THE BLOG
03/25/2014 06:41 pm ET Updated May 25, 2014

For Physician Assistants, One Word Can Mean a Lot

In the PA community, one word can mean a lot.

I'm a physician assistant (PA) and am also an athletic trainer (ATC). As an ATC, I labored for over a decade performing care and prevention of injuries for athletes ranging from professional and elite level college players to sixth grade soccer teams. The title "athletic trainer" was always a point of contention for ATCs, and it's debated on a regular basis. It certainly was tiring to constantly have friends, patients, and colleagues from other professions ask me things like, "So you work with horses?" or "Oh I see, you are one of those people who help put together workouts for gym members," etc.

When I became a PA, I walked (or crawled, after the grind of PA school!) into a wonderful profession where I was able to participate in overseeing the care of an entire patient, diagnose illness, prescribe medications, order tests, and practice medicine in collaboration with a physician. But the quirkiness of the title "physician assistant" still leads on occasion to some of the same questions I would get before, like, "So you are like a medical assistant?" or "You take the blood pressures and stuff?"

I should note, however, that this is changing, and changing quickly. I tell every patient that I see that I'm a PA, and ask them if they know what that is. More and more times, they say, "Sure, I've seen lots of PAs, you're kind of like a doctor, do a lot of the same things they do, and you work in a team with doctors and other providers, is that right?" To which I reply, "My friend, you got it!"

As you can guess, there is ongoing debate within my profession about changing our title, and sadly it has caused a lot of heat and rancor on both sides of the issue. The heat usually has to do with other things, like people not feeling heard and feeling dismissed. These are what I think really cause the strong feelings. But I think as a profession we've made some big progress on this. There seems to be a kind of truce between the various players and organizations, sort of an unstated agreement that we'll put aside the issues of what we call ourselves for now, and will instead focus on identifying things we have in common. Like better describing, to ourselves, colleagues, patients and regulators, what we actually do. As someone who feels empathy and respect for PAs on both sides of the issue, I think this is a million-dollar move and a fantastic direction for us.

I believe in building coalitions, in bridging gaps between differing individuals and groups by looking for partnership based on what we have in common, rather than focusing on where we differ. And a recent move by the US Veterans Health Administration, an organization rich with PAs, to change just one word may have the potential to bridge some very large gaps for in our PA world. This simple move would be to move away from regulatory language describing the role of what his historically been called a "supervising physician," looking to rename that relationship as a "collaborating physician." PAs have historically had official partnerships with physician, with each PA typically connected to a physician colleague by a formal agreement. The physician in such agreements have traditionally been called "supervising physicians," but this word no longer accurately reflects the breadth and depth of real PA practice, nor does it accurately describe the evolving and essential partnership between PAs and our physician colleagues. There are many practice models to be sure, but most PAs frequently function with autonomy, often along-side our physician colleagues, and sometimes physically alone (but electronically connected) in rural settings.

Autonomy and independence are two very different things. When I see a patient, examine them, listen to them, and make a decision to prescribe a medication, that is autonomy. I don't have to go ask my doctor, I don't have to have a co-signature, I just do it based on knowledge, skills, and experience. And if I'm out of my comfort zone with the patient, then I go talk to my MD, PA, NP, pharmacist, RN, or other colleague and use the team of which I am a part. Because I regularly consult with a physician, and have access to a team of providers who can support me anytime, then it's certainly not independent. And we know more and more that if "independent practice" means providers functioning with no regular interactions with other providers, then patients suffer.

Most PAs would agree that we're not after "independent practice," a somewhat mythological status that some of our nurse practitioner colleagues promote as some sort of an ideal. If the best care is team based care, then no provider should be an island, functioning completely independently of other providers. Not NPs, not MDs, and not PAs. We should be seeking out consultation and collaboration at every turn, and move away from the "this is how I do it, how I've done it for years, and how I will do it until I retire!" approach that has resulted in so much sub-standard care for so many patients over the years.

I'm running for the American Academy of Physician Assistants (AAPA) Board of Directors Secretary-Treasurer position, and the election is coming up in April. This is an issue that is being discussed by many candidates, and one that will continue to gain prominence, as our organization moves toward our annual conference and House of Delegates, a three-ring circus of the best kind. PAs from all over the country meet over parts of three days, and we debate, make policy, vote, and continue to carve out our growing and evolving role in the US health care system. I expect this to be one of the "hot topics" at our meeting, and that's a good thing!

Here's to a refined and modernized understanding of what PAs do, so we can better serve the millions of patients who are about to flood our medical system. We are proud of our partnership with MDs over the years, and after all, it was MDs who created us! Here's to a more accurate and sophisticated description of that essential relationship, where PAs and MDs continue to work side-by-side guided by principles of collaboration, consultation, and team-based care. And here's to moving beyond the outdated "supervising physician" model to the patient-centered concept of the "collaborating physician."

Because in the PA community, one word can mean a lot.

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