by Dave Mittman, PA, DFAAPA
I was thinking about the future of PAs and NPs and something struck me that I had felt for years, but had been unable to explain. Please allow me to try to now, as I want to introduce you to our profession’s “minimizers’ and if you are one, to ask you to consider changing a bit.
When you look at the future of the PA and NP professions, they will in many ways mirror each other. In the clinical arena, we do now and will increasingly continue to do much of the same things. Many of our political targets are the same; elimination of barriers, expanding practice, figuring where the doctorate fits in, dealing with attacks from those that do not want us practicing at our highest level. Similar problems and opportunities. The PA profession has one more thing to deal with that NPs have already dealt with a bit more successfully, and that is the real push and pull between the minimizer and maximalist.
What is that you ask? Let me try to explain as these are as much feelings and perceptions as facts. The PA minimizer is someone who many times is a great PA. They can be a leader or not, might be a teacher or precept students, and most are excellent full time clinicians. They are good people who love the profession, so what could be the problem? What they have in common is they look at professional issues as how they effect only them. Much of how they think about professional issues ends within 20 miles of their practice or home, some might expand up to worrying about their state. Their profession is one of being singular in scope, not national or more global. For example, when our title and the “assistant” part of it is brought up in conversation, they invariably say that “I have been practicing for 20 years with this title and I don’t see how it hurts me?” They agree that the title does not represent what PAs are or what we do, but to them that is of little consequence to their day to day practice. They don’t consider that there are patients that never came into see them because they were an “assistant” or that some legislators still see them as second class providers. Even if we were to devise a plan to change it, to them it would not matter. Their name tag has “assistant” on it, and hey, they have done pretty well so far in this world. If we bring up full practice responsibility, they will say “Why do I need that? My office runs fine just the way it is and I like having a physician to run things by”. “You know, I only really consult about once a month, but I would rather not have the responsibility”. And most will add that they make more money than they ever thought they would. We tell them none of that would not change, unless you want to practice alone. You would still be part of a team, just as the MDs, RNs and NPs you work with are, you just would not need MANDATORY supervision. You very well might make even more money! Mandatory ratios that hold back employers from hiring us, mandatory chart review or whatever other barriers your state makes you jump through would cease to exist. We could begin the steps to stop “incident to”. You would know your billings. You would be able to sign your name and professionally stand fully behind what you do. That today, most physicians don’t want to be saddled with anyone who will slow them down with restrictions. That increasingly large groups and hospitals are the employers, not the old “doc” they work with. Most importantly, these employers will hire the profession with the least restrictions they have to deal with, not the most. At the end of the discussion, they nod their head in agreement and say, “I agree, but you don’t understand”. “I don’t want to upset anything”. And when someone brings up the doctorate, even as an optional “add-on”, the response is, “I can do everything I want now-why would I want to spend the money to do that?” “It is not going to make me a better PA?” In all the cases and more, the minimizer looks at how these changes will effect them and only them. They do not take a national or global view of the profession. They will agree that someday we will have to deal with the problem of our title, but hopefully not in their working lifetime. They will, if pressed, agree that there will be a problem if in the future every other healthcare profession practices at the doctorate level and PAs do not. The fact that we spend as much or more hours in graduate level training as other professions that receive doctorates, has little bearing. Even that it is unfair to saddle our future students with this problem. They understand that insurers reimburse those with doctoral education much more easily than master’s level training and maybe, just maybe getting a doctorate would open their horizons in ways they have not yet considered. But again, not them. They are convinced it won’t help them. And by the way they tell you, if you get one, don’t think of calling yourself “doctor”. Way too confusing to the public and threatening to MDs. And we don’t want to threaten MDs. OK, we understand that but the world is changing. Minimizers clearly are not looking to maximize their future potential. Four years ago I wrote a blog about KODAK. If you scroll down on blogs you can read it below. It was a great company that owned photography in America and refused to change. Refused to see what was coming next. Closed their eyes. A company committed to not seeing the larger, and yes, more complicated picture. Buy any KODAK film lately? We need to take a view not of what is happening today, but what the future will be asking of us
So now let me tell you why minimizers are important. They are a connection to our past and very well might have saved our early profession. We still need them. Young ones learned their outlook from other old ones. They ask the questions we might not ask. They keep us grounded. When younger, our profession needed many more minimizers. Dreamers were needed also but too many would have been way too threatening. Minimizers represent the original feelings of the profession when the pressing need was to worry about survival. People who worry about survival do not worry about advanced degrees or full practice responsibility. They worry about doing a good job, showing the world they CAN do what only physicians did before them and getting a paycheck. They ARE local in scope. They leave the national and global worry to others. No crazy ideas that might just get us all in trouble. Totally understandable, but increasingly those days are gone. So, we need more of us to convert to maximalism. To become maximizers.The PA profession must recognize that things have changed. We must fully embrace the fact we are in a new medical world. We have to realize that what worked to promote us in the past, won’t work into the future. We need to embrace some of the worry of the minimizer, but temper it with the future needs of students who will be graduating 10, 15 and 20 years from now. Even considering the needs of people who are starting practice this year.
Let’s keep our history of grinding away locally, showing our clinical excellence, but now with a global scope and outlook. Keep being safe, but now sticking our legs, not just our toes out into the water.
Ready to make the change? I did.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.