Question? Let’s just say a family member of yours is sick to the point that you are scared. Maybe it’s belly pain, chest pain, but they’re sick. It’s your child. It’s someone you love dearly. You’re afraid. 

Have you ever had that happen?  Have you been on the other side of the stretcher where you’re really afraid?  You go to the emergency room and it’s a PA.  Would you be comfortable seeing a PA or Nurse Practitioner as opposed to a board certified doctor if your child was sick in a way that you thought was life threatening?

 I remember 10 years ago my son got a racquetball to the eye and he had a hyphema blue pupil and I thought it was a vision threatening injury. I was scared. I remember going to the pediatric hospital in Buffalo and I was scared. And when a physician ophthalmologist came in I felt reassured that I had the highest level of training to take care of my child. 

So coming back, if you were afraid would you want a PA or Nurse Practitioner taking care of your family member? Now as a guy who trains PAs in emergency medicine, urgent care, advanced emergency medicine, board reviews is a guy who lives in this world. And as autonomous of a PA in emergency medicine that I believe a PA can be for a total of 15 years, I’ve run emergency rooms by myself. I’ve run hundreds of codes, central lines, LPs, intubations, rapid sequence intubations, and thrombolytics for STEMIs. I’ve taken care of the sickest of the sick as a PA. So humbly, I would say, I believe that I’m in the top few percent of autonomous emergency medicine providers. Oftentimes my backup doctors had less critical care training then I did. They were family practice trained. 

So, would I want my child to be taken care of by a PA?  The answer is only if that PA had humility. If that Nurse Practitioner had humility, and they knew when to say “I don’t know about this. I’m going to go get help.” Absolutely. I’d be completely fine with it.  As a matter of fact, they might get better care than if they were seen by a doctor. If a PA or Nurse Practitioner had humility and they really embraced it I would be okay with that.

Here is a problem that I am seeing with the PA profession right now. There is a huge cry for independent practice. And then at times when I say “Independent Practice’ we mean OTP. Optimal Team Practice. Well, what does that mean? What do you mean? And I understand the argument. So I hear an argument that we need to increase access to care. There’s an argument there. I agree with that. If we had independent practice, a little more freedom, could we bring more care to patients. That’s possible. Is there a bureaucracy difference? Are we losing jobs to Nurse Practitioners because of administrative issues where we are tethered to a doc? I believe that’s possible but I also know some places that won’t hire Nurse Practitioners because they want that relationship. They want that legal binding relationship. If I was a board certified doctor, would I want to work with Nurse Practitioners and PAs. Absolutely. Would I want to have supervision responsibilities that are legally in place? I would.

Colleagues, I am very concerned about this toxic triad of the PA profession. What is the toxic triad of the PA profession?

Number 1 is Optimal Team Practice versus Independent Practice where we are trying to step away from the tethered nature to physicians. Physicians trained us and I can see doctors saying ‘Oh you don’t want to be trained by us anymore? Good luck. Have a good life.” It is my understanding that 50% of PAs out there have been PAs for less than 8 years. Optimal Team Practice, Independent Practice. I think we should talk about Optimal Supervision. What’s the Optimal Supervision that allows us to practice to care for patients optimally? Not Independent Practice, Optimal Supervision rules. 

Second part of the toxic triad is our name. Physician Associate versus Physician Assistant. I’m just telling you if someone came in and said ‘Hey I’m a pilot associate. I’m going to fly the plane.’ I’m going to assume they are a pilot. I’m a plumber associate. I’m going to assume that they are a plumber. That may violate informed consent laws.

My last one is this push for PAs to get doctorate degrees. I’ve met some doctoral PAs that are brilliant. They represent our career fantastically. I’ve also been with PAs who have flicked that title out as a merit badge and as an identity. ‘Hey this is who I am. I’m a doctor.’ That’s not the most healthy thing for us. Humility in medicine is the key. I don’t mean to cause controversy or bandstand. I am just concerned about our profession. Humility in medicine is the essence of what we do. 

God Bless.