Posts
Surgeons,
Patients and this discussion about life.
Robert Blumm
NEW
YORK
(Reuters Health) - A new survey of surgeons suggests many fail to
discuss their patients’ wishes in case a risky operation goes
awry, and
even more would not operate if patients limited what could be done to
keep them alive. Such medical wishes, called advance
directives, outline what can and cannot be done if patients are unable
to decide for themselves, but the restrictions are debated among
doctors.
“(Surgeons) feel the advance directive basically ties
their hands behind their back, and they’re not given the
tools to get
them through the surgery,” said Dr. Margaret Schwarze, one of
the
survey’s authors and an assistant professor at the University
of
Wisconsin School of Medicine and Public Health. She and her
colleagues asked 912 surgeons who regularly perform risky operations 14
questions on how they discuss a patient’s advance directives
and
whether they influence their decision to operate.
The survey’s
results, published in the Annals of Surgery, found that more than four
out of every five surgeons discussed which forms of life support the
patients would like to limit. But only about one half specifically
asked about the patient’s advance directive, which can
include
restricting the use of feeding tubes and ventilators to keep a person
alive. “I think some surgeons just don’t
discuss advance directives because they think it’s so
irrelevant,” said Schwarze.
Over
one half of the surgeons said they would not operate if an advance
directive limited what could be done to keep a patient alive after
surgery. The researchers said such
instructions can also cause tension between the surgeon and the
patient, because it shows the patient may be unwilling to accept the
therapies that come with high-risk operations. Compared with
brain surgeons, heart surgeons were much more likely to decline an
operation.
According
to the researchers, brain surgeons may see removing life support as a
reasonable decision, because their surgical complications can cause
brain damage. Schwarze told Reuters Health it’s not
uncommon
for heart surgeons to use techniques like CPR after an operation, and
restrictive instructions may get in the surgeon’s way.
“I
think it’s important for patients to discuss their values and
goals
with surgeons before a big operation,” Schwarze added in an
email to
Reuters Health. “It’s also incredibly important to
discuss this with
family members or someone who may need to make decisions.”
However, she added that surgeons should also address the
advance directive to get rid of potential confusion.
Dr.
Peter Angelos, professor and chief of endocrine surgery at the
University of Chicago Medical Center, agreed that family members should
be involved in the discussion. “An advanced
directive is
frequently a vague general statement, but in fact, every case is going
to be a very specific situation,” said Angelos. He
added that
family members who aren’t involved in a patient’s
conversation with the
surgeon can be at a loss after the operation.
The 900 responses were from 2,100 randomly selected heart, brain and
vascular surgeons in the U.S.
The
study is accompanied by an editorial, which the journal declined to
make available even though the survey’s results are online.
SOURCE: http://bit.ly/t9SVLr
Annals of Surgery, online December 1,
2011
Please
Send A Copy To Friends
Medicine Setting
by Bob Blumm, MA, PA-C, DFAAPA - November 21, 2011
Please
do
not construe from the title of this article that it is meant only for
the EM clinician. Clinicians will discover these presentations in
family practice and in the urgent care setting as well as in the
orthopedic office. My personal passion for writing this is to
demonstrate that the diagnosis may be hidden if we are in a specialty
setting, and that elusive diagnosis may be life threatening. I wish for
you to consider the following three scenarios and apply your skills to
seeking the answer that is correct not the one that is obvious. Give it
a try as this little example of mental gymnastics cannot injure you but
make you a better provider.
Scenario 1- An otherwise
sedentary 43 year old
female has decided to begin exercise due to her recent 20 pound weight
gain. Two weeks ago she has a UTI for which her PA treated her with
Levaquin 500 mg qd. Today she has gone to the tennis club and has
played two games of tennis. During the game she suddenly developed a
pain in the right lower ankle region while simultaneously hearing a
“pop.” She enters the ER Fast Track area in a
wheelchair
with an elevated ankle that has ecchymosis and grade 3 edema and a cold
foot.
Scenario 2- A 53 year old business
executive from a
large Manhattan firm has decided to visit a friend for the Christmas
holidays. Seeing a large pile of logs he decided he would chop wood for
the morning fire. After having an oversized Starbucks coffee and
feeling quite energetic from the caffeine rush, he found an oversized
ax in the shed and started to carry large logs to the chopping block to
begin his work. He developed a strong swinging motion and brought the
ax to his side and then straight down on the log. After 45 minutes of
this activity, he suddenly developed a severe pain to his left shoulder
that radiated down his left arm. The pain became so severe that he
states;”it took my breath away.” The patient was
driven to
the ER by his host and was sent to Fast Trak with shoulder and elbow
pain.
Scenario 3- A 36 y/o fireman from
Buffalo, NY was
engaged in the firefighters tournament, which was being held on Long
Island. Unable to make the trip with his Hook and Ladder Company by
plane due to his fear of flying since 9-11, this contestant drove the
entire night non-stop except for coffee and to relieve himself. At 11
AM Fireman Woody has been admitted to the ER and triaged to Fast Track
for pain and swelling of the knee and calf while rapidly climbing the
tower. Apparently, while carrying the hose, his knee buckled and now he
has pain and swelling from the knee to the ankle.
Read the scenarios and take a few
minutes to think
of a diagnostic
plan. Perform the exam and explain your actions to yourself. Mention
the physical assessment techniques that you would perform as well as
any additional testing you would perform including medications that you
would order. What is your final diagnosis? If you wish you can send it
to this author and I will respond. Hopefully I will not be inundated
with responses.
Please
Send A Copy To Friends
Anaphylaxis:
Treating A Potential Killer
by Bob Blumm, MA, PA-C, DFAAPA -
November 14, 2011
What
Does the Physician expect from the PA?
Bob Blumm, MA, PA-C, DFAAPA
We
initiated this essay with the
presentation of the
Physician/PA team,
segued into new ideations that are not all embraced by everyone
immediately as they represent change. People become comfortable living
in the present and consider it unnecessary work and money to make
changes that are perceived as a sudden outburst by a few people. This
newest focus on the name we were initially called and the first
national debate was discovered as starting in 1996 and today there are
six thousand PAs that have called for action.
Our
second portion
of the essay focused on what these PAs expect of
their physicians in a
responsible relationship. We are now flipping the coin to ascertain
what exactly the physician expects of the PA. Education:
1.
Core
knowledge- There is the expectation that the PA has a basic
compendium
of core knowledge in the sciences and knows the reasons for disease and
its prevention as well as having the ability to use science and
evidence based knowledge to create a differential diagnosis.
2.
Aptitude- The PA should have the ability to utilize
various
communication sources such as conferences, journal reading and internet
research to help the team to move forward, This area is important
because everyone profits from physicians, NPs, PAs, secretaries, and
technicians and the patient. PAs are considered as part of a strong
organized team working together with goals and time frames.
3.
Thoroughness- Whether it be related to a medical
practice or a
surgical practice there is the need for continuity, for additional
diagnostic testing, for referrals to appropriate specialties and to
generate a synopsis of these facts for occasional presentations
relating to office management and protocol..
4.
Continued Medical
Education- Medicine evolves from day to day and it is
essential to
attend a yearly PA meeting as well as the specialty meeting of the
physician. In addition it is expected that the PA will read new and
relevant information that applies to the caseload of the practice and
to share information and evidence based studies that reflect more
modern and proven methods to prevent a disease and lessen its ability
to injure the patient.
5.
There are a small number of physicians
and groups who will encourage their PA to take a residency program that
has didactic and clinical training. My physician partner sent me to his
mentor at Johns Hopkins early in our relationship to learn the
fundamentals of the physician or professor that he admired. I was later
sent to Vienna, Austria to study under Professor Hans Bruck, a famous
Austrian surgeon for three weeks. I have joined Dr. Acker at one week
meetings of the Pan Pacific course every two years so that we could
split our time more effectively and bring home twice the information.
This type of activity is interpreted as the physician has trust in
their associate PA.
2. Attitude:
A. The physician wants the PA to
treat the practice as it were his or her own. There must be a
consideration for all of the parameters that the physician considers
because this relationship is meant to be like a marriage and both
people will profit. Dr. Acker, my supervising physician and I have been
working together for 39 years and I took a two year hiatus to join the
corporate world and discovered that the trust that developed between
Dr. Acker and myself was more important than corporate titles without
appreciation.
B. First impressions count. The first impression of
the practice and the professionalism of the office are determined by
the physician/PA/NP Patient relationship. This supersedes the
physician/PA relationship. Proper respect for the patient who is the
customer is first and the ability to integrate similar clinicians into
a practice setting and work cohesively is important to the overall
success of that practice site.
My
physician
described our
relationship when becoming a recipient of the Paragon Award for the
Physician/PA Team as a calling not a vocation- not a sinecure to earn a
living.
C the PA practices with the understanding that he/she will
always be the associate.
He described this as the priest to someone’s bishop
Subordinate yet having full ability to demonstrate their
approach.
Control of ego- if the associate thinks that he/she indeed is
more
proficient than the physician, then the associate should apply to
medical school.
To
assume in medicine is to court disaster and
therefore fastidious and zealous attention should be given to every
patient and their problem.
D. Relationships
1. A perfect relationship between a physician and a PA is
built on trust.
2.
Longevity- these relationships are meant to be enduring, not
unlike a
marriage. One should not switch teams as one would with running shoes.
3.
Profit sharing- incentives and financial remuneration should
be fairly
distributed based upon the success and expansion of the practice.
D.
What do patients expect of the Physician/PA team?
1. The patient must feel that the physician has complete
trust or faith in the PAs ability to treat his/her patients.
2.
The PA is knowledgeable and qualified to treat each patient
problem
with sensitivity, taking the time to listen and to maintain the similar
approach as the supervising physician.
3. The physician and the PA have an excellent relationship
with sharing of ideas and with evident mutual respect.
These
are the ingredients for successful physician/PA teams.
Please Send A Copy To Friends
Physician / PA Teams
What does the
PA expect from the physician?
by Bob Blumm,
MA, PA-C, DFAAPA - October 9, 2011
Patients and this discussion about life.
Robert Blumm
NEWYORK
(Reuters Health) - A new survey of surgeons suggests many fail to
discuss their patients’ wishes in case a risky operation goes
awry, and
even more would not operate if patients limited what could be done to
keep them alive. Such medical wishes, called advance
directives, outline what can and cannot be done if patients are unable
to decide for themselves, but the restrictions are debated among
doctors.
“(Surgeons) feel the advance directive basically ties
their hands behind their back, and they’re not given the
tools to get
them through the surgery,” said Dr. Margaret Schwarze, one of
the
survey’s authors and an assistant professor at the University
of
Wisconsin School of Medicine and Public Health. She and her
colleagues asked 912 surgeons who regularly perform risky operations 14
questions on how they discuss a patient’s advance directives
and
whether they influence their decision to operate.
The survey’s
results, published in the Annals of Surgery, found that more than four
out of every five surgeons discussed which forms of life support the
patients would like to limit. But only about one half specifically
asked about the patient’s advance directive, which can
include
restricting the use of feeding tubes and ventilators to keep a person
alive. “I think some surgeons just don’t
discuss advance directives because they think it’s so
irrelevant,” said Schwarze.
Over
one half of the surgeons said they would not operate if an advance
directive limited what could be done to keep a patient alive after
surgery. The researchers said such
instructions can also cause tension between the surgeon and the
patient, because it shows the patient may be unwilling to accept the
therapies that come with high-risk operations. Compared with
brain surgeons, heart surgeons were much more likely to decline an
operation.
According
to the researchers, brain surgeons may see removing life support as a
reasonable decision, because their surgical complications can cause
brain damage. Schwarze told Reuters Health it’s not
uncommon
for heart surgeons to use techniques like CPR after an operation, and
restrictive instructions may get in the surgeon’s way.
“I
think it’s important for patients to discuss their values and
goals
with surgeons before a big operation,” Schwarze added in an
email to
Reuters Health. “It’s also incredibly important to
discuss this with
family members or someone who may need to make decisions.”
However, she added that surgeons should also address the
advance directive to get rid of potential confusion.
Dr.
Peter Angelos, professor and chief of endocrine surgery at the
University of Chicago Medical Center, agreed that family members should
be involved in the discussion. “An advanced
directive is
frequently a vague general statement, but in fact, every case is going
to be a very specific situation,” said Angelos. He
added that
family members who aren’t involved in a patient’s
conversation with the
surgeon can be at a loss after the operation.
The 900 responses were from 2,100 randomly selected heart, brain and
vascular surgeons in the U.S.
The
study is accompanied by an editorial, which the journal declined to
make available even though the survey’s results are online.
SOURCE: http://bit.ly/t9SVLr
Annals of Surgery, online December 1,
2011
PleaseSend A Copy To Friends
Seeking
Differential Diagnosis in the
EmergencyDifferential Diagnosis in the
Medicine Setting
by Bob Blumm, MA, PA-C, DFAAPA - November 21, 2011
Pleasedo
not construe from the title of this article that it is meant only for
the EM clinician. Clinicians will discover these presentations in
family practice and in the urgent care setting as well as in the
orthopedic office. My personal passion for writing this is to
demonstrate that the diagnosis may be hidden if we are in a specialty
setting, and that elusive diagnosis may be life threatening. I wish for
you to consider the following three scenarios and apply your skills to
seeking the answer that is correct not the one that is obvious. Give it
a try as this little example of mental gymnastics cannot injure you but
make you a better provider.
Scenario 1- An otherwise
sedentary 43 year old
female has decided to begin exercise due to her recent 20 pound weight
gain. Two weeks ago she has a UTI for which her PA treated her with
Levaquin 500 mg qd. Today she has gone to the tennis club and has
played two games of tennis. During the game she suddenly developed a
pain in the right lower ankle region while simultaneously hearing a
“pop.” She enters the ER Fast Track area in a
wheelchair
with an elevated ankle that has ecchymosis and grade 3 edema and a cold
foot.
Scenario 2- A 53 year old business
executive from a
large Manhattan firm has decided to visit a friend for the Christmas
holidays. Seeing a large pile of logs he decided he would chop wood for
the morning fire. After having an oversized Starbucks coffee and
feeling quite energetic from the caffeine rush, he found an oversized
ax in the shed and started to carry large logs to the chopping block to
begin his work. He developed a strong swinging motion and brought the
ax to his side and then straight down on the log. After 45 minutes of
this activity, he suddenly developed a severe pain to his left shoulder
that radiated down his left arm. The pain became so severe that he
states;”it took my breath away.” The patient was
driven to
the ER by his host and was sent to Fast Trak with shoulder and elbow
pain.
Scenario 3- A 36 y/o fireman from
Buffalo, NY was
engaged in the firefighters tournament, which was being held on Long
Island. Unable to make the trip with his Hook and Ladder Company by
plane due to his fear of flying since 9-11, this contestant drove the
entire night non-stop except for coffee and to relieve himself. At 11
AM Fireman Woody has been admitted to the ER and triaged to Fast Track
for pain and swelling of the knee and calf while rapidly climbing the
tower. Apparently, while carrying the hose, his knee buckled and now he
has pain and swelling from the knee to the ankle.
Read the scenarios and take a few
minutes to think
of a diagnostic
plan. Perform the exam and explain your actions to yourself. Mention
the physical assessment techniques that you would perform as well as
any additional testing you would perform including medications that you
would order. What is your final diagnosis? If you wish you can send it
to this author and I will respond. Hopefully I will not be inundated
with responses.
PleaseSend A Copy To Friends
Anaphylaxis:
Treating A Potential Killer
by Bob Blumm, MA, PA-C, DFAAPA -
November 14, 2011
Anaphylaxis
is more than a medical term, but is a life changer and a
very real medical emergency. I cringe when I consider that some of my
colleagues have given a kid an injection of penicillin and have not
waited 30 minutes for the possibility of a reaction. I saw my sister
have this reaction when I was a kid, and her angioedema made her look
like a Jack-o-lantern on Halloween night. She was fortunately brought
to the hospital immediately and she responded to the epinephrine. It is
important for us to consider the collateral damage done to the parents
and siblings of someone that has an anaphylactic reaction to a
medication or shellfish, iodine or any other agent including middle and
upper aged people placed on an Ace inhibitor.
The
pathophysiology of this problem is quite simple
as a hypersensitivity reaction occurs when the normal immune system
responds in an excessive manner. The type of reaction and the severity
of the response will be the determining factor of life or death. Most
reactions are Type 1 and happen immediately. I had the opportunity of
seeing this as I was teaching at a PA program about five years ago as I
watched a student bolt for the door. I followed her in a few seconds as
I had seen a face that was filled with fear and saw her gasping for
air. She was able to say that she had a peanut allergy and I looked in
her pocketbook, found the Epi-Pen and wacked her immediately. When I
returned to the class after escorting her to the program director, I
discovered that one of the students was eating a bag of peanuts. Think
of it, this can happen on a plane a train or an automobile. This can
happen in a movie house, the theater or in church or synagogue, yet we
don’t carry Epi-pens just like we don’t have
defibrillators in the trunk of our cars.
I
made one of the most stupid errors of my life,
actually the epitome of poor judgment, when I went to dinner with some
friends and he had a reaction (delayed) to shellfish and asked me to
bypass the ER of a “dog and cat” hospital in our
community and to treat him at home. I followed his suggestion out of
temporary insanity or delusions of grandeur and gave him a shot of
epinephrine, started a line, gave him an antihistamine and steroids and
had a bag ready for him. He could have ended up in a body bag instead
and he was not only running for Mayor but was an attorney. I was an ER
PA at the time and had forgotten that the ER was well prepared, could
have made him stay on a monitored bed for 12 hours after treatment and
the ER had insurance, whereas I was working
“commando” as my Doc is a Plastic Surgeon. I
don’t think my liability policy would have covered this
stupidity and assault. That is me standing naked in the front window of
Macy’s and I hope that none of my colleagues ever have a
thought process that was as damaged as mine on that evening.
The
management of anaphylaxis is immediate concern
for airway control and immediate injection of IM Epinephrine. In most
cases you will not be dealing with a cardiac patient on five different
cardiac meds but these may be the exception to the rule, which is why
there is some security to that foolish term: “physician
supervision.” That situation may signal that it is turf time
for those with a weak stomach or who just wouldn’t know what
to do next if there was a crisis from the injection. The average adult
can receive between 0.3 to 0.5mg of Epinephrine 1:1000 IM depending on
their individual weight. Since Americans seem to be so obese or
overweight in this past decade, the higher dose may be more
appropriate. Steroids have no use in the immediate care of this patient
and 50 mg of Benadryl is a proper dose for an adult utilizing the IV
route. Oxygen is always a perfect drug and should be placed on the
patient immediately on presentation.
Hopefully
you will not need to cope with this situation
frequently but this small article is useful as a reminder of the acute
care simply stated as well as a lesson on the stupidity of this
caregiver at this time. By the way, he made it just fine and I gave him
his steroids a few hours later since I couldn’t sleep
anyway.
Please Send A Copy To Friends
What
Does the Physician expect from the PA?
Bob Blumm, MA, PA-C, DFAAPA
Weinitiated this essay with the
presentation of the
Physician/PA team,
segued into new ideations that are not all embraced by everyone
immediately as they represent change. People become comfortable living
in the present and consider it unnecessary work and money to make
changes that are perceived as a sudden outburst by a few people. This
newest focus on the name we were initially called and the first
national debate was discovered as starting in 1996 and today there are
six thousand PAs that have called for action.
Our
second portion
of the essay focused on what these PAs expect of
their physicians in a
responsible relationship. We are now flipping the coin to ascertain
what exactly the physician expects of the PA. Education:
1.
Core
knowledge- There is the expectation that the PA has a basic
compendium
of core knowledge in the sciences and knows the reasons for disease and
its prevention as well as having the ability to use science and
evidence based knowledge to create a differential diagnosis.
2.
Aptitude- The PA should have the ability to utilize
various
communication sources such as conferences, journal reading and internet
research to help the team to move forward, This area is important
because everyone profits from physicians, NPs, PAs, secretaries, and
technicians and the patient. PAs are considered as part of a strong
organized team working together with goals and time frames.
3.
Thoroughness- Whether it be related to a medical
practice or a
surgical practice there is the need for continuity, for additional
diagnostic testing, for referrals to appropriate specialties and to
generate a synopsis of these facts for occasional presentations
relating to office management and protocol..
4.
Continued Medical
Education- Medicine evolves from day to day and it is
essential to
attend a yearly PA meeting as well as the specialty meeting of the
physician. In addition it is expected that the PA will read new and
relevant information that applies to the caseload of the practice and
to share information and evidence based studies that reflect more
modern and proven methods to prevent a disease and lessen its ability
to injure the patient.
5.
There are a small number of physicians
and groups who will encourage their PA to take a residency program that
has didactic and clinical training. My physician partner sent me to his
mentor at Johns Hopkins early in our relationship to learn the
fundamentals of the physician or professor that he admired. I was later
sent to Vienna, Austria to study under Professor Hans Bruck, a famous
Austrian surgeon for three weeks. I have joined Dr. Acker at one week
meetings of the Pan Pacific course every two years so that we could
split our time more effectively and bring home twice the information.
This type of activity is interpreted as the physician has trust in
their associate PA.
2. Attitude:
A. The physician wants the PA to
treat the practice as it were his or her own. There must be a
consideration for all of the parameters that the physician considers
because this relationship is meant to be like a marriage and both
people will profit. Dr. Acker, my supervising physician and I have been
working together for 39 years and I took a two year hiatus to join the
corporate world and discovered that the trust that developed between
Dr. Acker and myself was more important than corporate titles without
appreciation.
B. First impressions count. The first impression of
the practice and the professionalism of the office are determined by
the physician/PA/NP Patient relationship. This supersedes the
physician/PA relationship. Proper respect for the patient who is the
customer is first and the ability to integrate similar clinicians into
a practice setting and work cohesively is important to the overall
success of that practice site.
My
physician
described our
relationship when becoming a recipient of the Paragon Award for the
Physician/PA Team as a calling not a vocation- not a sinecure to earn a
living.
C the PA practices with the understanding that he/she will
always be the associate.
He described this as the priest to someone’s bishop
Subordinate yet having full ability to demonstrate their
approach.
Control of ego- if the associate thinks that he/she indeed is
more
proficient than the physician, then the associate should apply to
medical school.
To
assume in medicine is to court disaster and
therefore fastidious and zealous attention should be given to every
patient and their problem.
D. Relationships
1. A perfect relationship between a physician and a PA is
built on trust.
2.
Longevity- these relationships are meant to be enduring, not
unlike a
marriage. One should not switch teams as one would with running shoes.
3.
Profit sharing- incentives and financial remuneration should
be fairly
distributed based upon the success and expansion of the practice.
D.
What do patients expect of the Physician/PA team?
1. The patient must feel that the physician has complete
trust or faith in the PAs ability to treat his/her patients.
2.
The PA is knowledgeable and qualified to treat each patient
problem
with sensitivity, taking the time to listen and to maintain the similar
approach as the supervising physician.
3. The physician and the PA have an excellent relationship
with sharing of ideas and with evident mutual respect.
These
are the ingredients for successful physician/PA teams.
Please Send A Copy To Friends
Physician / PA Teams
What does the
PA expect from the physician?
by Bob Blumm,
MA, PA-C, DFAAPA - October 9, 2011
Robert Blumm Bob Blumm
PA Physician Associate Physician Assistant
PA Physician Associate Physician Assistant
Therelationship between the PA
and the physician is similar to a marriage. I would hope that a female
PA responds with her view as I am speaking from the position of a male
and my expectations may differ from that of the feminine gender. All
marriages require communication, affirmation, honesty, sharing
responsibilities and in general, a lot of hard work. There is a very
real progression from dating to living together and finally until
making the relationship legal by culminating in marriage. Years ago I
heard a comment that rings true until this day: "marriages are not made
in heaven but come in do it yourself kits.” This requires a
commitment by both individuals to give 100% toward the contract or the
marriage. So what do I consider a six point plan for a PA/Physician
contract in theory?
A. Recognition- the only
manner in which a spouse can gauge the relationship is with feedback
and affirmation. One of the differences between a marriage and a
contract between a physician and a PA is the fact that one of these
scenarios has a lead partner and the other requires joint consideration
and respect. In case you haven’t guessed, a medical contract
has
a lead partner. The lead partner has the obligation to affirm good
work, commitment, excellence as a diagnostician, patient acceptance and
other incidentals such as dress, grooming, interaction with the other
staff and nurses and completeness of charts and dictations. There is
nothing wrong with praising an employee for a job well done.
B. Responsibility-
There should be a clear delineation of responsibilities with a scope of
practice and a method of providing guidelines and education that will
make the PA a more engaging and competent member of the team.
C. Respect-
It should not require a statement but, nevertheless, it is important
for the physician to appreciate that the PA is an extension of the
physician and her/his concern for the practice. Never, never, never
should a physician throw his/her PA under the proverbial bus nor
criticize the PA in the presence of a patient. If the workup was not as
perfect as expected and the differential diagnosis was not as broad as
the physicians, this needs to be handled in the privacy of a closed
room, not in the presence of a patient. Both parties need to be aware
of their educational differences and respect each other’s
abilities as well as their shortcomings. Mistakes are opportunities for
both the PA and the physician to learn, both about a disease and about
each other’s area of expertise.
D. Professional knowledge- Professional
knowledge is gained by continuing education, by seeing a varied
practice load, not just sore throats and earaches and, mainly, by
mentoring and discussion of complex presentations.
E. Trust- The
physician needs to learn to trust the PA if there are guidelines and
protocols in the practice. Chart review is a manner of discovering if
this essential plan is being followed and is an opportunity for both
parties to dialogue concerning approaches and the practice protocol in
dealing with a patient problem. If the physician is going to walk into
the room after the PA has examined a patient and repeat an exam on a
continuing basis, this would make PAs true
“assistants” and
demean their title as well as their value and trust.
F. Profit sharing-
Discussion on this topic should be approached after six months of
observing the relationship. If the PA is an aggressive first to come
and last to leave type of person, then this should be recognized and
discussion can ensue as to added benefits, income, CME or other perks
such as a private plane (only kidding.)
These are fundamental essentials of a good working relationship
Please Send A Copy To Friends
Physician / PA Teams
by Bob Blumm,
MA, PA-C, DFAAPA - October 2, 2011
by Bob Blumm,
MA, PA-C, DFAAPA - October 2, 2011
Robert
Blumm Bob Blumm PA Physician Associate Physician Assistant
Blumm Bob Blumm PA Physician Associate Physician Assistant
Oneof the few
differences between PAs and NPs relates to an area that is poorly
defined as supervision. In the most rudimentary form, PAs require it,
NPs don’t. When people hear this word, supervision, most
think of
a taskmaster folding his or her arms while the PA kneels submissively
caring for their patient. The reality of the word supervision is that
it implies that the PA is not an independent practitioner, but is one
joined at the hip to a physician. This relationship is loosely called
the physician/PA team. By definition it infers that the PA has access
to a physician by some manner, whether in person, by telephone, or by
some other means of communication. Many of these teams function
successfully in this manner. Many of the PAs practicing in this role
have won the full respect and confidence of the supervising physician.
This issue of being joined as a team, however, has had some negative
implications on our practice, especially when combined with the term
assistant.
In many states the NP can
practice
independently of a physician, although a majority of the NPs I know
have some type of agreement with numerous physicians who are on a list
of back up consultants. Individuals with whom they can confer when the
problems of the patient may be beyond the scope of practice or the
training and education of the NP. This is good for the NP, good for the
patient, good for the physician and good for healthcare in general. All
General Practitioners require the expertise of specialists from time to
time; the expertise of cardiologists, neurologists, endocrinologists,
pulmonologists, orthopedists, and so on and so forth. This fact is
irrespective of what level the provider practices at, whether a
physician or an advanced practice clinician. No clinical practitioner
is expert in every field or sub-specialty and we all have a list of
those to whom we can, and should at time, refer a patient. The NP,
though, is not hindered by terminology. Their title is one that conveys
a semblance of independence. Ours does not, and it is confusing to most
everyone.
Helen Keller profoundly
stated,
”the most pathetic person in the world is the person who has
sight but no vision.” This is a compelling statement from
someone
who walked in darkness all of her life. Most individuals accept life
and its shortcomings, but visionaries are different. They are not
limited to seeing that which is visible, but rather that which is
invisible.
Dr. Eugene Stead, the founder
of
the Physician Associate profession, the title he saw as appropriate,
was a visionary. Dr Stead believed that trained non-physicians could
work alongside physicians as a team and in doing so expand the delivery
of health care in America while physicians were answering the call of
duty to South East Asia. Many of Dr. Stead’s contemporaries
felt
that his idea was a temporary loss of sanity. After all, how could
anyone, other than a physician order and interpret lab work, diagnosis
an illness, and formulate a treatment plan?
Arthur Shopenhaver said;
“Everyman takes the limits of his own field of vision for the
limits of the world.” It was our good fortune that all men
are
not as short sighted. Many are the pioneer physicians who stood behind
the new concept of PAs and were willing to stand up in their hospitals,
medical societies and in the halls of government to state that these
well trained , compassionate clinicians were able to perform many of
the tasks that were normally done by the physician. They had no fear of
reprisal, as they were earnestly seeking to fill a gap in health care,
and the end result justified the means of getting there. Dr. John
Kirklin was one of these physicians and was responsible for the
“surgical physician assistant.” Dr. Frances Mc
Gill, an
OB/GYN, also believed in these new professionals and taught them the
essentials of her specialty, as well as the peri-operative role. Such
people have broken the proverbial mold, for they had the courage of
their convictions and followed their imaginations. Some were
criticized, some were laughed at and scorned, yet they held fast to
their ideals. They were unshakeable, immovable, and stubborn enough to
not let go of an idea and we became the recipients of their efforts.
Today another group
of people with vision have committed to following an idea. One that is
catchy. What started as a small, grass-roots effort has grown to a
drive involving six thousand like-minded professionals hoping to
accomplish a goal. They realize we are a much more sophisticated group
of people with far more education and a groundswell of colleagues who
have proven our worthiness as medical practitioners. A collective
entity that has proven we are much more than assistants. The goal is
changing the title of our profession back to its name at birth:
Physician Associate. The name our founding father felt best suited our
role, but one that was changed at the outcry of a great many physicians
who felt the title misrepresented our ability and worth, something we
have time and again, resoundingly, proven wrong.
Some of the original
grass-roots members and all of the 6,000 colleagues who have since
joined the cry for change were recently called “anarchist. A
former professor and Dean, a well-respected compatriot of ours, was
accused by some of his friends and colleagues of drinking the same Kool
Aid that they drank in Ghana. Some of those against the name change are
marginalized, indeed. What the naysayers fail to realize, however, is
that those of us joined in this battle will not go away. We will not
stand still. We will multiply like so many bacteria on a Petrie dish
and we will overcome whatever obstacles present themselves.
People and organizations
often make errors. A Western Union internal memo once referred to the
phone as one with shortcomings and no practical use. Thomas Watson,
Chairman of IBM in 1943, inferred that the world would never need more
than a handful of computers. Ken Olsen, President, Founder and Chair of
Digital Equipment Corporation echoed that same sentiment. These men and
organizations were leaders, but had lost their ability to see beyond
today. Our heroes are those that believed in us as a profession and
watched us become 85,000 strong. Our visionaries are those that can see
that the present name no longer fits this profession, that in fact it
is one that does us great harm. Many of the great leaders who have
aided this profession in its growth have lost their ability to believe
beyond today and have succumbed to fears and rhetoric that say this
change of names is impossible. Nothing is impossible if you have the
will and the commitment to ask for it, demand it and help finance it. I
see a rainbow in our future and sincerely hope that I will be there to
see its glory.
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Contracts
and Professional Liability Insurance Policy
by
Bob Blumm, MA, PA-C, DFAAPA - September 12, 2011
and Professional Liability Insurance Policy
by
Bob Blumm, MA, PA-C, DFAAPA - September 12, 2011
Robert Blumm Bob Blumm
PA Physician Associate Physician Assistant
PA Physician Associate Physician Assistant
SeniorPAs
are often contacted when former students find themselves in
“practice problems.” This communication is an
example of a
practice problem and a solution.
A former student
has been working for a physician group for the past three years and is
obliged to work at two practice locations seeing thirty patients at
each. The PA has been instructed to spend no more than seven minutes on
each patient, and this is only one of her problems. During our
conversation, I discovered that there was no on site supervision and
telephone communication had been discouraged when questions surfaced,
as the PA was chided for lacking necessary knowledge or intuitiveness
in dealing with the problem. No physician in the group has checked a
sampling of her charts since serving in this position. The salary
promised was not delivered, and she has worked for eight dollars less
per hour. The malpractice insurance promised was not appropriated, and
she is on a group rider with a poor company. This situation has been
ongoing, and no corrections have been made. She has been threatened
with a poor reference letter if she leaves the practice.
Why are professional clinicians
so ignorant when dealing with a set of negatives like I am presenting?
These all represent an unsafe practice environment, lack of
supervision, failure to comply with an oral contract, a standard of
care that is severely lacking as well as an ever increasing opportunity
to be the victim of a malpractice suit without the liability insurance
that offers protection for her as an individual. I counseled her to
terminate her employment immediately regardless of the threats.
Contacting OPMC is a possibility, and legal advice may be required.
This advice will be costly, as she has no liability policy that offers
her counsel and guidance.
How can other young
PAs prevent themselves from being found negligent of a standard of care
and being totally unprotected by a personal professional liability
policy?
My message to all PAs is to have a written contract
establishing responsibilities, supervision, salary, hours, vacations
and time off, sick pay, CME support and personal Professional Liability
Insurance. This is a necessary acquisition for all PAs and should be
entered into with pride as it bespeaks intelligent business practices.
To do anything else is to flirt with problems and allegations THAT
CANNOT BE ERASED BY TOUCHING A DELETE BUTTON. Plan and protect your
future with a contract and an individual professional liability
insurance policy.
Important
Decisions for September
by Bob
Blumm, MA, PA-C, DFAAPA - September 12, 2011
Decisions for September
by Bob
Blumm, MA, PA-C, DFAAPA - September 12, 2011
Robert
Blumm Bob Blumm PA Physician Associate Physician Assistant
Blumm Bob Blumm PA Physician Associate Physician Assistant
Themonth of September
is one of those pivotal months due to events and seasonal changes. We
start this month with preparation for a Labor Day Picnic and quickly
move into the preparation for school, for those that have children.
This includes all the supplies that you failed to purchase in August,
school uniforms or clothes, backpacks and of course getting that
college freshman off to their designated school. All of these actions
apply to family members and the question is; what have you done for
yourself?
In the month of September, it
is
suggested that you prepare for the upcoming fall and winter seasons by
getting your personal Influenza immunization. Why September? Because
this immunization takes at least an average of two weeks to become
effective in a protective manner, and October and November are heavy
Flu months. As a clinician you will be examining these patients in your
offices and clinics as well as encountering them in hospitals and acute
care facilities. There is the added incentive of the fact that your
kids will be coming home with all sorts of strange bugs, and October is
a heavy conference month, which means being in rooms with hundreds of
other people and traveling on planes and trains with no new air being
forced through the systems. Remember that influenza is contagious due
to droplet transmission by sneezing, coughing, shaking hands of all the
new people you will meet and in general because you are meeting the
main vector, people.
For those who have
experienced influenza, you may have had a light course of an
unforgettable course. It can make you sick for a few days or for a week
or more. This interferes with your responsibilities at home and on the
job. Also remember that this can be life threatening in those under age
2 or those who are elderly. The usual presentation is weakness,
coughing or sneezing, joint pain, lethargy, fever, headache, sore
throat. The best treatment is prevention, which is why I have this
under the “to do” list for September. The influenza
immunization has a high although not perfect probability of saving you
from a week of severe sickness. There are drugs that one can take to
shorten the course but they always seem to be under scrutiny. Certain
pain medications such as NSAIDS can be helpful but they are certainly
not deterrents and chills. Not all patients present exactly alike and
some have multiple symptoms without having all of the signs and
symptoms.
I guess the last question is:
can
the flu shot make me sick? Hypothetically you cannot get the flu from
an immunization as it is made from a weakened or killed virus. Some
people may develop inflammation at the site of injection, have
headaches and a runny nose of feel a bit off for a day or so but this
is nothing in comparison to actually coming down with influenza. What
else can you do to prevent this disease? I suggest carrying one of the
available OTC anti-microbial hand washes or washing your hands
frequently. Stay out of crowds if you can prevent transmission by this
route, cover your mouth and nose when coughing or sneezing and
encourage your loved ones and friends to do likewise. Develop good
personal hygiene as well as sleep hygiene, which means getting the
proper amount of sleep and taking your supplements and eating healthy.
Drink plenty of water, flavored or unflavored, as proper hydration is
always a positive adjunct. You could also make a copy of this article
and give it to your friends and family. Have a healthy season.
Please Send A Copy To Friends
A Tribute to the Memory
of Sept 11, 2001
by Bob Blumm,
MA, PA-C, DFAAPA
of Sept 11, 2001
by Bob Blumm,
MA, PA-C, DFAAPA
Robert
Blumm Bob Blumm PA Physician Associate
Physician Assistant
Blumm Bob Blumm PA Physician Associate
Physician Assistant
Thereare certain situations that
have left an indelible memory which forever changed us, our attitudes
and our destinies. Those that are baby boomers, born in my generation,
will never forget the day that President John F. Kennedy was
assassinated. We remember where we were, what we were doing and
remember the faces of frozen grief and horror on those we encountered
at the moment the news was released and throughout the following few
days. This senseless killing brought America to tears and forever
changed lives and the plans of many of the young people in the United
States. Our response to this American tragedy was to grieve as a
nation, to embrace each other and for some, to develop a spirit of
courage like the fallen leader. Many joined the Armed Forces of the
United States out of a spirit of patriotism. I remember because I was
one of the many. Our destination would now be Southeast Asia in a small
country called the Republic of Vietnam and our mission to stop the
aggression of communism. We lost many lives because of that war and the
names of the fallen heroes are forever inscribed on the wall of honor
in our nation’s capital as an enduring tribute.
On September 11, 2001,
our country once again staggered under the tremendous loss of
lives the attack on the World Trade Center. Many
unsuspecting parents, husbands and wives and children said goodbye that
morning, blew a kiss and walked toward their transportation for a date
with tragedy and their destiny. Once again ,we remember the day, what
we were doing, where we were standing and, again, we saw the horror
unfold before us on national television as the two buildings that
represented the strength of this nation were attacked by separate
planes and crumpled to the ground in an inferno of heat and melting
steel. I was operating when the first plane hit Tower 1 and then heard
that Tower 2 was hit. As our case was complete, we went to the
surgeon’s lounge and watched this catastrophe and thought of
those whom we know, some who were members of our family, who were
working there that morning. Surgery that was elective was cancelled as
our hospitals went into a red alert and standby mode to prepare for the
casualties that never came. I remember this also because I went to the
site of Ground Zero the following morning to lend my support to the
rescue efforts.
Once again, I saw faces
frozen
in grief, tears falling from the eyes of the bravest; other eyes were
dry from shock. The people involved in the rescue efforts were
America’s bravest; they were police and firemen, medical
personnel, clergymen and women, steel workers and construction workers,
truck drivers and soldiers, even specially trained dogs. The
politicians came; the Mayor and Police Commissioner were there. Fire
commissioners and assistant commissioners lost their lives alongside
their men as they were in the command centers at the base of the
building before it collapsed. Some of these people escaped with their
lives and still awake to the horror of the day, feeling guilt that
they, too, were not among the missing and the dead. Many of my
colleagues who are reading this article lost loved ones and they, too,
will not forget.
What happened in New York City
also happened in a field in Pennsylvania and at the Pentagon in
Washington, DC with the same senseless loss of life and the same
nightmare that creates PTSD and forever changes a person’s
future
and outlook. Some of those that were most injured psychologically are
the children of the lost, along with the parents who grieve this
anniversary. Today, my son and his wife and their two young children
live in Battery Park City across the street from the tragedy. I can
vividly remember the night that I returned from ground zero covered in
ash and dirt on my scrubs. My wife would not launder these as she said
that the scrubs contained the ashes of those that died and she buried
them in a special area in our garden.
These incidents affected
America and Americans in the same manner—they created unity
from
tragedy and pride in the flag instead of separation. There was an
appreciation for all those that lost loved ones and especially for the
fallen heroes who gave their lives so that others could be saved. I had
wrote a special editorial in Advance for Physician Assistants that
month that described what I saw and experienced and was meant to share
the intimacy of life and death with you, my colleagues. We
take
the time on this September 11 to remember and hopefully to recapture
the dream of unity that builds a nation and a people rather than the
pettiness that separates the aisles of congress and interferes with the
aspects of living in a democracy where there is liberty and justice for
all. Perhaps from the ashes of this Phoenix, we will arise again with a
spirit of cooperation and rebuild our infrastructure, discover jobs for
those that are unemployed, create programs that place people on a road
of recovery and on the road to healing. This takes bipartisanship, this
requires us to unclench hands that are presently a fist and are being
used against each other and our leaders. It is a time to remember and a
time to build new bridges that will create prosperity and health for
this nation founded under God. We can be a part of the effort if we
remember and are willing to change and create a new dream for America.
The Parable of
the Talents
Bob
Blumm, MA, PA-C, DFAAPA
the Talents
Bob
Blumm, MA, PA-C, DFAAPA
Robert
Blumm Bob Blumm PA Physician Associate Physician Assistant
Blumm Bob Blumm PA Physician Associate Physician Assistant
Theworld of finance
and the general economy took a surprise down spin a few years ago when
the infamous Bernie Maedorf admitted to the fact the he could no longer
pay his investor’s refunds as his Ponzi scheme had finally
run
dry. More than 19 Billion Dollars was invested in his huge opportunity
to guarantee large dividends on a yearly basis whereas seemingly he and
a few others were the recipients of this promise. Charitable
institutions bought in, fund managers, hospitals, religious
institution, an, in general, people with a dream that soon sounded too
good. As early members pulled out, there was just not enough capital to
reimburse the investors and his son’s had to turn states
evidence
on him. He received a 150 year jail sentence but the greater damage is
the he destroyed people’s ability to trust. They had trusted
him
with their entire financial future and this misplaced trust created a
bankruptcy situation.
The parable about the
talents related to a rich man that gave three servants a large sum of
money and told them to invest it wisely as he was going on a long
journey and would return to check on their accomplishments. He gave one
person 10 talents, another five and the last person received
1. A
talent was an amount of money so let’s call it a million
dollars.
The guy with the ten million bought a slew of Starbucks shops and
people came in large numbers to purchase this superb $4.00 coffee and
with his investments he doubled his 10 million which became 20 million.
The fellow with 5 million bought many Dunkin donuts enterprises and he
charged two dollars for his coffee and 99 cents for his donuts. He
managed to double his money and now turned the five million into ten
million. The last servant, when approached my his benefactor who had
trusted him had placed the money in a safe mattress because he was
concerned that his master was a hard task master and was petrified of
losing the money. The master’s trust was certainly misplaced
as
fear and lack of imagination and creativity he did not even bring it to
a bank with a minimal interest rating. This fellow lost it all and his
one million went to the person who had made 20 million. This entire
parable related to trust. What would these people do with their life
and with his money?
How in the word does this
make a connection with the PA and NP communities? I have sat on many
admissions boards and have listened to the earlier members of the
professions unfold their plan as it seemed like they would be looking
to change the landscape of medical care in America by finding rural
areas that needed their services or they would work with the geriatric
populations. Years later we discovered that our trust was slightly
misguided as they went into surgical specialties, large inner city and
suburban practices and gained a reputation for being excellent
providers. So, it’s true, they didn’t follow the
dictates
of their early game plan but they did use their training for the good
of the people and entered new fields that embraced them with open arms.
There was a small group like the guy with one talent, who took that
medical knowledge, shifted careers like gears on a five speed and
entered Law school or became creative in the field of Coding and broke
down services to their multiple lower denominators to increase
insurance reimbursement. This too is part of the American dream in that
you can do and become anything as a citizen and the people who became
affected were those that trusted their initial mission statement and
those that lost the services of what could have been a good medical
provider.
There are many who like the
ten
talent person who have expanded their roles, have gone on medical
missions, and have volunteered in disasters, functioned from their
hearts not their pocketbooks. They are seen in oncology units,
geriatric units, research, pediatrics, family practice. Some have
become experts in mental health, in every sub-specialty of surgery,
they placed their lot in learning cardiology and neurology and
endocrinology so that they would be around to care for the baby boomers
who would be utilizing all of their services. There is also the small
number who joined the nation’s military so that they could
both
care for and actually be “in harm’s way”
because they
had strong nationalistic pride. I support all of my colleagues, PAs and
NPs alike for your commitment, dedication and trust. You are making
this a better health system and a stronger America. Let’s
hope
that out trust is not misplaced on a legislative level by losing what
we have all planned on for our futures, Medicare and social security.
If these stay intact we can feel the cozy blanket when we hit the
cold Days.
Looking at the past and
the future of Surgical PAs and NPs
Bob Blumm, MA,
PA-C, DFAAPA
the future of Surgical PAs and NPs
Bob Blumm, MA,
PA-C, DFAAPA
Robert
Blumm Bob Blumm PA Physician Associate Physician Assistant
Blumm Bob Blumm PA Physician Associate Physician Assistant
From 1999 to2004
I
served as the Liaison
to the American College of Surgeons representing the AAPA. Part of my
job was to attend all general meetings of the College and to
particularly be present at the Allied Health meetings as this is where
APC’s were discussed and decisions were born. This particular
year of which I am writing was a positive forward move as some of the
most important people in the College spoke to the issues of assistants
at surgery. I am presently discarding all of my writings and paperwork
of the last 20 years at my wife’s bequest but I am hanging on
to
a few so that I can do what I am attempting at this moment which is to
bring the current APC’s to an understanding of our past
history
and the projections for the future.
On Oct 13, 1999 at 0830,
a diverse group of practitioners and administrators descended upon the
Mascone center in San Francisco to listen to four speakers who were the
assembled first assistants from every group that has this honor. This
group consists of surgeons, residents, PAs, NPs, CSA’s,
CSTCFA’s, RNFA’s, Perfusionists, which at that time
made up
the bulk of assistants at surgery. They were handed a statement or
Issue Brief; “The Surgical Physician Assistant---A
Summary.” In addition to this brief , they received an
article
from the Journal of Trauma, Injury, Infection and Critical Care
entitles;”Use of physician assistants (generic) as
surgery,
Trauma House staff at an American College of Surgeons verified Level ll
Trauma Center.
Dr. Fabri of Florida, then
Chair of this committee ,opened the meeting with a 10 minute talk
followed by Dr. Ralph Doerr, who spoke for 35 minutes. Dr. Doerr spoke
from his past experience as a Physician Assistant who had now been a
surgeon for 25 years but was thoroughly conversant with the subject
from a contemporary viewpoint at that time. Although some of his slides
were outdated and even far more a decade later he spoke from the
position of one of our strongest allies. The last two
speakers
spoke on the Role of the Nurse Practitioner in a surgical practice and
the last on “Changing role of the CST in the
future.” What
would have been a lively discussion period was curtailed by the
Chairman for discussion the following year by this same assembled group
and additional new people from all surgical professions.
Dr Fabri made the following statement;”The total number of NP
and PA graduates exceed that of MD graduates.”
Thought- what does the AMA and the ACS
think of this? Is this a problem for physicians? Do they perceive us to
be a threat? How will they deal with this statistic? Dr Fabri
added;” (at that time) 49 states accept the PA/NP model, have
verified their job description and has authorized their reimbursement
for services rendered.” Thought- Is this considered
competition?
Is this considered a rationale for hiring APC’s? Are they
calculating the deficit to MDs medical reimbursement if both of these
groups were independent?
Dr. Fabri went on to say;
“When MDs are employed in the backdrop of global fees, it
allows
mid level providers to perform preoperative exams, causes less
confusion for family and friends, there is greater documentation, more
significant findings, more detail and more communication.”
Thought- Now that’s an epitaph! Dr. Fabri went on
to
say;” In a surgical practice it would be usual and customary
for
a PA (and more recently additionally a NP) to perform and report on all
aspects of the pre-operative workup. The PA would give the informed
consent (now the duty of only the surgeon) as well, would do
pre-operative teaching. PAs (and now NPs) would perform the Discharge
Directions; do moderation in the form of “rounds.”
They
would write the prescriptions for patients at discharge and during
subsequent visits, orchestrate the post-operative care in both the
hospital and the office.”
Thought-MDs and Dos must
give their own informed consent. If PAs and NPs engaged in the informed
consent it would be the grounds for greater litigations for these
clinicians. From Dr. Fabri’s statements some MDs can be led
to
believe that they can almost abandon their patients. We need to educate
PAs/NPs on this matter as we are the secondary caregiver and the
surgeon remains “Captain of the ship.”
Dr. Fabri; “Surgery is teamwork.
There is a greater affinity to practice as a team in surgery than there
is in primary care. The College must look at new and exciting ways to
promote the team.”Thought- Great for PAs and NPs but I
consider
the Primary Care providers to be an important part of that
matrix
of the surgical team as they have a role in understanding and
communicating their health history and treatment and can encourage the
patient by being knowledgeable about the procedures. This needs to be
covered in our conferences such as those of the AFPPA and the AANP and
AAPA.
Dr. Fabri;”Both PAs and NPs
are
listed as having substantial involvement in the First Assistant
Role” Over this past decade this has proven itself
to be
true and Fabri was almost a prophet as his futuristic thinking relates
to what has happened up to 2011 and the inclusion of more PAs and NPs
into the surgical workplace. More than 2% of NPs are now in surgery and
their numbers will increase precipitously and 27% of PAs are in this
specialty.
Dr Doerr than stated; “Issues
to PAs relate to cost, competition, accuracy quality and medico legal.
All studies suggest that PA employment improved access, efficiency and
care. The added benefit is that surgeons can perform more
surgery.” Thought-What’s to say? That’s
great! He
then spoke of the future but the numbers of PAs and NPs were inaccurate
as they were out of date and are even more out of date in 2011 where
there are 240,000 NPs and PAs .He projected that there would be 65,000
PAs in 2006 and that was correct. He projects that MD candidates will
decrease. He has noticed that NPs are increasing every year and almost
double the PA number and lastly he said that there would be lower
compensation for MLP’s.
The PEW Paper suggested
in that year that PAs should be considered as incorporated into the
medical staff of an institution. This is now a reality in 2011. Present
conditions (1999) will be modified as the current system undergoes an
overhaul—it has! MDs are seeing Privilege Changes as
suggested by
the Regulatory Board of hospitals and HMO’s. These
institutions
mandate verifiable training, education and competence based upon a a
clinical practice over a two year period. Those Boards will determine
the appropriate Scope of Practice, define competency standards and
perform practice audits. Dr. Doerr believes that this will carry over
to the PA/NP professions and that they too will have mandated
competency exams to maintain or add to their current privileges.
Summary: Dr. Cosgrove, then
chief of Cardiovascular surgery at the Cleveland Clinic and I spent
fifteen minutes in private conversation about PAs , who I was
representing at this meeting. He has an international reputation and is
proud that in 1999 he had 55 PAs on his team. I asked his opinion of
their value and he stated that “Neither the hospital or he
personally could do without them.” Members of the APACVS and
Dana
Gray told me that NPs are lumped into this figure also which is
interpreted as to their combined value. In closing both then (1999) and
today (2011) it is suggested that NPs and PAs continue to develop a
better relationship and strive to work in a cooperative collegial
manner. We are well on that road as we go to each
other’s
conferences, share committee work and in general realize that our
efforts to work as team mates will enhance patient care in the United
States.
PleaseSend A Copy To Friends
A
Glimpse in the Mirror
Bob
Blumm, MA, PA-C, DFAAPA
August
15, 2011
Glimpse in the Mirror
Bob
Blumm, MA, PA-C, DFAAPA
August
15, 2011
Robert Blumm Bob Blumm
PA Physician Associate Physician Assistant
PA Physician Associate Physician Assistant
Inmy personal diverse reading
program, I am presently engaged in devouring Ian McEwan’s
Solar.
This novel centers on a Nobel Prize-winning physicist who is fast
approaching 60. Although he is no longer an academic titan, his
reputation allows him to collect huge speaking fees and impassively
head a government program to battle global warming. His personal life
is another matter. An incorrigible womanizer, he has chased off four
spouses with affairs and now a fifth wife has turned the tables on him.
The story begins when the main character, the physicist, takes a shower
and walks past a full length mirror and takes a glimpse at the person
who stands before him. His hair is gray and starts two inches above his
ears with the remainder bald. His chest has become soft and more
female, as if he has breasts. His abdomen, which was once flat in his
20-35 years, began to slowly go through a metamorphosis at 35-50: it
swelled annually by five pounds and he was caught “sucking it
in.” Now, the 50-60 demonstrates the effect of human blubber
on
the skeleton of a male and he is confronted with a collapsed penniculis
and has been unable to see his toes in a shower when looking straight
down for the last fifteen years. Suddenly, his self confidence drains
from him as the water drains from the shower. What am I trying to share
with the readers of this article?
Firstly, we
have a need to occasionally place aside the medical literature and to
read varied novels which give us insights into the realities of life
and make us more interesting as professionals both to our peers and our
patients. Secondly, from the narrative, I was able to draw an analogy
of the effects of self discovery: glimpsing into a mirror, on both our
personal and professional demeanors. I can recall when both my wife and
kids chided me lovingly about “sucking it in,” as
obviously
they were far more aware than myself…the egotistical PA
moving
up the ladder of success, to a metamorphosis in my body habitus. What
became a joke later became a matter of concern to those who loved me
because I developed diabetes, hypertension and an enlarged heart. This
began to equate into concern and the idea that I didn’t care
about myself nor did I care that I had a family that loved me and that
wanted me to live well into my seventies or eighties and that, at this
rate, I was going to leave planet earth earlier than the timetable.
This did affect my self confidence to a degree and my ego lessened
because of the reality of the wages of lack of self control in diet and
exercise. I wore my shirts outside as to not bring attention to what
existed below my neck. I found it easy to become the butt of my own
jokes concerning weight as I saw I was a lost cause. How does this
relate to all of you normal PAs and NPs and your daily practice?
Perhaps it’s an early wakeup
call if you are at the “suck it in” stage of life.
In that
case, I am doing what I have always endeavored to accomplish: help my
colleagues. But this also falls into a practice setting because we are
lacking the ability to set an example for our patients who suffer from
the same dilemma. We are not examples of what we are preaching to them.
It’s sort of like a surgeon who is trying to convince a
balding
patient to get a hair transplant, when his own head looks like a shiny
dome that can light the darkness. They are saying to themselves, then
why has he not visited a colleague who does this procedure? For the
obese patient, who is non compliant, it becomes a constant source of
worry, agitation and frustration to the health care providers. My IM
physician, Dr. Ed Hallal of Bay Shore, NY, maintains a healthy
morphology because he constantly encourages his patients concerning
diet and exercise.
Lastly, what you think of yourself
affects your ability to render the type of care that is essential for a
health care provider. Focusing on our personal failures takes some of
the steam out of our enthusiastic approach to patient care and we lose
the ego that is necessary for a leader or clinician. To explain that
remark more thoroughly, I mean to say that all leaders, every one of
them, have an ego and with it the desire to be the best and to at least
be successful in their challenges. As clinicians, we desire to use our
knowledge and skills in a manner consistent with the other colleagues
that we respect and to do so without impediment. If we discover the
impediment, we then chose to focus on it and work hard on making
changes. The old saying is that “tomorrow is the first day of
the
rest of our lives.” We can change personally and encourage
our
patients to refrain from look at past failures and look to future
success. Our old stumbling blocks can become stepping stones to
success. So, the end of the message is the same as the beginning. Slow
down as we all work too hard, listen to your family that loves you and
stop long enough for self evaluation: take a glimpse in the mirror.
PleaseSend A Copy To Friends
Medical
Personnel Returning from Combat Duty
Position
Paper sent by
Bob
Blumm, PA-C Past President ACC
Personnel Returning from Combat Duty
Position
Paper sent by
Bob
Blumm, PA-C Past President ACC
Robert Blumm Bob Blumm
PA Physician Associate Physician Assistant
PA Physician Associate Physician Assistant
Iam sending this paper to all agencies
and forums to serve as a reminder that the ACC, which now serves NPs
and PAs as an Advocate for the professions scope of practice, did in
fact publish a white paper to honor and make a special pathway to those
who served “in harm’s way” and upon
returning to
CONUS desire to further their education and become either NPs or PAs.
We feel that they have given a part of their lives to serving in a time
of war and that they deserve special consideration when applying to
programs of advanced practice clinicians. The following is a joint
effort of the executive committee 2-3 years ago demonstrating what we
feel would best serve both professions as a “thank you for a
job
well done.”
As we all know, America is
involved in military action in the Middle East. This has increased the
use of all military nursing and medical personnel. It has also exposed
many of these caregivers to combat, trauma and other medical
experiences and training that they could not have received in any other
way.
The physician assistant and
nurse
practitioner professions have extensive roots in military medicine. In
fact, the first three PAs at Duke were Navy Corpsmen and the
professions link to the military endures up until today. It is the same
with the nurse practitioner profession, as many NPs were former nurses,
medics and corpsmen. Today, both the NP and PA professions enjoy
commissioned officer status in our armed services and are a vital cog
in the wheel of military health care.
The American College of
clinicians recognizes these roots. Upon their return to our shores,
nurses, medics and corpsmen should be greeted warmly and praised for
their sacrifices. The College also thinks that their vital experience
and training has created a new pool of potential students for NP and PA
education. Most of these people possess the tools to become excellent
leaders and clinicians.
The College asks all
PA and NP programs to look favorably on these veterans if they apply to
their training programs. We ask that every program work to allow these
people get the information needed to become NPs and PAs. We also
request that our members reach out to NP and PA programs in their areas
to advocate for their local returning veterans with military
experience. In the near future, the ACC will design an outreach program
to inform potential military of their post service opportunities as
advanced practice clinicians.
In summary, the
College thinks that we are now at a unique period where qualified
combat and trained RNs, medics and corpsmen will be returning to
America. We would like to see those veterans who feel that they would
like to become PAs and NPs embraced by the NP and PA professions, and
we call upon our members to request that their local training programs
act favorably regarding these applicants for future training.
PleaseSend A Copy To Friends
Interpreting
Our Words Concerning Being
Advanced
Practice Clinicians
by
Bob Blumm, MA, PA-C, DFAAPA - August 1,
2011
Our Words Concerning Being
Advanced
Practice Clinicians
by
Bob Blumm, MA, PA-C, DFAAPA - August 1,
2011
Whenyou are a clinician,
a speaker, a writer or politician you are faced with the problem of
becoming a target of another individual who has different roots,
different religions and traditions, different belief systems in
general. My mother in law called it “Joseph’s coat
of many
colors,” while a fellow called Saul of Tarsus mentioned that
he
was “all things to all men.” Sounds like Saul would
have
been an aspiring candidate for public office as that comment would make
him a magician, an exaggerator, narcissistic or just a liar. We are all
different and our manner of speech reflects something of who we are. I
like to write articles that cause people to gain insights but
occasionally, because of my style or grammar or the absence of editing
from a specialist, I am challenged or subject to slight scolding
concerning the English language or perhaps the individual will stop
reading altogether on the assumption that if one cannot put a sentence
together intelligently then they are probably an ignoramus and not
worth reading.
Ten years ago I wrote an
editorial and while speaking of being a PA I described it as a
"calling." Wow, that word calling can create a “tremor in the
Force.” In a scholarly manner, this individual mentioned that
he
did not mean any disrespect but he had never heard a child
say,”
Mommy I dreamed that I would be a physician assistant some
day.”
As I relate his comment to both PAs and NPs, the follow-up was that he
could not understand why anyone would do the same work as a physician
for a fraction of the pay, a percentage of the respect and all the
other fringe deficits that go along with the job. He did have a dream
though, as he mentioned that if he were given the chance to convert his
PA credential to an MD on just a say-so, he couldn’t think of
any
reason to decline. I agree to a point as if tomorrow I became Bob
Blumm, MD, I would be one of the best advocates for the advanced
practice clinician. He concluded his remarks with “I just
don’t get it and never did. That’s why I
haven’t
practiced as a PA since 1982.”
As an author
I am expected to reply to comments, so I apologized that I had upset
him by using the word “calling.” I then added that
although
you haven’t practiced for 20 years, I see that you still have
an
eye for detail. I mentioned that it’s a shame that we lost
him as
a colleague because somewhere deep beneath the surface is the vestige
of a PA. My reply was based upon his signature that still was
associated with the PA credential. I have discovered that PAs and NPs
choose to take this course of study for special reasons and that they
have no desire to become physicians. We certainly are intelligent
enough to become physicians but our decisions were made upon things
such as lifestyle, limited obligation to a practice setting, less time
in academic preparation, less malpractice insurance and more time to
make commitments to be functional parents or mates. Some have even
professed that they wanted to enter the work force sooner to begin to
care for the sick and oppressed.
Another of the commonalities
between PAs and NPs is that it is a first choice occupation for some
but for others they have served as other types of medical or nursing
professionals and this was yet another step up the ladder and may have
been a mid-life choice. What we share in common is first that we have
an inner commitment or calling or desire to help humanity by healing
wounds of sickness, injury and disease. We have a commitment to
continued learning and development of clinical skills and a deep belief
that what we do and our new skills will make us better clinicians and
even more of an influence on the health crisis that we face as a nation
and over the earth. I think that many of my colleagues share my
emotions and given a choice would make the same decision. Be proud of
who and what you are, as you have studied and sacrificed so that you
could become bread for those who are hungry and need to be touched by a
health care provider who cares.
PleaseSend A Copy To Friends
Sound
the Trumpet, Our Forgotten Weapon
Bob
Blumm, MA, PA-C, DFAAPA
July
31, 2011
the Trumpet, Our Forgotten Weapon
Bob
Blumm, MA, PA-C, DFAAPA
July
31, 2011
Longbefore the days
of telecommunications, military leaders used three strategies to
inspire their troops. First, Commanders in the field would lead from
the front and be an example and an inspiration as they became
vulnerable and visible to both their armies and those of other
countries. Secondly, the spoils of victory were displayed in the form
of captives, riches and colors. They were not only displayed but they
were shared with the troops. Lastly, there was the sound of the trumpet
as it was the means of communication and inspiration. The trumpet
awakened them, called them to arms, signaled when to turn or charge and
gave forth the sound of victory.
Today, I am sounding
a trumpet utilizing one of the best sites to help PAs to find jobs and
make mid career decisions. I am utilizing a website that has blessed
many and continues to be a source of blessing as PAs find a livelihood.
There are no hidden agenda here and Bill and Karen would like to see a
few people that really care take the time to write an article or blog
so that we are all communicating. But is there anything to communicate
about? As our profession continues to expand there will always be new
issues, important matters, difficult choices and a need to share our
views. This is where you and I come in. We can share our thoughts
agreeing or disagreeing respectfully for the purpose of bringing the PA
profession forward.
I don’t need to elaborate
on the spoils of war as every PA can look into their own state and
observe the actions taken by volunteer leaders to expand legislatively
and to protect our profession from attacks from other professions.
Louisiana is an example of a recent attack and the response is needed
from that state’s PAs and their brothers and sisters in the
profession across the nation. I am personally very involved with a
committee of eight members and possibly two more in a drive to change
our name from assistant to associate. The websites are carrying the
news and there are places for you to communicate and send your personal
message to the AAPA. We have over two thousand messages sent from PAs
in one week.
All of the advances that you
are
observing are due to the fact that there are volunteer leaders on a
state, specialty and national front. The time spent is beyond your
imagination but the fruits of our labors become evident to our members.
Leaders need to lead from the front and sometimes take a stance that is
important for the profession although members sometimes disagree or are
not looking to the future. Leaders need to communicate with their
members, their boards and with other leaders across the country such as
we are proving with the name change issue. This is becoming the
handiwork of this generation of PAs as they move into a place of
leadership and servant hood. That’s really what it is all
about,
serving one another.
The last strategy for an
effective tactical victory is to sound the trumpet. It is an excellent
means of internal communication and requires the cooperation of every
website, every journal and every PA who has an address book of other
PAs. The trumpet is the tool used to declare unity, pride and victory
to the PA universe. This website is willing to be utilized as are many
others because this issue will be brought to a successful conclusion.
It remains our job to advertise our profession, to tell our patients
who we are and what we do by proclaiming the fact that we are indeed
caregivers and a part of the answer for a health care system that is
spinning out of control. So sound the trumpet and send your letter and
let it be a proclamation of what you believe and desire for the future
of our profession. *** www.associatenamechange.com***
PleaseSend A Copy To Friends
Dilemmas,
Opportunities, and Solutions in Common
Robert
M. Blumm, MA, RPA-C
Copyright
2002 Jobson Publishing, LLC.
Reprinted
with permission by Clinician Reviews.
Opportunities, and Solutions in Common
Robert
M. Blumm, MA, RPA-C
Copyright
2002 Jobson Publishing, LLC.
Reprinted
with permission by Clinician Reviews.
Introduction Comparing notes with an NP educator/clinician at a national
consultants' meeting inspired this veteran PA to consider ways the PA
and NP professions can team up to address their shared challenges.
For me, this has been
an exciting two years. I've had the opportunity to travel to sites
around the country, comoderating at national consultants' meetings for
a major pharmaceutical company. It was great to meet and befriend so
many practitioners from so many places.
This also was my first chance to
meet Margaret Fitzgerald, MS, APRN, BC, NP-C, an NP educator and
practicing clinician-and my comoderator. Margaret and I enjoyed the
opportunity, together with some of the meeting participants, to
dismantle many of the walls that exist between the PA and NP
professions. Throughout our dialogue, I was reminded that we share
common dilemmas and common opportunities-and reflected that together,
we can find common solutions.
Our Shared Dilemmas
NPs
and PAs share the issue of credibility, thanks to our powerlessness to
be properly tracked by the pharmaceutical industry. How can we be
credible when so many pharmacists unilaterally override us as the
prescriber?
Apparently, doctors experience this,
too. I recently had a prescription filled at a chain drug store.
Printed on my medication bottle, to my amazement, was the name of the
first physician on the prescription slip-not the name of my
cardiologist. The pharmacist had not made this choice because of a bias
about my cardiologist's credentials (she is not a PA or an NP), and
hopefully, not because of her gender; it was simply because another
physician was listed first on her prescription pad.
We first addressed
this issue at the 1994 Clinicians' Conference in Connecticut, but to
this day it remains a seemingly insurmountable problem. Would it be
possible for our two professions to take on this issue-and perhaps come
up with a satisfactory solution? Remember, there is strength in numbers.
Our reimbursement problems,
too, persist. I applaud the American Academy of Physician Assistants
for its fine work in getting PAs approval for Medicare
reimbursement-and the American Academy of Nurse Practitioners, the
American College of Nurse Practitioners, and other NP organizations for
diligently pursuing these matters on behalf of NPs. Yet until we have
universal reimbursement, until every insurance company in the land is
mandated to pay for services provided by an NP or a PA, then we remain
restricted and our professions are weakened.
This coming year will
bring increased malpractice insurance rates for both PAs and NPs. Here,
because of dramatic increases in our numbers, our patient loads, and
our vulnerability, we shall share a fate similar to that of our
physician colleagues.
The Opportunities During
the rapid metamorphosis of health care, each new challenge can be
translated into an opportunity to promote ourselves and extend our
overlapping roles. The burden of higher malpractice insurance premiums
has impacted all of us-particularly the ob/gyn physicians. There is an
acknowledged need for tort reform and a lowering of the malpractice
ceiling. And yet, at the same time that we "nonphysician" clinicians
partner with our physician colleagues to help, we must also consider
the opportunity this situation presents. For instance: In cases where
NPs and PAs share insurance companies, perhaps we could offer to help
create a top-notch risk reduction course or program that will include a
10% premium reduction for each PA or NP who attends it.
With the growing shortage
of physicians and declining enrollments in medical schools, a dark
cloud is forming on the horizon. Like Dave Mittman, publisher of this
journal (and my contemporary, friend, and colleague), I shudder to look
into the crystal ball. There, 20 or 30 years in the future, we see
ourselves sharing a geriatric suite at University Medical Center. Who
will be caring for us, and with what credentials? Will they be
compassionate toward us in our motorized wheelchairs, or will they
consider us a burden? And who will be staffing critical care areas?
Will their roles change? Clearly, we must move together toward a vision
of health care as we hope to see it!
An additional opportunity
arises with the proposed maximum 80-hour workweek for physician
residents. It will be nice for residents to "have a life," but they
will pay for it in experience-or the lack thereof. I can only reflect
on my personal knowledge in surgery and emergency medicine; but after
you've worked grueling hours and been pressed to the max, it's that
ruptured abdominal aortic aneurysm at 3 AM that defines you and shows
just how far you can really go. I've been there; I've felt that
adrenaline surge. And I've found within myself the ability to run yet
one more mile-to find gold at the end of the rainbow when the patient
emerges from the hospital 10 days later.
"We pay a price to gain a prize."
It concerns me that despite the potential payoff of reduced errors,
residents may pay the price of lost experience.
Common Solutions
How does all this affect each of us, personally and professionally? And
how do we respond?
Regarding the ob/gyn crisis,
we can demonstrate our commitment to the health care team by extending
our hands and becoming active partners with our physician colleagues in
the realm of tort reform and other malpractice issues. By doing so,
perhaps we can dispel the medical societies' fears and doubts
concerning "midlevel providers." Of course, this may take time.
Meanwhile, if ob/gyn
physicians continue to drop obstetrics, this could be catastrophic for
the many women who need prenatal and complete ob/gyn care. NPs and PAs
will be affected, too-but they can choose to become part of the
solution. The care needed for women to bear healthy babies may well be
provided by certified nurse-midwives and by PAs and NPs who practice in
ob/gyn. These NPs and PAs may then be motivated to pursue postgraduate
studies, further qualifying them to take up the slack and fill in the
holes-as we have so often done in the past.
Likewise, we
must find our fit in the shortfall of medical care that will result
from the 80-hour workweek for residents. Residency programs are closing
almost as rapidly as malpractice companies. Hospitals, medical centers,
and government-funded agencies will all need to reach out to other
qualified providers.
We are those qualified providers.
Surgical PAs
function as first assistants and perform well in surgical intensive
care. The new role of hospitalist has been successfully filled, thanks
to board-certified internists and other physicians working in teams
with NPs and PAs; this model has proven itself. In emergency
departments, experienced PAs and NPs performing in a resident-like role
successfully meet the challenges of overcrowding, dumping, and
unnecessary visits.
Conclusion
Nurse
practitioners and physician assistants are still the answer to the
American health care crisis. We have the education, the experience, the
commitment, the passion, the tools, the enthusiasm-and the numbers-to
make a difference. If we each take one step forward, America will soon
hear the marching steps of thousands from both of our professions, with
thousands of voices expressing the urgent medical care needs across our
country. Maybe then, people will no longer ask, "What is a PA?" or
"What is an NP?"-because they will have experienced firsthand the
excellent treatment that defines our roles.
Where do we fit
in the vision that I have described? Where do we see our respective and
collective professions in the next three years? The next ten? Are we
ready to risk becoming proactive, working toward a healthier
America-starting today? I, for one, vote yes. Together, let's make the
years 2001 to 2010 known as the Decade of Progress, forged by our
professions!
Robert M. Blumm has practiced in plastic surgery
for 30 years and owns a private first assistant business. He acts as a
preceptor to PA students from the State University of New
York-Stonybrook, the New York Institute of Technology in Westbury, and
Touro College in New York City. Currently Chairman of the Surgical
Congress of the American Academy of Physician Assistants (AAPA) and the
AAPA Liaison to the American College of Surgeons, Mr. Blumm is a past
president of the New York State Society of Physician Assistants and the
American Association of Surgical Physician Assistants.
Copyright 2002 Jobson Publishing, LLC.
Reprinted with permission by Clinician Reviews.
PleaseSend A Copy To Friends
Physician Associate: A Change Whose Time Has Come
We,the undersigned physician
assistant leaders assert that the time to change the name of our
profession has arrived. While we can debate much about a name change,
we have all agreed to the below statements and thoughts. We also fully
agree that the name change advocated below will advance the profession.
We call on the leaders of the profession and all PAs to announce and
start to implement this change as soon as possible. We are leaders who
believe it is increasingly unwise to wait longer to make this
long-needed change. Collectively, the below-signed PAs have given much
of their lives to the profession and are dedicated to its advancement.
Why We Need a Change
Our
profession’s original name was physician associate.
Physicians
demanded that “associate” be changed on the grounds
that it
did not properly describe the desired scope of PA practice. Forty years
later we have outgrown the "assistant" title. It no longer accurately
represents the profession. It is inaccurate and confuses consumers. The
title is misleading and carries negative connotations which we can and
should avoid. As we move into a new model of healthcare delivery it is
of the utmost importance that our profession’s name
accurately
describes our role.
Why a Change Is Justified
--
The PA role is truly one of partnership; of association and
collegiality. We work as associates and have for many years. Our
profession’s birth-name in 1965 was physician associate.
-- “Physicians assistant”
is a generic term. It can mean anything: a person in the office that
bills patients, a records assistant, the person that sets up and cleans
the exam room, all the way to a certified, licensed PA. The profession
must move from this generic name to one that aptly and more accurately
describes our function
-- In our society, "assistant" denotes a technical
job, not a profession.
-- PAs are held to the same legal and medical
standards as physicians.
-- The title is confusing and misleading to
our patients and the public in general. Since the name practically
guarantees that “physician assistants” will be
confused
with “medical assistants”, patients are at risk of
thinking
they are receiving substandard care or expect that after the
“assistant” a physician will also be seeing them.
Most
times this does not happen, nor does the physician or the PA expect it
to happen. It is time to have the name mirror the reality that exists.
-- The internationalization
of PAs is important to the profession. Having to explain that the
common meaning of the name “assistant”
under-represents our
true practice is a barrier, in international forums, to full
understanding.
-- The above problems also
may
keep prospective applicants and others away from becoming PAs as they
would not want to go through extensive schooling only to become
someone's assistant.
-- Almost all professions
at the level of training of a PA (pharmacy, PT, OT, NP) are or soon
will be at the doctorate level. Our education and practice is
professional, as should be our title.
-- “Assistant” obscures the
PA's true role in the practice. Physicians who might otherwise consider
a PA do not hire one as they feel they need someone more than just
another "assistant".
-- All professions should
be able to name their profession. “Physician
Assistant”
both demeans and misrepresents our profession. It is time to claim the
name that is both appropriate and our birthright and discard the one
that was forced upon us.
The Process
-- The
profession, ideally through the AAPA Board or HOD, should immediately
adopt a policy that states that "Hereafter the profession will work to
be retitled "Physician Associate," as it more accurately reflects the
profession in the 21st century".
-- If the Board or House is
reluctant to do this on their own, then the entire profession should be
polled using the AAPA's full database.
-- This renaming can
be done over a number of years, with the ability reserved to use either
title in the interim if necessary, depending on state legislation, etc.
-- The PA profession should advise
organized medicine that this change is not an effort for independent
practice but is a move to more accurately describe the scope and status
of the profession and place it at a level where it belongs. It should
also be explained that the name physician associate had been chosen for
us by organized medicine to represent the PA profession 45 years ago.
PAs should stress that after 45 years of delivering quality medical
care across the entire spectrum of practice, we are choosing a more
appropriate name and that we would expect nothing less than the full
support of organized medicine, which will also benefit from the change.
-- PA programs should include the name physician
associate whenever possible--along with the title physician assistant
if need be.
-- “Physician Associate” allows
us continued use of the initials "PA", which are well-known to the
public.
-- “Associate” does
not imply that PAs are equal to physicians. Associate professors are
not full professors. Associate deans are not full deans. There are
precedents for this.
-- The profession should consider funding
State-level efforts to effect this change.
-- The argument
that a change will open laws at the State level is a hollow one. This
action can be introduced as a "cosmetic" name change amendment which
will have no impact on PA practice law. If opposed, the profession can
educate the legislature as to the source of the opposition, that we are
asking for no increased privileges, and the current title is confusing
consumers and others
-- This name change should be done
BEFORE the profession embarks upon any large public relations campaign.
We can effectively brand the profession through the use of the new
name, avoiding any confusion of our status when compared with medical,
podiatry, chiropractic and other assistants.
Therefore, we the undersigned
PAs declare that because of the above reasons and more, the PA
profession should adopt the name "Physician Associate" and begin an
educational campaign to other medical professionals and the public
regarding Physician Associates.
1. Robert M. Blumm, MA, PA-C,
DFAAPA, Immediate past president APSPA, Past president AASPA, Immediate
past president ACC, Past president NYSSPA, Past AAPA Liaison To ACS,
ACC Liaison to ACS, Past Chair Surgical Congress AAPA, Editorial Board
Advance for PAs, Clinician 1, Advanced Practice Jobs, past editorial
board member Physician Assistant, Clinician News, Author, National
Conference Speaker, Consultant, Paragon Award Winner Physician /PA
Team, John Kirklin M.D. Award for Excellence in Surgery
2.Robin
Morgenstern, PA past AAPA Secretary, past president Illinois Academy of
PAs, past Director of the PA Program of Cook County Hospital, Chicago,
Past Midwest Advertising manager Clinician Reviews Journal.
3.Maryann
Ramos, MPH, PA-C, Founding President NJSSPA, Secretary of the AAPA
House of Delegates, Delegate or Alternate for many years; Current
Member, Nominating Committee; Current Legislative Chair for Physician
Assistants for Latino Health - Puerto Rico; Past President American
Academy of Physician Assistants in Occupational Medicine; Established
Liaison between occupational physicians and PAs and Affiliate PA
Membership in ACOEM; Awarded the Meritorious Civilian Performance
Medal, US Army Medical Corps, 2008; Past Federal Civilian PA of the
Year 2002(AAPA Veteran's Caucus); Past PA of the Year (AAPA President's
Award 1980)
4.Blaine Carmichael, MPAS, PA-C, DFAAPA, Co-Founder
Association, Past president, Vice President and current Delegate at
Large of Family Practice Physician Assistants, Founder Bexar County PA
Society, Founder, Que Paso - What's Happening PAs of San Antonio,
Moderator of PRIMARY PA forum, Board Member, American College of
Clinicians, Founding member of PA History, Texas PA of the year, 1990,
has published widely and speaks at many national, state and local PA
conferences
5. Dave Mittman, PA. Past AAPA Director, Past
President NY State Society of PAs, Co-Founder and creator Clinician
Reviews Journal and Clinician 1. Medical Communications Expert. First
PA in the USAF Reserves. Lifetime PA Achievement Award/President'sAward
NJSSPA and NYSSPAAAPA National Public Education Award Winner-1983
6.
Frank Rodino, PA, MHS, Past Public Education Chair AAPA, Past NYSSPA
President. Currently President and CEO Churchill Communications: A
Medical/Scientific Communications Company
7. Thomas Roselle, PA-C Past NYSSPA Consultant, PA Entrepreneur, Clinic
Owner
8.
David M. Jones, PA-C, MPAS, DFAAPA, Member, Past Governmental Affairs
Council, AAPA Legislative Co-Chair for at least 10 years, Oregon
Society of PAs (Chair for the 2009 session), Past President of OSPA
(twice), AAPA Co-Rural PA of the year 1988; second term as a member of
the PA Committee, Oregon Medical Board
9. Roy Cary, PA-C, DFAAPA
Co-founder and past president of The American Academy of Physician
Assistants in Legal Medicine. Co-founder in Cary & Associates,
LLC
and holds a position as Senior Partner. Mr. Cary is also a member of
the Physician Assistant Advisory Committee of the Nevada State Board of
Medical Examiners. Retired Air Force Major.
10. James R
Piotrowski, PA-C, MS , DFAAPA , Co-founder Association of Neurosurgical
Physician Assistants , Past president of ANSPA , Past Vice President
and board member of FAPA , Co-founder of the FAPA-PAC , Past member
Florida BOM PA Committee, Past Trustee of the AAPA PAC and Chairman of
the AAPA-PAC , Past PA member of the council of AANS and CNS, Past
editor of the ANSPA 's Journal.
11. Lisa D' Andrea Lenell, PA-C,
MPAS. Internal Medicine PA, Adjunct Faculty Midwestern University,
National Radio Host ReachMD XM160
12. Michael Halasy, MS, PA-C Health Policy Analyst/Researcher Author of
well known PA Blog
13.
Gary Falcetano, PA-C, Bariatric Medicine, Stockton NJ, Managing
Director – Collaborative Clinical Communications, LLC.
Captain
(Ret.) US Army Reserve, Past Group Publisher Clinician Reviews /
Emergency Medicine / Urgent Care, journals.
14. Charles O'Leary,
PA-C, Hominy Family Health Center [FQHC], 35-year practice same site;
LTC [Retired] US Army/OKARNG [2 tours Afghanistan, awarded BSM/CMB];
past-OAPA Vice-President, Past OAPA Newsletter Editor, 1992 Oklahoma
Rural PA of Year, OU-Tulsa Medical College PA Preceptor, Past Hominy
School Board President, Past Commander American Legion Post 142
15. Gerry Keenan PA-C, MMS, Emergency Medicine, Bar Harbor, Maine
16.
Martin Morales, PA MHA. Director, Physician Assistant Services, Long
Island Jewish Medical Center / North Shore LIJ Health System.
17. Stephen E. Lyons MS, PA-C, W .Cheyenne Clinic Coordinator, Take Care
18.
Robert Nelson, PA-C. Executive Director, Island Eye Surgicenter, LI,
NY. Administrator a various surgicenters in NY metropolitan area,
Author, Speaker, Director at Large-Outpatient Ophthalmic Surgery
Society, Member Corporate Development Planning Committee OOSS,
Consultant, Surgical PA 30 years.
19. Eric Holden, PA-C, MPA,
EMT-P 23 years of practice in emergency medicine.Member of state,
federal, and international disaster medical teams. Medical provider at
level 1 and 2 trauma ctrs, HMO's, community E.D.'s, rural/under served
E.D.'s, and solo provider at high acuity inner city facility. Author of
multiple articles in peer reviewed medical journals.
20. Rebecca Rosenberger, MMSc, PA-C, Current President AAPA-AAI
21. j. Michael Jones, MPAS-C, Chair PA Section American Headache
Society, Director Cascade Neurologic-Headache Clinic..
22.
Pamela Burwell, MS, PA-C. Distinguished Fellow, AAPA .Founder and
Director, Peacework Medical Projects. AAPA Humanitarian of the Year
Arizona PA of the Year
23. Eleanor H. Abel, RPAC, MS, CRC
Upstate Medical University, Syracuse-current District B Director At
Large, NYSSPA. Liaison and membership chair for NYRCA. Medical provider
with 22 years of experience in Hematology/Oncology and previously
employed in Surgery and also Physical Medicine and Rehabilitation.
Specialize in pain management, advocacy for people with disabilities,
Past coordinator and current assistant coordinator for the NYSSPA
Public Education Committee
24. Ronald H. Grubman, PA-C Founder,
Conmed Inc., 1984. President and CEO for 23 years. Conmed acquired and
currently a public company on the NYSE. 25. Ken Harbert, Ph.D., CHES,
PA-C, DFAAPA Dean, School of Physician Assistant Studies. South
College, Knoxville, TN
26. Eric Schuman, MPAS, PA-C. Adult &
Pediatric Neurology Kaiser Permanente Portland, Oregon. Adjunct
Assistant Professor, Oregon Health & Science University
Physician
Assistant Program
27. Charles A. Moxin, MPAS, PA-C, DFAAPA, Past
President Association of Family Practice Physician Assistants, Past
AAPA HOD delegate for Family Practice, Past Editorial Board member for
Arthritis Practitioner, Author, National Conference Speaker,
Pharmaceutical Advisory Board member
28. Kenneth E. Korber, PA
PhD(c): Director of Strategic Development - CE Outcomes LLC, Curriculum
Architect - First PA Postgraduate Fellowship in Cardiovascular Care,
Clinical Associate University of Illinois College of Medicine, Past
Member Board of Directors: Association of PAs in Cardiology, Member -
Association of Postgraduate PA Programs, Founder - AAPA Medical Writers
Special Interest Group; former Faculty - AAPA Chapter Lecture Series.
29.
Kenneth DeBarth, RPA-C, Past President NYSSPA, Past NYSSPA Newsletter
Editor, Past Secretary/Treasurer South Dakota Academy of PAs, founding
editor SDAPA newsletter, past chair AAPA Professional Practices and
Relations Committee, former owner Heuvelton Medical Group, NY.
30.
Ryan O'Gowan, PA-C, FAPACVS. Acting Manager, NP/PA Critical Care
Workgroup. Program Director Physician Assistant Residency In Critical
Care
Umass Memorial Healthcare
31. Chris Hanifin, PA-C. NJSSPA Immediate Past President
32. Cindy Burghardt, MS, PA-C, Nephrology PA for Renal Associates, San
Antonio, Texas.
33. John Sallis, MBA, MMS, PA-C PA consultant -Negotiation management
34.
James Doody, PA-C Director of Pediatrics and Primary Care 1st Health
Centers, Assistant Clinical Professor University of Colorado Health
Science Center, former Director of Pediatrics Lake Grove School,
Editorial Board Member Physician Assistant Magazine, Provider liason
Medical Home Initiative for State of Colorado.
35. Karen Fields, MSPAS, PA-C Founder of Medical Mentoring
(medicalmentors. net); Cofounder PAWorld.net
36. Richard Mayer, PA. Vice President Provider and Network Development.
Lenox Hill Hospital, NY NY
37.
Sharon Bahrych, PA-C, MPH, listed in Marquis’s
Who’s Who of
American Women, published author of 60 lay and medical journal
articles, state and national CME presenter,co-founder of APAO, clinical
trials researcher with a NIH rated grant, currently working on a PhD.
38. George Berry, MPAS, PA-C. Pediatric Trauma Coordinator Regional
Pediatric Trauma Center, Schneider Children's Hospital
North Shore-Long Island Jewish Health System
39.
Lisa F. Campo, MPAS, PA, DFAAPA; Past President NYSSPA. Former Chief
Delegate/ delegate AAPA HOD; former Committee member Wagner College PA
Program Advisory and Admission Committees; President LCFC-LLC
Consulting; Advanced Clinical Physician Associate the Mount Sinai
Medical Center; practicing PA 30 years.
40. Kristina Marsack, PA-C, President, Association Plastic Surgery PAs,
past-Treasurer, APSPA
41.
John W. Bullock, PA-C, DFAAPA. Past Chief Consultant to the US Air
Force Surgeon General for Physician Assistants, Founding member and
past Vice President of PAs in Orthopaedic Surgery. AAPA Federal
Services PA of the Year.
42. William Gentry, MPAS, PA-C Senior Physician Assistant-Neurology
Audie L. Murphy Veterans Medical Center
43. Harmony Johnson PA-C, MMS President, PAs for Global Health
44. Cristobal E Perez, PA-C Faculty Associate, Department of
Neurosurgery. UTHSCSA
45. Frank Crosby, PA-C One of first PAs to practice in UK
46. David L. Patten, PA-C, COL, SP, TXARNG. Deputy Commander for Texas
Medical Command
47. Michael France, CCRC, MPAS, PA-C, Director of Clinical Research,
Alamo Medical Research, MAJ USAF Retired
48.
Robert L. Hollingsworth, DHSc, MS, PA-C. Owner, Sole Provider Red
Springs Family Medicine Clinic, N.C. Preceptor for the Physician
Assistant Programs at Methodist College in Fayetteville, N.C, Duke
University in Durham N.C. and East Carolina University, in Greenville,
N.C. Active preceptor for several Nurse Practitioner Programs within
the state. Former Instructor: Methodist College Physician Assistant
Program
49. James C. Allen, IV, MPAS, PA-C, DFAAPA; Director,
Physician Assistant Clinical Training Programs, University of Texas
Medical Branch-Galveston/Correctional Managed Care; Former Secretary
Bexar County PA Society 2003-2005; Dual Certified Aerospace
Physiologist; US air Force Aerospace Physiologist of the Year 2003;
Past President Towner-Shafer Society, US Air Force 1993-1994; Retired
US Air Force Major
50. Michelle Ederer, MA, RPA-C Past President, New York State Society
of PAs
BobBlumm: Robert M. Blumm
has received national recognition as a distinguished fellow
of the
American Academy of Physician Assistants (AAPA). He is the past
president of the Association of Plastic Surgery Physician Assistants,
and was past-president of the American Association of Surgical
Physician Assistants, past president of the American College of
Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of
the AAPA. In addition, Bob received the John Kirklin MD Award for
Professional Excellence from the American Association of Surgical
Physician Assistants. Along with his associate, Dr. Acker, Bob was the
first recipient of the AAPA PAragon Physician-PA Partnership Award. He
has been a contributing author of three textbooks, written 150 plus
articles and is a sought out conference speaker throughout the United
States.
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