The Secret Ingredient
People always want to know the secret ingredient. And,
frankly, I can't blame them. In a lot of ways the physician assistant
profession seems too good to be true.
We study medicine for two to three years after obtaining a
bachelor's degree. We practice medicine without post-graduate training or
residency. We can switch specialties without recertification and our scope of
practice can change from one day to the next.
Naturally, people wonder how, in a complex and high-stakes
field like medicine, this amount of career flexibility is even possible.
Sure, we have great training programs. Plus, many PAs come
into their careers with years of related experience. And our skills are honed
as we gain experience on our jobs. But here's the real reason our profession
works: the supervising physician.
A faction of PAs reading this just cringed, though I'm not
sure why. There seems to be a perception that our required agreement to
collaborate with a physician somehow holds us back as providers. Calls for
increased PA autonomy inevitably lead to suggestions that we abolish the
supervisory agreement. While there are some instances where the MD-PA
partnership is a liability (and a largely logistical one at that), these views
The truth is, the PA-MD partnership is the single strongest
aspect of our profession. It is the reason I could apply for a job in any
specialty right out of school (and land one in a field like critical care).
It's the reason I didn't toil through a residency program with outrageous hours
and minimal pay. It's the reason I can place central lines and perform lumbar
punctures. It's the reason I can spend my evenings in the Emergency Room or the
Operating Room or any other room that chooses to hire me.
Our chameleon-like ability to adapt the scope of practice of
our supervising physicians is what attracted me to the physician assistant
profession. My supervising physicians aren't shackles around my ankles, they
are mentors and partners and friends.
However, navigating the PA-MD relationship is not always
easy. Last time I counted, I was contracted to 49 individual supervising
physicians. That group includes dozens of personalities, preferences and quirks
that factor into my clinical practice. Try
these tips to get the most out of your PA-physician collaboration:
Respect the Scope: Good
employers will allow PAs to practice at the top of their license at all times.
However, this must still fall within the scope of the supervising physician.
While PA independence is at an all-time high, make sure you don't find yourself
outside the limits of your physician's
scope of practice. That can be a very lonely place.
Close the Loop: After
you have worked with a new physician, reserve a few minutes to get feedback
about your performance. Almost every clinician will respect this proactive
approach. Often, this will also provide an opportunity to let the physician
know how they can help you grow in your practice. This form of "closed-loop"
communication will foster trust and a stronger clinical team.
Be Direct: If
there is an issue with a supervising physician, address it early and
professionally. You can brush aside small troubles, but a real problem will
eventually boil over into workplace conflict. Correct a misunderstanding as
soon as possible. If you set a high standard of respect in the workplace, the
PAs following behind you will benefit from your leadership.
Pick Your Battles: Unfortunately,
there are still people who do not want to work with PAs. Luckily, this minority
of physicians who oppose our profession shrinks by the day. Don't focus on
trying to convert the non-believers. If your professionalism, hard work and
clinical skills don't speak for themselves, that battle cannot be won. However,
you should still expect to be treated with courtesy and respect in the