A Title Fight Pits Doctor Assistants Against Doctors

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After 23 years as a physician assistant, Leslie Clayton remains rankled by one facet of her vocation: its title. Particularly, the term “assistant .”

” is what Leslie Clayton refers to.

Patients asked her if she is going to medical school, or if she is still in the middle. Even her family was confused by the term. She said that it took her years to realize she did more than just take blood pressure and perform similar tasks.

“There’s a common assumption that we need to have some kind of direct oversight to ensure that our work is done properly. Clayton practices at a Golden Valley clinic, Minnesota. “We don’t assist. As part of a team .”

, we provide care.

Physician assistants want to be respected more and are rebranding themselves as “physician partners.” In May, their national group officially changed the name of “assistant” to “associate,” transforming into “American Academy of Physician Associates.” The group is asking for state legislatures to legalize the name change in rules and statutes. The association estimates the entire cost of revising the profession’s title will reach nearly $22 million.

Renaming the P.A. Name has sparked doctors’ blood pressures. Some patients mistakenly believe that a “physician assistant” is a junior physician, just as an attorney who is not yet a partner is an associate. The head of the American Medical Association warned that the change “will undoubtedly confuse patients and is clearly an attempt to advance their pursuit toward independent practice.” The American Osteopathic Association, another group that represents doctors, accused the P.A.s and other nonphysician clinicians of trying “to obfuscate their credentials through title misappropriation.”

“There is an assumption that there has to be some sort of direct, hands-on oversight for us to do our work, and that’s not been accurate for decades,” says Clayton. (Liam James Doyle for KHN)

In medicine, seemingly innocuous title changes are inflamed by the unending turf wars between various levels of practitioners who jealously guard their professional prerogatives and the kind of care they are authorized to perform. Just this year, the National Conference of State Legislatures catalogued 280 bills introduced in statehouses to modify so-called scope-of-practice laws that set the practice boundaries of nurses, physician assistants, pharmacists, paramedics, dental hygienists, optometrists and addiction counselors.

Lawmakers let North Carolina dental hygienists administer local anesthetics; permitted Wyoming optometrists — who, unlike ophthalmologists, do not attend medical school — to use lasers and perform surgeries in certain circumstances; and authorized Arkansas certified nurse practitioners to practice independently. The physicians’ lobby aggressively fights these kinds of proposals in state legislatures, accusing other disciplines of trying to incrementally horn in on things doctors claim only they are competent to do.

Physician assistants, as they are still legally called, have been steadily granted greater autonomy over the years since 1967, when the Duke University School of Medicine graduated four former Navy medics as the nation’s first class of P.A.s. They can now perform routine tasks like prescribing medications, ordering tests, and examining patients. Most states allow this to happen without the need of a physician signoff. The profession is pressing for more: it wants to abolish state mandates that P.A.s must be formally supervised by physicians or have written agreements with a doctor spelling out the P.A.’s role.

A P.A. is generally a degree that takes 27 months to earn. master’s degree takes 27 months to earn and includes about 2,000 hours of clinical work. By comparison, family physicians usually attend four years of medical school and then do three-year residencies during which they clock about 10,000 hours. Specialists are more likely to spend time in residencies. Nearly 150,000 P.A.s were practicing in 2020 in the U.S. Their median annual pay that year was $115,390, slightly above the $111,680 median pay for nurse practitioners, who perform jobs similar to P.A.s. The median annual pay for a family physician was $207,380.

P.A.s don’t have to be frustrated with their titles. In August, the American Association of Nurse Anesthetists renamed itself the American Association of Nurse Anesthesiology — its third name since it was founded in 1931. Dina Velocci, President of the American Association of Nurse Anesthetists stated that the term “anesthetist”, is difficult to pronounce and baffles the public. She even helps people sound out each word. It is pronounced uh-NESthuh-tist in America. This refers to a registered nurse with a bachelor’s degree, often in nursing. After that, they have received additional years of training and education in anesthesia. )

The association’s new name was justified because “we’re doing all the anesthetics here in this country,” Velocci stated. I am not trying to claim that I am a doctor. “I’m using the word “nurse” in front of it.” Physicians groups have opposed the change. However, the legal title for this profession is still certified registered nurse anesthetist (or CRNA).

The P.A.s claim there is no ulterior motive for changing their names. Jennifer Orozco (P.A. president) stated that changing the title was done to correct the misperception that they only help. Rush University Medical Center in Chicago is the administrator of the association. It won’t affect what we do .”

They say that “assistant” is confusing not only patients, but also state legislators and those who hire doctors.

They claim that the term “assistant” confuses not only patients but also state legislators and those who hire medical professionals.

The P.A. association’s consultants developed more than 100 alternatives, including “medical care practitioner” and the widely derided neologism “praxician.” “Physician associate” won out thanks to several advantages. It allowed P.A.s with similar initials to continue to identify themselves. The name was also flirted with throughout the history of the profession to distinguish highly-trained P.A.s and those with less training. The association even briefly used “associate” in its name for two years in the 1970s, and Yale School of Medicine has offered a physician associate degree since 1971.

A name change won’t solve all the problems P.A.s have. Some states require doctors to meet with P.A.s regularly, visit them at different locations periodically, and review patient charts on an ongoing basis. Some employers find nurse practitioners more attractive because they are subject to less supervision.

” We have heard from our P.A. April Stouder, associate Director of the Duke Physician Assistant Program, stated that colleagues are being passed over by nurse practitioners for jobs.

Many physicians are concerned about the safety of patients if P.A.s get too far away from their supervision. Dr. Colene Arnold is a Newington, New Hampshire gynecologist who started her medical career as an assistant, with very little supervision. She said that she didn’t realize the severity of her condition and that it was scary .

Dr. Kevin Klauer is the CEO of the osteopathic associations. He said that misdiagnoses made by a single P.A. They are more common than when a doctor is involved. He said, “If you visit Jiffy Lube and want an oil change or a tire rotation, they’ll do that.” “Medicine does not look like .”

Orozco is the P.A. President of the association, Orozco, stated that such fears are exaggerated. She said, “They will always work with doctors and want to continue working in that team-based environment.” She said that doctors should be open to P.A.s because they can fill in for physicians who are not available in primary care, behavioral healthcare, and telemedicine, and allow them to concentrate on more complex cases.

“I could have a jet engine mechanic change my tires on my car,” she stated. “But do I really need it every time ?”

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