PA Voices His Views at CNNMoney

Lynn, (responding to the question why did I take down my CNN interview?) First of all, I will say that the number one reason was because a group of medical students created a web posting with my private information, where I live, my phone numbers, where I work, who I work with (by name) and then they made personal threats against me. This was what convinced CNN that it should be taken down. Their behavior raises a lot of questions.

Secondary, I received so much criticism, especially from the PAs whom I was trying to defend, that I felt like my whole point was lost in the political firestorm and the “physicians-may-not-like-us” panic.

When my statements appeared in ala carte fashioned, out of context of the “conversation” which I was having with the very disrespectful and mis-informed physicians and my most intense statements were cherry picked into sound bites, my words took on, regrettable, new meanings so some readers. I especially drew fire from fellow PAs over my statement (once again said in contrast to the physicians who were claiming that we have to present every patient to them), that I never have to ask my SP questions. Those PAs were making it sound like that I was very arrogant or that I believed, politically, that PAs should not ask doctors questions . . . as a principle (even if it puts the patient in danger).  Again, I was making a factual statement in contrast to the ridiculous claims of the docs (which oddly, didn’t seem to bother those PAs).

I will use this opportunity (even though this is beyond your question) to again try and explain why I have not asked my SPs questions.

I am in a unique situation . . . however; I bet that many seasoned PAs in primary care don’t have to run to their SP every day to ask questions.

I have my own headache clinic under the umbrella of a general neurology clinic. The two neurologists (SPs) don’t even care that much for headache disorders. Most of my patients are my own, who come directly to the headache clinic from outside referrals. Sometimes, if the neurologist has a headache patient who is too complicated for them, they will refer them to me.

I have worked in headache disorders for most of 29 years. I have the privilege of having worked with the top headache specialist in the world, including for years at the department of headache a Mayo Clinic, Rochester. Now some will see this as arrogance but I see it as a simple lack of stupidity.  Anyone of average intelligence, who has worked in my settings, in such a narrow field, should learn the field in an almost comprehensive way. As I have said before, I have a tremendous respect for MDs . . . but I also have respect for PAs. We are not idiots! I’m not even the sharpest tool in the PA shed. But it only makes sense that you will become competent in a field in which you have worked for so many years. That is my point.

It  would seem silly if my SP sent me one of his hard headache patients that he could not help, then I turn around and present that patient back to him for advice?  It would be ludicrous! Some PAs have claimed (on another blog) that because I am so arrogant I will not ask the SP a question about things I don’t know about.  They need to understand the culture of our practice. I did not determine the culture, but I live by it. The attitude here (and it does make sense) that if I am seeing a patient who has a problem that is not in my area of expertise, say a headache patient who ask me about MS symptoms, that it is best for the patient if I refer them to my SP for a complete MS evaluation rather than me trying to curbside them in the hall and trying to manage a patient in an area that I don’t know well. So if a patient has a non-headache problem, I would never, ever hesitate to refer them to the best possible provider (likely an MD) to evaluate them and treat them. That is the way my SPs want it. But I would not go and ask them questions about how I would manage their MS.

The question was asked (not by Lynn) of who made me the PA spokes person. I am an independent person who has my own opinions. Again, this is not the Russia of the 1950s. If anyone made me their spokes person is was the crowd of PAs who do nothing . . .who never speak up. Someone needs to come to the plate. Next time, please speak up for our profession. But I'm not going to set back and allow us to be bashed over and over again in the media and there be no response.

Mike – I’m glad that you’re noticing AAPA’s “spunk”. The Academy is doing a lot in the way of Advocacy right now; we’re taking meetings with officials inside the White House, placing ads in prominent Capitol Hill publications, trying to leverage our new GAIN program so that PAs are speaking out on behalf of their profession, etc. I appreciate you wanting to be a vocal advocate for the profession you obviously care so much about, but as mentioned above we do need a united voice during this time of constant change. I’d love for you to join our Grassroots Advocacy and Information Network (GAIN). By being a part of this network you’ll have the opportunity to ask questions of AAPA staffers about all that is happening on the Hill as well as being directly involved in advocating for your profession. I know you said politics aren’t your thing, but we’d love to have you (or any other PA reading this) join the conversation. This is your profession, you all have strong voices & we need to unite together to become one.

I also noticed that your article was taken down from CNN. I was wondering if you had any insight into this?

I think Mike gave his opinion and is entitled to do that. There are many PAs that know enough to practice with minimal supervision and I think that's what Mike was saying.

PAs should be able to say what they think and more importantly feel. Anyone who says "I will never know more than a physician" is limiting themselves or to scared to admit that they can get good after  years of practice. That was Mike's point and I am glad he said it.

Maybe the docs are right-some PAs are just not that good and if they feel that way, maybe they should stop seeing patients?

Dave

I have to admit that I am some what befuddled by the visceral and personal attacks from within our fair profession. I was expecting and indeed have received a lot of hate mail and blog posts from MDs who emphasize that PAs are very poorly trained, very dumb and make mistakes left and right because of their stupidity. Indeed, this was the framework of the discussion on CNN Money which caused me to respond with a letter to defend my colleagues, which led to the interview.

What has happened to us that we have drifted into this paradigm of chronic inferiority?  How has this culture of being under-achievers overwhelmed us?  The NPs certainly don’t have it. In the coming world, unless we wake up, there will certainly be a tiered system where NPs will fall just beneath the MDs as their much-loved colleagues and PAs the assistants to both.

Of course I am not saying that med school = PA school nor NP school. I strongly believe that both PAs and NPs need supervision during their first years of practice. Of course MDs come out of their programs much better prepared. But are we made up of such an inferior cognitive matrix that we can never become competent?  Are you saying if a PA has spent 20 years or more in practice, that they still must run humbly and submit their reasoning to the far more advanced 28 year old new med school grad before each decision that he or she makes so he or she doesn’t do harm to a patient?  So a doc with 4 years of medical school and 5 years of residency (9 years total of medical specific training) is far better prepared than a PA with 2 years formal training and  20 years of specific medical training?  Then we PAs are all idiots and stupid as you referred to me.

If the problem is just political, then count me out. I told the truth and politics is not my forte. My patients are served extremely well and my SPs would be the first to tell you that I know more than they do in my area of work. They know a hell of lot more than me in their areas of work.

The last issue, that some authority, NCCPA or AAPA or whoever should reprimand me or take away my license for sharing my opinion . . . you must be kidding? Is this the USSR of the 1950s?  Is Stalin in power at the AAPA as the thought police? Good heavens I hope not. Actually I’ve seen positive signs that the AAPA is getting some spunk for a change.

So, if I am the only voice within PA-dom that believes that PAs can reach a high level of competency with experience . . . yes that ever rivals or exceeds that of MDs in certain situations . . . then I will stand alone. But I am only speaking what is the obvious.

Have a great day, Mike

I am very disturbed by this article from CNNMoney.com The article does not show the team-based approach to health care that PAs are known to embrace. I think some of the statements by Mr Jones were very unfortunate and obviously taken out of context. It is never appropriate to ventilate during a politically sensitive time in health-care. We should be very wary of how we phrase our comments.

David,

Terri said she was going to put this story on Advance’s blog and I came to check it out. I wanted to make a comment related to your comment.

I will have to say, right away, that I wish that CNN had given me the opportunity to edit that piece before it was published because I think I could have done a much better job with the language to clarify it. I was discussing a complex situation, but for the sake of brevity, it was edited to a few sound bites.

You are right that simplistic language, such as “The PA knows as much as the doc” is politically inflammatory. I can vouch for that as I’ve had some very personal and threatening postings and contacts from docs because of my words.

What I meant by my statements is the simple truth, that a PA in primary care, who have worked for over a decade, needs very little supervision . . . and in my humble opinion, would be more cost-effective if they were not required to have supervision.

I alluded to my own situation and now I regret that because it is so unique. I work as a sub-specialist within a specialty clinic. In my sub-specialty, I don’t only know as much as my supervisors but actually much more than they do . . . about my sub-specialty. This is not arrogance, as the docs have claimed, but simply stating a fact. This fact is based on the obvious circumstance that I have spent the most of 28 years working with the best minds in my sub-specialty (such as the Mayo Clinic).  However, with that said, I certainly don’t know half as much as SPs in our general specialty . . . nor do I need to because I never see those patients.  

It was an honest statement that I have never asked my SPs a question in the six years I’ve been here and again this is not arrogance but a simple fact. Now, when I did work at Mayo Clinic and entirely within my sub-specialty (with 5 other sub-specialty docs), I would ask them a question . . . about once every 2-3 months.  I was not putting my patients in any kind of jeopardy but why ask a question when you know the answer?

It would be the same if you took up the sub-specialty within ENT of OM. You spent 20 some years in OM, seeing hardly anything else. You studied with the most famous experts in OM for most of that 20 plus years and now you work in a general ENT clinic. Would it make sense that you would ever need to ask the general  ENT guys a question about OM if that was your life?

But again, you point is well taken about the language and I wish I could have changed that before it was published. Now I’m having hell to pay by some very insecure docs who have their feathers ruffled by the bizarre concept that a PA could know as much about them in anything. Some are suggesting that they will try to get me fired for . . . telling the truth I guess.

Mike Jones

What enitity or person made Jones the spokesman for the PA profession.  NCCPA and AAPA should discipline this guy.  He is an idiot to say such things publically.  He has chagrined the entire profession.  Yes, after 26 years as a practicing PA and my 5th recertification I know a lot but I have not attended medical school.   I practice WITH my physician supervisor who is a Pediatrician of 40 years experience.  I will never know all that she knows.  Of course after 10 years or more we are seasoned and can handle the greater percentage of cases without asking a question.  Mr. Jones having said he has never asked or never asks his supervisor a question reveals his own medical arrogance and I consider such an individual to be a danger to the health and wellbeing of his patients.  He does not speak for me and I believe not for most of my collegues.  This is the kind of rhetoric that has labled advanced practice nurses and caused physicians to be guarded about their desire for independent practice.  Mr. Jones needs to attend medical school so that he can realize what he does NOT know.   Maybe the board of health in Washington should call him in for a short interview!

I've been a PA for 15 yrs, the past 10 in ENT.  I would agree with Mr Jones that the disparity of pay and the "reward" the physician gets for minimal supervision is a bit much. I would also agree that after 10 yrs in the field, that the PA is a very seasoned and trusted practitioner. However, I would be careful about making comments about knowing as much as your supervisor.

Politically that can be very damaging. Ethically, if you know more than your physician then you should consider getting a new supervisor.

Remember, we're trying to continue to expand our influence among physicians. If they sense an uprising within our ranks, we could be drastically limited in out scope of practice.