Readers Debate the PA's Role in Today's Practice

Editor's note: We work hard to write about issues that will help physicians run their practices in a manner that is both prosperous and efficient, while still delivering quality patient care. And we are delighted when our readers let us know what they are thinking. This month, we excerpt a blog from a podcast on how PAs are becoming popular in practices. We also excerpted a blog on one physician's views on the changes needed in healthcare. The articles have been edited for space and are followed by comments made by readers at PhysiciansPractice.com.

PAs Taking the Modern Medical Practice by Storm

Every year the National Commission on Certification of Physician Assistants (NCCPA) releases data on the physician assistant (PA) profession. This year's data reveals the profession is growing by leaps and bounds. In 2010, there were just over 80,000 certified PAs nationwide. In 2016, the number has grown to just over 115,500 certified PAs.

If the NCCPA's data is any indication, many of these PAs are young women. In fact, the NCCPA found that 28 percent of certified PAs are women aged 30-39, and 14.2 percent are young women aged 20-29. Dawn Morton-Rias, PA-C, told the Physicians Practice Pearls podcast being a PA provides young women a certain flexibility that being a physician cannot.

Jerome says: A way to pretend to be a doctor. Tell it like it is. P.A. [does] not = M.D.

John replied: What an ignorant statement...

Armand says: It doesn't matter how well you're trained, you people will never have the depth of knowledge physicians acquire in medical school, residency and fellowship training, stop pretending something you're not. Physicians, be aware that we need to stop this nonsense, these people are spending lots of money to convince politicians that they know what they're doing. They're a threat to our patients, especially those that take care of patients without supervision. Unbelievable!!!

Ted A. replies: I completely agree. PAs may think this because they like to think it and they were probably told [they were equal] by those who trained them. PAs, nurse practitioners, and pharmacists, all have organizations that are actively investing in influencing the middle call boards in most of the states to look at them as MDs using another acronym. I just got finished listening to a piece on NPR where a newly minted pharmacist explained that they have most of the skills that physicians to do which are required for them to become providers. Very aggravating!

13 Red Flags Your Pain Patient is a Drug Seeker

As doctors, we know the complications the opioid epidemic can cause. We have all seen patients who were seeking drugs, whether we recognized it or not. And I would hazard a good guess that we've all fallen for prescribing controlled substances to a seeker at one point or another in our careers.

Doctors and other healthcare providers want to do our best for our patients. When they are in pain, we want to alleviate it. But, we are often conflicted when we are treating a patient in pain because so many tried to scam us in the past and we cannot honestly tell which ones are telling the truth or not.

Robert says: Wellness checks by the county sheriff departments or local police departments assist when the red flags go up also.

Linda replies: In some areas I think the police are so overwhelmed, they don't have time unless it is a big drug ring they can bust. But yes, to solve this crisis, we need the police in many cases.

Jeff says: What is also needed is an article/program on activities and behaviors to help confirm the need for medications. Most docs will provide a letter of introduction for a patient moving to a different area along with records. It is patients who do the opposite that are usually legit: Never call early, never lose their meds or drop them in toilet, are still active (exercise and work full time), aren't no shows, don't drink, expect to and readily sign narcotic agreement form.

Linda replies: Excellent points and I agree. The patients who need these meds are truly being harmed.

Changing the Healthcare Conversation

It is virtually impossible to develop a relationship with poly-chronic, poly-morbid patients with a waiting room full of people with routine issues who pay the bills.

It happens every day, people present with serious health issues and there's barely enough time to manage the conditions, and none to manage the patient.

If you did take the necessary time to manage the patient, it would put your practice in economic peril because the present fee-based system is based upon volume, not value. The value-based systems require you to work in the blind with month's old data and little information. The right analytics are very expensive, and the skill sets to use them are still being learned with the exception of early adopters, who are few and far between.

Anonymous says: This is an enlightened first step sensible approach. Unfortunately, you have brain washed medical students in training and residents in training with bullshit like "pain is the 5th pathway" and value-based care is better than fee-for-service, even though the definition of value and quality is still quite elusive and controversial. You have enslaved doctors in training with enormous student debt without giving them reason to forsake high paying volume and procedural related specialties for under-paid ground level entry primary care. Teach young doctors how to do a thorough history and physical and give them the time and resources to add appropriate technology and not go broke and the patient's care will improve. Give docs who go into primary care [15] years debt absolvent on student loans. Beef up pay for cognitive services. Put a majority of primary-care physicians on the Medicare Payment Review Committee (practicing ones not lifelong Beltway consultants) and add some lay members and you will see the quality and care improve.

Andrea says: Thank you for pointing to the true solution: having the physician be responsible for adding value to healthcare. I am ready to pick up the baton to support health for the people in my community. Blessings!