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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