Liam James Doyle for KHN
After 23 years as a physician’s assistant, Leslie Clayton remains annoyed by one facet of her vocation: her title. More precisely, the word “assistant”.
Patients asked if she was heading to a medical school or if she was right in the middle of it. The term has confused even her family, she says: It took her parents years to figure out that she does more than take blood pressure and perform similar basic chores.
“You assume there has to be some sort of direct, hands-on monitoring for us to do our job, and that hasn’t been accurate for decades,” says Clayton, who practices at a clinic in Golden Valley, Minn. “We are not helping. We are providing care as a team.
Seeking to better understand and appreciate their profession, physician assistants strive to rebrand themselves as “associate physician”. Their national group officially changed “assistant” to “associate” in its name in May, turning into the American Academy of Physician Associates. The group hopes state legislatures and regulators will legally enshrine the name change in bylaws and rules. The total cost of the campaign, which began in 2018, will reach nearly $ 22 million, according to a consulting firm hired by the association.
Doctors push back
But renaming the name PA has raised the blood pressure of doctors, who complain that some patients will mistakenly assume that an “associate doctor” is a young doctor, just like a lawyer who has not yet been associated is a. associate. The head of the American Medical Association warned that the change “will undoubtedly confuse patients and is clearly an attempt to advance their quest for independent practice.” The American Osteopathic Association, another group that represents physicians, accused PAs and other non-physician clinicians of trying to “obscure their credentials by misappropriation.”
In medicine, the seemingly innocuous title changes are exacerbated by the endless wars between the different levels of practitioners who jealously guard their professional prerogatives and the type of care they are authorized to perform. This year alone, the National Conference of State Legislatures listed 280 bills introduced in state houses to amend the scope of practice laws that set the limits of the practice of nurses, physician assistants, pharmacists. , paramedics, dental hygienists, optometrists and addiction counselors.
Lawmakers have authorized dental hygienists in North Carolina to administer local anesthetics; allowed Wyoming optometrists – who, unlike ophthalmologists, do not attend medical school – to use lasers and perform surgeries under certain circumstances; and licensed Arkansas Certified Nurse Practitioners to practice independently. Meanwhile, the physician lobby is aggressively fighting these kinds of proposals in state legislatures, accusing other disciplines of trying to gradually focus on things that physicians claim to be the only ones who can do.
Physician assistants, as they are still legally called, have been granted greater autonomy over the years since 1967, when Duke University School of Medicine graduated four former Navy medics as the MA’s first class. country. Today, PAs can perform many of the routine tasks of a primary care physician, such as examining patients, prescribing most types of drugs, and ordering tests. In most states, this all happens without the need to have a doctor’s approval or to have a doctor in the same room or even in the same building.
Typically, a master’s degree in PA takes two academic years and includes around 2,000 hours of clinical work. Over 125,000 AMs practiced last year in the United States; their median annual salary was $ 115,390. In comparison, family physicians typically attend four years of medical school and then complete a three-year medical residency, during which they total approximately 10,000 hours. (Specialists spend even more time in residences.) The median annual salary for a family doctor in 2020 was $ 207,380.
PAs aren’t the only specialists to complain
PAs aren’t the only ones losing patience with their titles. In August, the American Association of Nurse Anesthetists rebranded itself as the American Association of Nurse Anesthesiology – its third name since its inception in 1931. President Dina Velocci said the term “anesthesiologist” confuses the public and is difficult to pronounce, even when she helps people pronounce every syllable. (It’s uh-NESS-thuh-tist in the US and indicates a registered nurse, who usually has a bachelor’s degree in nursing, and then received several years of education and training in anesthesia.)
The new name of the association is justified since “we make the lion’s share of all anesthetics in this country”, says Velocci. The legal title of the profession remains registered nurse anesthetist (CRNA). “I’m certainly not trying to say I’m a doctor,” Velocci says. “I’m clearly using ‘nurse’ before that.” Nevertheless, groups of doctors condemned the change of name of the association.
Likewise, PAs say there is no ulterior motive in changing their name. “Changing the title is really just to address this misperception that we’re only helping,” says Jennifer Orozco, president of the PA association and administrator of Rush University Medical Center in Chicago. “It won’t change what we do.”
They say the “assistant” confuses not only patients but also state legislators and those who hire medical professionals. When Clayton recently testified before Minnesota lawmakers about a scope of practice bill, lawmakers “just couldn’t understand” the concept of “an assistant who doesn’t have a direct supervisor. She said, adding that the message they told her, “You really need to do something about your title.”
The PA association debated many names. It also included “practitioner of medical care” and the widely derided neologism “praxician”. “Associate Doctor” won, thanks to several advantages. It allowed PAs to continue to present themselves with the same initials, and it had been flirted as an alternative throughout the history of the profession to distinguish PAs with higher qualifications from those with less training. The association even briefly used “associate” in its name for two years in the 1970s, and the Yale School of Medicine has offered an associate’s degree in medicine since the program began in 1971.
Why frustrations run deeper than a job title
But a name change alone will not solve the other disadvantages PAs face. In some states, physicians are required to meet with PAs regularly, to visit PAs periodically in person if they work in a different location, and to regularly review sample patient charts. States generally require less supervision for nurse practitioners, who perform similar duties as physician assistants, making them more attractive to some employers. “We’ve heard from our PA colleagues that they are masquerading as nurse practitioner jobs,” said April Stouder, associate director of the Duke Physician Assistant Program.
The physician lobby has opposed greater freedom for nurse practitioners, and many physicians express similar concerns about patient safety if PAs are allowed to stray too far from physician oversight. Dr Colene Arnold, a gynecologist in Newington, NH, began her medical career as a medical assistant, practicing with little supervision. Looking back, she said, “I didn’t recognize the gravity of what I was seeing, and it’s scary.”
American Osteopathic Association CEO Dr. Kevin Klauer says misdiagnoses by PAs working alone are more likely than when a doctor is involved. “If you go to Jiffy Lube and want an oil change and a tire rotation, that’s what they’re going to do,” he says. “Medicine is not like that.”
Orozco, the president of the PA association, says such concerns are overblown. “They will always collaborate with the doctors and really want to continue working in this team environment,” she says. Physicians should welcome PAs to help fill physician shortages in primary care, behavioral health and telemedicine and free up physicians to focus on complex cases, she adds.
“I can have a jet engine mechanic change the tires on my car,” she says, “but do I need them every time? “
Kaiser Santé news is a national newsroom and independent editorial program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.