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The Whole of the Team is Greater than the Sum of its Parts


In a changing healthcare environment, it’s important for physicians, PAs, and everyone else in the care team to get on the same page.

This has been an unprecedented time for change in the American healthcare system. The recent decision to uphold key elements of the Affordable Care Act on June 25, 2015 solidified this transformation in our nation’s healthcare system and provided a form of stability to the trajectory of healthcare delivery into the short-term foreseeable future.

I spend a lot of time reading news, opinion columns, etc., as they relate to the healthcare system in general, as well as the technology of the delivery of medicine. I find it interesting to read the comment sections of blogs and op/eds to get at what people in the trenches are really thinking.

What I have sensed from these comments is a general discomfort about change in the healthcare system. This applies to the change in how providers at the point of the sword (physicians, PAs, NPs, CRNAs, etc.) view each other, as well as their own place and security in the healthcare system. This is a natural behavior but one worth addressing nonetheless.

As a PA in a surgical subspecialty for the past six years, and with 34 years of practice experience under my belt, I feel very confident in my ability and contribution to our practice. I also perceive a substantial level of respect from my peers, (including surgeons) in the OR suite.

It was much harder and more angst-ridden to find my place in the healthcare system when I was one of the “few.” Now, PA laws and regulations have begun to modernize, reducing the barriers to practice and helping us better meet the needs of today’s patients. This not only matures the governance of the profession, but ensures roles and competencies on the healthcare team are better defined.

When PAs were rare, like all new things, we were seen as a novelty. With more than 100,000 PAs in clinical practice in the U.S., in every specialty and subspecialty, PAs are harder to ignore in today’s world. Reading the blogs and comment sections you come upon a number of common opinions / comments from physicians and other sources.

• “Why did I spend some much time and money to go to medical school when PAs, NPs and others can do much of what I do in medicine?” I feel physicians’ pain and understand where this is coming from. The delivery of healthcare in the U.S. is changing dramatically, and the pace of change - with a new emphasis on delivery within the scope of a healthcare team -is accelerating, creating uncertainty for physician and others.

• I’ve seen some speculation about how these “lesser-educated” providers have created unnecessary morbidity and mortality. I also understand where this is coming from and I’m not offended by it. In our team practice, I strive to practice to the level of care of my surgeon partner and not a lesser standard. We are all human. Physicians, PAs and others all make mistakes. However, a recent study published in the journal, Circulation: Cardiovascular Quality and Outcomes reported that patients with chronic heart disease receive the same quality of care from a PA or an NP as they would from a physician.
Here are a couple of things I want to underscore about PAs and our role within the healthcare system:

• PAs practice medicine, and do so to the physician standard of care. All providers on the healthcare team are essential to expanding the provider base to care for the ever-expanding number of patients. None of us can solve the human resource demands of the healthcare system alone. Together, the whole of the team is greater than the sum of its parts.
• PAs were a team before team was cool and you’ll find that the PA-physician relationship is a collaborative one. The scope of a PA’s practice is determined, in the best cases, at the practice level between physicians and PAs.  After 34 years of practice, 97 percent of what I do day-to-day is autonomous, independent decision-making interspersed with the occasional appropriate physician consult when things fall outside of the “norm” and are unusual. As my experience base broadens, this happens less and less.

As I like to say often, “It is what it is.” Our healthcare system is changing. As clinicians, we all need to find a way in which to work together and improve the care that we provide to the patients who rely upon all of us for their care. This can best be accomplished by a mutual understanding and respect between and among all professions.

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