous when PAs generate $500,000 for a practice and get paid $75,000.

    • Mark

      When working in consulting my bill rate was 6X my salary on an hourly basis. So the amount a PA keeps relative to what they generate is probably pretty much in line with other industries.

      Consider that the doctor who employs the PA has to pay taxes. For every dollar an employee has taken out of their paycheck, there was most often another dollar paid for by the employer.

  • docguy

    how are you coming up with 500k revenue… I have a NP and does generate her salary, but I’m not taking home an extra 425,000 dollar because I have her, maybe an extra 12k a year, maybe not, but it helps my life a bit..

    500k is more than a lot of family physicians total receipts for a year, so how are PAs generating more than a PCP.

  • Michael Funk, PA-C

    There is alot more to the business of medicine that PAs are not involved with and that doctors deserve to get compensated for. We have about 100 members on our staff, there are so many other aspects of running the business that are too numerous to list here. As a PA, I see patients during the day and go home at night and I don’t have to worry about the business, unlike my physician supervisors. I might bring in $1m but that doesn’t mean that money is going their pockets.
    On another issue above, some NPs work as lone wolfs and don’t consult with physicians on difficult cases. The hospitalist addressed this in another article on this web site and the experience presented above shows the difference in care given by a doctor with 20,000 hours of supervised residency training (on top of medical school) as opposed to a NP with 500 hours (all that is required in Florida). PAs are required to work with physician supervision and I consider that a strength of the profession.

  • Anonymous

    anon: PhD are working in the “clinical setting”