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Hi I'm genuinely interested to know about the social environment of working PAs. If any practicing PAs could comment on their experiences it would be most helpful:

 

How are you referred to by patients? By your supervising physician? By other healthcare workers (nurses, technicians, admin)? Are you called Doctor? If so, is it weird being called Dr. without any official doctoral certification? Is there any tension/controversy regarding the titles of PAs in the workplace? Do you wear white coats or does the physician only wear one?

 

These are non-essential aspects of being a PA that I'm interested to know and that no one mentions! Thanks in advance for your insight :)

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If someone called me "Doctor", or assumed I was a Doctor in any situation where I wasn't in fact a Doctor, I would correct them with the appropriate title. So yeah, I'd think it would be pretty weird to let someone think you're a doctor when you're not.

You'd be called a Physician Assistant or PA, and go by your first name.

Since when do physicians only wear white coats?

 

 

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22 hours ago, PA00 said:

If someone called me "Doctor", or assumed I was a Doctor in any situation where I wasn't in fact a Doctor, I would correct them with the appropriate title. So yeah, I'd think it would be pretty weird to let someone think you're a doctor when you're not.

You'd be called a Physician Assistant or PA, and go by your first name.

Since when do physicians only wear white coats?

 

 

since never actually - we stole the practise from scientists to make us look better way back when medicine was snake oil and wishful thinking. 

A lot of people where white coats now (hehehehe even radiologists :) ). have to stay warm in those scrubs after all.

What is more interesting/confusing is when you have a nurse etc with a phd in nursing. They then ARE a doctor just not a medical doctor, but they do have medical training. 

 

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1 hour ago, Clapton said:

Why would they call you "Doctor" if you don't have any doctoral certification ?

I have seen it - after all you are doing things that most people think doctors do. You can tell patients a 100 times you are not X but that doesn't mean it will stick. 

It took a a few days once to convince someone that I wasn't a staff cardiac surgeon - and they refused to go into surgery still until I went over things with them (while the head of cardiac surgery was just standing there....awkward).

 

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I was actually asking for CURRENT practicing PAs to give their experience, not unsuccessful applicants. I know that your answers are merely assumptions and are not at all helpful. Try answering a question you're qualified to answer @PA00. 

 

I'm asking this question because when I explain/educate the public on PAs, the #1 question I receive is: "so do I call you Dr?" To which I reply "Well, no because PAs do not have a doctoral designation." But the term "Dr." To patients has a very different meaning than the title on their degree. When I reply no, the response I get is: "but if you're prescribing my medication, treating me and performing MD tasks, why can't I call you Dr. X? You are essentially my Doc."

I really don't know why I would have to explain this to anyone who knows what a PA is....its very obvious why there would be confusion among patients. Patients don't care about your formal designation, they care about the the clinical tasks you are performing. If I'm formulating a treatment plan and prescribing meds, the way the public would typically associate an MD would, its really not that absurd that the "lay" version of Dr would be used.

Since I have not yet started my PA education, I was wondering if these SOCIAL aspects of PA practice could be expanded upon. I realize that they are non-essential aspects (clearly stated in my post) but that doesn't make them un-interesting nor irrelevant.

Ill clarify again that I'm looking for those with actually patient-PA-MD interaction experiences to answer only! I want to hear from an actual PA how they are addressed by the public, by staff and by the surpervising MD. Thank you and sorry if that was unclear.

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56 minutes ago, PAalltheway said:

I was actually asking for CURRENT practicing PAs to give their experience, not unsuccessful applicants. I know that your answers are merely assumptions and are not at all helpful. 

Snap! Oh man, that was so satisfying to read. Had to make an account to give you props. 

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1 hour ago, PAalltheway said:

I was actually asking for CURRENT practicing PAs to give their experience, not unsuccessful applicants. I know that your answers are merely assumptions and are not at all helpful. Try answering a question you're qualified to answer @PA00. 

 

I'm asking this question because when I explain/educate the public on PAs, the #1 question I receive is: "so do I call you Dr?" To which I reply "Well, no because PAs do not have a doctoral designation." But the term "Dr." To patients has a very different meaning than the title on their degree. When I reply no, the response I get is: "but if you're prescribing my medication, treating me and performing MD tasks, why can't I call you Dr. X? You are essentially my Doc."

I really don't know why I would have to explain this to anyone who knows what a PA is....its very obvious why there would be confusion among patients. Patients don't care about your formal designation, they care about the the clinical tasks you are performing. If I'm formulating a treatment plan and prescribing meds, the way the public would typically associate an MD would, its really not that absurd that the "lay" version of Dr would be used.

Since I have not yet started my PA education, I was wondering if these SOCIAL aspects of PA practice could be expanded upon. I realize that they are non-essential aspects (clearly stated in my post) but that doesn't make them un-interesting nor irrelevant.

Ill clarify again that I'm looking for those with actually patient-PA-MD interaction experiences to answer only! I want to hear from an actual PA how they are addressed by the public, by staff and by the surpervising MD. Thank you and sorry if that was unclear.

Not a current PA, but I have worked with a few PAs so I hope this helps in some way.

The PAs introduced themselves as [insert first name], physician assistant of Dr XYZ. They will inform the patient that any information obtained in the interview / examination will be discussed with Dr XYZ to reassure the patient. They will then ask for the patient's permission to proceed with the interview / examination.

PAs in Ontario are able to prescribe specific medications under medical directives by a supervising physician, but cannot to independently prescribe. I am sure OP is aware of this, but I am clarifying for the sake of other members

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6 minutes ago, ArchEnemy said:

Not a current PA, but I have worked with a few PAs so I hope this helps in some way.

The PAs introduced themselves as [insert first name], physician assistant of Dr XYZ. They will inform the patient that any information obtained in the interview / examination will be discussed with Dr XYZ to reassure the patient. They will then ask for the patient's permission to proceed with the interview / examination.

PAs in Ontario are able to prescribe specific medications under medical directives by a supervising physician, but cannot to independently prescribe. I am sure OP is aware of this, but I am clarifying for the sake of other members

Thank you! That truly is insightful and interesting. I'm glad that formalities exist and now am sure I will learn them once I start in the Fall. This information will allow to better explain the role of PAs to those who ask me!

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8 minutes ago, PAalltheway said:

Thank you! That truly is insightful and interesting. I'm glad that formalities exist and now am sure I will learn them once I start in the Fall. This information will allow to better explain the role of PAs to those who ask me!

Glad to help in any way. Congrats on being accepted into PA! 

Enjoy the rest of your summer.

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"Hi, my name is Anne and I'm a Physician Assistant working with __." [shakes hand]  Start with patient encounter. 

  • Our practice has been using PAs for the past 7 years so our patients are used to PAs. I elaborate a little bit more about how patients react to being seen by a PA below. 

Patient: "Are you a doctor?

  • My response:" No I'm a Physician Assistant." [insert elevator pitch about PA education and practice, 4-5 sentences I use frequently with patients, pre-PA students and other allied health]

Patient: "Are you training to become a doctor? When are you done?"

  • I still get this question a lot, and understandably some patients didn't hear me the first time when I introduced myself as a PA. 
  • My response: "I actually finished school for Physician Assistant studies, and I've been practicing with Dr. X for the past 6 years. [insert elevator pitch about PA education and practice]

Depending on the practice, the patient may see: 

  1. The PA only
  2. The PA first, then the physician (in the same patient encounter)
  3. The medical learner (i.e. medical student, PA student, resident, or fellow) first, then the physician (in the same patient encounter. 
  4. The physician only

Note #2 and #3 are essentially the same --> 

In Ontario, many PAs practice in a setting where the patient sees the "PA only": 

  • A PA colleague of mine who works in family medicine has her own list of patients for the day. She is very experienced and consults the physician perhaps a few times a month  for very complex, atypical or unusual cases.

  • A new grad would likely review each case (as part of training, mentoring and orienting the PA to a new practice) to begin with but as they gain more experience they will likely transition to indirect supervision where PA sees patients autonomouly.

  • My PA colleague is usually more on time than the family physician (she doesn't like to keep her patients waiting, and is very thorough, yet efficient, good bedside manner helps too!), and there are some patients that would prefer to see the PA rather than the physician because of the rapport the PA has built with that patient over time. At the end of the day, the PA is doing the same clinical duties as the physician (e.g. well baby exams, PAP smears, skin biopsies, vaccinations, sore throat assessments, follow-ups, new consults, etc.), but you have two clinicians seeing patients simultaneously. She also prescribes medications under medical directives, but does not do narcotics - those patients who require prescription of opioids and other controlled substances see the physician. 

  • If the patient is adamant on seeing the physician only (this very rarely happens), then it doesn't take a lot of time to quickly grab the MD.
    • One strategy you can use as a PA is to inform the patient that they are more than welcome to see the physician, but while they're waiting you can get started on the history and physical, which will be case reviewed with the physician. The PA proceeds to do the entire encounter history to physical, review investigations, formulate diagnosis and treatment plan. We do patient education around treatment modalities & preventative health, and take time answer all of their questions - they usually are impressed at the time, attentiveness and how thorough the PA is during the encounter. By the end of the encounter the patient is happy, they get to see the MD (if at this point they still want to at this point, and are happy to see the PA again.  
    • If patient is resistant (I haven't seen this happen in 6 years in practice, but it is still a possibility), then just inform the patient the physician may see them but they may have to wait longer, which most patients are not happy to do anyway. 

The "PA first, then physician after" is very similar to how physicians work with 3rd and 4th year medical students (clinical clerks)/residents/and medical fellow model, where there is more direct supervision as the physician does participate in the patient encounter.

  • This model is much more common in the beginning  of a PA's experience with work (as I mentioned above, to orient, mentor and train a PA to a new practice).
  • Some physicians prefer this way (i.e. see every patient) because of personal preference rather than actual need as the PA is usually capable to see simple, routine conditions and with more experience handle more complex conditions autonomously with physician collaboration (e.g. established medical directives, review cases/chart after each patient without seeing the patient or at end of the day, tec.). 
  • You still have two clinicians seeing patients simultaneously - while the physician goes to finish off the PA encounter, the PA can now start on the next patient. 
  • In cases where the PA starts, and physician finishes, the interaction usually goes like this: 
    • "Hi I'm Anne, I'm a PA that works with Dr. X__. I'll be getting us started today, and Dr. X  will be joining us after." [PA proceeds to do entire encounter, communicate diagnosis (depending on case), review imaging, explains treatment modalities before the MD comes in]
    • PA exits room --> Case reviewed with physician ( either by 1 - PA case presents to MD,or 2- physician will read the PA's clinical note in the EMR) --> Physician enters room while PA starts on next case
    • Physician: "Hi I'm Dr. X_, Orthopaedic Surgeon, I had a chat with Ms. Dang, our PA and she's told me a lot about you. [Quickly verify a few pertinent facts, 1-2 exam findings, review imaging, confirm/discuss treatment options] 
    • The amount of time the physician has spent with the patient is significantly decreased as the PA has done 90% of the work. With years of practice my clinical reasoning and familiarity with treatment protocols in this practice. 
    • As a result of this model, although the MD is going in to "verify" what the PA found, we have been able to decrease wait times to be seen by a specialist, reduce physician workload and decrease time spent seeing patients in clinic (shorter clinic hours) while simultaneously increasing the volume of patients the physician can see without burning out. 

We don't wear white coats, because my physician does not wear a white coat in clinic. Business casual for us in clinic. PAs in hospitals wear scrubs, some wear the PA white coat, but note it is a different length than the physician white coats. More common for "PA Hospitalists" as the white coats provide handy pockets to put pocketbooks, pens, etc. 

Hope that provides some clarity!

Anne

Blog: http://www.canadianpa.ca
Twitter: http://twitter.com/AnneCCPA
Linkedin: https://www.linkedin.com/in/annedang/
Canadian Pre-PA Student Network: https://www.facebook.com/groups/canadaprepa/

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