Physician Assistants, It’s Time for a Change

My dear PA friends, I’m tired.

I know you all feel me. You are tired too. We all work as Physician Assistants day in, and day out, and many of us (too many in my opinion) are.. tired.

Here’s the thing. PAs are hard working people. Many of us were multitasking superstars while we were getting our undergraduate degrees. We took poor paying jobs or volunteered the little time we had to collect patient contact hours or shadow other PAs. The work we did WAS meaningful though and that often sustained us. Some of us even had previous careers, as EMTs, Paramedics, Therapists, or even something completely different such as real estate or banking. We were very productive members of society but felt that need to do more, so once we learned about the PA profession, we did everything in our power to get there.

Most of us graduated with a bachelor’s degree. We applied to CASPA, made it past the interview process and went through a grueling two plus years of PA School. The work we did WAS meaningful though and that often sustained us. We took the PACKRAT and then ultimately the PANCE exams, and passed, and then the real work began.. we all got jobs working as Certified Physician Assistants. Finally, we’d made it. We eventually got a paycheck and started adulting, saving for retirement, some of us starting families and buying houses. Rainbows and unicorns, right?

Wrong.

That steep learning curve, you know, the one in the first year after graduation but before you feel like you are actually a PA, was so (so) tough. Even with amazing colleague support, we struggled. We woke up at night, thinking “I forgot to chart they had no pitting edema” or “maybe I should have added a CMP instead of a BMP”. We questioned everything and, sometimes (though we won’t admit it) we felt like failures. The work we did WAS meaningful and that often sustained us.

Once we got our feet under us, I’d say in the 2-5 year range, we started to feel confident in our decisions. Every small win up to that point helped us become clinically strong. But, my friends, there’s this huge elephant in the room that no one REALLY tells you before you start PA school.

The truth is, we don’t always get to practice at the top of our license. Our hospitals and employers often don’t understand our training, nor do they realize our value. Sometimes, they value other professions more than ours, and it feels unfair and, honestly, it’s exhausting. The work we do IS meaningful but I’m afraid it won’t sustain us.

I know there are practicing PAs laughing at the above statement. This, of course, is no surprise to them, and I think many of us assume that everyone knows this is an issue. Maybe, everyone does already know, but my friends, I’m tired. I’m tired of the battles with administrators or employers to prove our worth. I know you are too. Our work-life balance is, in fact, NOT balanced. We feel undervalued and we’ve worked so hard to get where we are. Do you know what I’m also tired of? The complaining.

It’s time for a change.

I’m serious, like, DEAD serious. I know I’m going to get emails for this. I KNOW that you all are going to be angry at me for what I’m about to say. I’m involved in many social media PA forums, I know what the complaints are. I know what people are grumbling about. And, often, I don’t disagree with the complaint.

It’s time we, as PAs, stop complaining about these things and actually do something about them. It’s okay to say that you are tired. It’s okay to complain, even. However, when you do complain, my first question to you is this: What are you doing to make it better? What are you doing to make a change in the PA profession? Are you involved in any committees? What about your state PA Association? Have you joined AAPA or PAFT? Did you know they are working for you to help address these issues? Do you precept PA students? Do you mentor? Have you contributed to a journal or worked on a quality improvement project? Have you pursued a PA leadership position?

I will sit with you and empathize with your situation. What I will not do, however, is sugar coat anything, nor will I allow you to wallow in self-pity. I once heard someone say not to come to the table with a complaint without a possible solution. If you want to complain, fine, but be ready to have a solution ready. When you aren’t engaged with the problem, no one hears your voice but the people you complain to.

Now, I KNOW some of you are going to tell me there’s nothing that you can do. You are going to say that you are stuck in a job, working a million hours a week with no extra to give. And, that’s fine. I’ve been there, with young babies and a 40-hour workweek that includes night shifts and weekends and holidays. I’ve missed birthday parties and Christmas’ and small milestones for my children. I get it. If you don’t have the time, you DO have the money. Yes, we all have a gazillion dollars in student loans, and mortgages and cars, but we also have a responsibility to invest in our profession. If you don’t have the time, then just join those PA associations who are working HARD to improve our profession.

What PAs Can Do to Make a Change

I look at this from two perspectives. In any situation, to make a change you will actually feel, you must make a change in your own arena. This means you have to get involved where you work. In a more broad sense, and to make a more permanent and more impactful change, you have to get involved at the state and even federal level. This may sound overwhelming, but baby steps will get you there and I have some suggestions below for each.

Get Involved in Your Own Arena

There’s this quote I keep seeing that resonates with me. I believe it originates in the political world possibly in the early 2000s, and though some politicians claim it, there’s no actual proof who said it first. Regardless, it translates to PAs working in a profession that has a very active political component. The quote “If you’re not at the table, you’re on the menu.” very much applies to the PA profession. If we aren’t in those board meetings, those committees who make clinical and administrative decisions, who is representing the PA’s needs? The answer is no one. As the proverbial “black sheep” of medicine, we are often forgotten. I know this because I have lived it and inquired about it. I have heard of an entire hospital hurricane disaster plan designed without consideration for the advanced practice providers within an institution. When it came time to use the plan, the people making decisions had no idea what to do with the APPs and had to make some adjustments on the fly, in the chaos of an impending hurricane. If PAs (or other APPs) were at that meeting, a lot of confusion could have been prevented.

So how do you get an invite to those meetings? You start small. You join committees. All hospitals and many clinics have a variety of committees and many of them are looking for more people. Find a committee that addresses your concerns, go to a meeting and listen. Listen to the way they talk about a problem, and after a meeting or two, carefully bring up how PAs could be the solution. There are a lot of egos at these meetings you will have to contend with. Proceed gently, make friends, not enemies, bite your tongue until it bleeds, but attend. Be helpful, but not too forward. If you are female or a minority, I hate to say this, but be cautious. There is still quite a bit of discrimination in this day and age (that’s an entirely different post) and you must tread lightly if you want to make a change. This, my friends, is how you start. If your department or office has a monthly or quarterly division meeting, go to it. I realize you may not get paid for it, but it truly is in your best interest.

So you can’t join a committee or attend a meeting? Get involved somewhere else:

• Process improvement and/or Quality Improvement projects are a perfect way to make clinical changes. Start simple by asking what process could be changed. Involve your team, come up with a better way. Collect pre-data and set a date for the new process. Collect post-implementation data and compare them. Did you make a change?
  
• Update a supply list or cart. If you are constantly hunting down equipment, In the ER suture carts almost always need updating.
  
• Make an orientation manual for new APPs, full of resources, phone numbers, and clinical practice standards.
  
• Host a skills workshop for APPs, Physician residents, nurses, or other staff. This could be focused on clinical skills such as suturing, assessment, EKG placement, and interpretation etc.
  
• Host a disease-focused workshop/presentation where you cover various topics, updates in clinical practice. It does not have to take a long time, nor a lot of effort. Reviewing a powerpoint over 10-20 minutes and working with your colleagues, or staff members, providing valuable clinical practice update or giving them confidence in their skills really boosts morale.
  
• Start a preceptor program
  
• Start a PA residency/fellowship

Get Involved With PA Associations

When you retire, what do you want to say you did for the PA profession? What Legacy do you want to leave?

I have asked myself these questions a lot lately. I want to be able to tell my children I made a difference. I supported Pre-PAs and mentored PA students, and that I fought for our profession when it was right to do so.

Today, right now, if you are not a member of your State PA Association, go join. The link is right there, I’ll wait. Don’t tell me you can’t afford it.. do you want a job you enjoy in 10 years? Skip the starbucks a few times a week, you can afford it.

This simple level of involvement is crucially important to preserving the PA profession. Even if you can’t go to a conference. Even if all you do is pay dues, you NEED to be involved. In adition, you should be encouraging ALL Pre-PAs, PA Students and your PA colleagues to do the same. If you can, go to your state PA Association conference and learn. Speak to the leaders and get a sense of the work they are doing. This will help energize and Empower you to go back and continue the fight.

Next, you should browse the PAFT and AAPA websites. They speak to our profession on a national level and both provide very different services. PAFT has some fantastic articles “Death by a Thousand Cuts” and AAPA has many amazing resources for PA leaders, preceptors. The AAPA Conference is also a fantastic place to network (and get CMEs!). And on that note, you should be filling out the annual AAPA Salary Survey and any possible related surveys. If you want to objectively make changes, these surveys help apply some quantitative data to our plight.

Consider Some Alternatives

Take a good hard look at what is causing your burn out.

• Is it your specialty? After working in a general emergency room for four years, I was tired of the drunks and the drug seekers and the general mistreatment I was getting. I had been yelled at, screamed at and was tired. A change of specialty into pediatric emergency medicine really made a difference for me.

• If you love your specialty, could it be the people you work with? I have been fortunate to have mostly amazing physician colleagues, but one or two bad locums really can impact your quality of life when it comes to working. Is there a staff member with a likely personality disorder? You will never change their personality, so if this is causing your burn out you need to leave fast.

• If the rat race is what is causing your burn out then consider becoming a PA entrepreneur. Many PAs have developed their own business based on their passions, I would encourage you to entertain this if you feel like you want to get out of the clinical arena in general.

• Also, consider that an additional degree could improve your situation. Do you aspire to become an executive? If so, consider an MBA or joining healthcare administrator associations. These advanced degrees are not necessary for you to become a PA executive, however they can help support your cause. There are other doctoral degrees you could consider, they are controversial though, so be aware of that!

• Have you considered teaching PA students? With the significant increase in PA programs across the nation, there are plenty of PA programs to teach even on a part-time basis. Join and get acquainted with PA education techniques. I also really like this podcast, Airwaves and Educators Podcast.

• If none of the above interest you, be a trailblazer. Several years ago I noticed that our clinical practice guidelines l needed some serious updating. I steadily, slowly, and often on my own time worked on these to improve them and earned myself a position on the quality improvement team as a result. This route is not for everyone but I am the only APP to work in that department with an APP title, which has the added benefit of showing hospital administration what PAs can do outside of the clinical arena and possibly paving the road for future non-clinical APP positions. Time will tell if that comes to fruition but it is a step in the right direction.

What Not To Do

If you are still reading, I’m impressed! You are dedicated to the PA profession. But, I need to be very honest with you about the things you need to stop doing.

• Stop complaining to people that aren’t going to help you make a change. No one wants to hear people whine all the time. Just stop. Constructively air your grievances and pick your battles. If you are emotionally distraught about it, go for a run.
  
• Stop with the Nurse Practitioner bashing. I don’t see it often, but when I do, it boils my blood. Our NP colleagues are working hard to advance their profession. You don’t have to agree with their methods, but you do need to stop bashing them. Yes, I said it. It is unprofessional and it’s not helping your case. This includes social media too. If you feel like it’s “not fair”, look at the specific issues you have and address it logically. Are NPs getting paid more than PAs for the same work? Address it with your employer, but stop denouncing their profession. They also work very hard, and there are plenty of examples of good and bad clinicians in every arena.
  
• On the above note, stop the comparison. Stop worrying about advanced practice pharmacists and all the other professions that are making changes. If it concerns you, get involved. You can use these as examples of why we need to make changes in our profession, but do NOT use these example to complain. Take a good, hard, look at your ego and decide if you are going to be the in the “it’s not fair” camp or if you are going to do something about it.

Friends, I am not perfect. After almost 8 years as a practicing PA and nearly 20 years taking care of patients, I have learned these life lessons along the way. I also have a very long way to go before I get even close to getting it right.

I’m sharing this out of my love for our tribe, and out of some frustration for what we are all dealing with. My hope is that we all work together to take the best care of patients and each other that we can.

-C