Talk:Physician assistant

Reorganizing the article

I'd like to consider breaking out some of the content into sub-articles, specifically on the PA professions in the UK and US. This would be a hierarchical summary style breakout, something like this:

• Mid-level practitioner (note: even if it changed the title, and there's plenty of text within the page that describes issues with that as the topic name, it should probably stay the top level title)
  • Nurse practitioner
    • ...
  • Physician assistant
    • Physician Associates in the United Kingdom
    • Physician Assistants/Associates in the United States
  • Clinical officer
  • ...

Within the context of the Physician Assistants/Associates in the United States article, I would like to include information on multiple US PA organizations that may or may not be eligible for their own, separate articles. If they do, they'd get them, but I want to cover the AAPA (professional org) NCCPA (certifying body) PAEA (educational org) and ARC-PA (educational program accreditation body), as well as the PA Historical Society and PA Foundation. It would also be a great place to capture the history of the profession from a US perspective.

Ideally, this will give a broad overview, and allow each country's readers to dive into the specifics on the profession as it is implemented locally.

Thoughts? Jclemens (talk) 21:19, 25 December 2022 (UTC)

I think this is a good idea. Tannim101 (talk) 20:23, 10 April 2023 (UTC)

Throughout there is confusion around the USA model and other jurisdictions. this has lead to factually inaccurate statements. needs heavily editing or re-writing. 185.58.164.47 (talk) 09:07, 12 April 2023 (UTC)

Yes, and thanks for your efforts... but next time, try leaving the dates blank on cn tags (a bot will fill them in) or adding the current date. Jclemens (talk) 20:13, 12 April 2023 (UTC)

Clarity in lead

clarifying sentence in lead that they are not physicians. “Mid level provider” is not an international term and can cause confusion. Tannim101 (talk) 20:44, 7 April 2023 (UTC)

I would be happy with replacing "mid level provider" with "non-physician medical clinician" or something similar. MLP is generally regarded as pejorative by American PAs and NPs. Jclemens (talk) 22:50, 7 April 2023 (UTC)

From a UK point of view, the clearest way to convey to a lay reader what PAs are, is: "Physician associates are professionals who have a 2-year qualification in healthcare and are not doctors". I know that negative definitions can be frowned upon, but sometimes they're important. If I had to explain to my gran what PAs are, that is exactly what I would say. Dr. Vogel (talk) 23:04, 7 April 2023 (UTC)

As we've noted before, the UK vs. US connotations of doctor vs. physician is still challenging. The "two year" bit does also not translate well, because in the U.S. PAs have 12-13 years of schooling (K-12 grades), then a four year bachelor's (undergraduate) degree (including various required subjects relevant to medicine), and only then may they enter graduate-level PA school, which covers roughly 2/3rds the curriculum of a U.S. Medical school in half the time. Compare that to most Commonwealth and other countries where an MBBS is essentially a six-year undergraduate degree, and the "two year" bit would make it seem to be 1/3 of an MBBS, when in fact it is really much more than that--in the U.S., the licensure exams and postgraduate (residency/fellowship) training are what really set MDs and DOs apart from PAs. Jclemens (talk) 02:25, 8 April 2023 (UTC)

Personally I think the best thing to do is to split it, and then have a small umbrella article. @Tannim101 does have a point. If the article doesn't make it clear that PAs are not doctors, we're doing the reader a disservice. Dr. Vogel (talk) 10:41, 8 April 2023 (UTC)

It's true, and it's a good branding issue. Physician Assistants/Associates routinely provide superior care, demonstrating that the added ego and financial cost do not make up for the small improvement in diagnosis for undifferentiated illness by using a physician in situations where a PA is more appropriate. I try not to be insulted when my patients call me "doctor," thinking I'm an M.D., it's a benign error on their part. Mostly tongue in cheek, of course. Mostly. Jclemens (talk) 17:28, 8 April 2023 (UTC)

I think you're comparing lengths of education internationally which doesn't really work. and seem to be including childhood school years as part of their "PA education". Tannim101 (talk) 20:20, 10 April 2023 (UTC)

The first part is correct, which is why the second part is wrong. Current PAs in the United States have a minimum of 6 years of full time college education, just like an MBBS does. Many have more, a growing number hold doctoral degrees of some sort. Claiming that PAs are less well educated than physicians is not true in an absolute sense, even if it may be true in a general sense. [1]. Jclemens (talk) 18:55, 12 April 2023 (UTC)

It is your error, because your patient has been misled; either actively or through your omission. Superior care? laughable, zero evidence. 180.150.80.115 (talk) 07:29, 1 April 2024 (UTC)

Not in the least. I have an earned doctorate, so a patient addressing me as doctor is using my correct academic degree. As far as evidence goes... what sort are you looking for? There's plenty. e.g. Kozikowski, Andrzej PhD; Morton-Rias, Dawn EdD, PA-C, ICE-CCP, FACHE; Quella, Alicia PhD, PA-C; Puckett, Kasey MPH; Jeffery, Colette MA; Mauldin, Sheila MNM; Goodman, Joshua PhD. Public experience with and perspectives on medical care provided by PAs. JAAPA 36(10):p 1-10, October 2023. | DOI: 10.1097/01.JAA.0000977684.35719.f0 Jclemens (talk) 01:35, 2 April 2024 (UTC)

So, I made some more changes. We need to discuss how to phrase "dependent practitioner" because it isn't the same for every jurisdiction: some need onsite physician presence, I just need to have one's cell phone number, and other PAs don't even have to have a supervising doctor at all, based on their U.S. state laws. Frankly, "dependent practitioner" is pretty old terminology, like "physician extender" and doesn't capture how PAs work in many U.S. settings. Obviously, in places where medical training is abbreviated compared to how U.S. attending physicians are trained, their PAs are going to be less competent and less well trained than U.S. PAs. A U.S. PA education is likely better than medical school in many of the world's less well resourced countries.... but how do we capture that? Jclemens (talk) 01:03, 9 April 2023 (UTC)

If what you're saying about PAs in America having more medical training than doctors is true, then that's so far removed from the UK that we definitely need multiple articles. Perhaps split whatever is about the US into a new article with the title Physician assistant (United States). Dr. Vogel (talk) 01:26, 9 April 2023 (UTC)

Dependent Practitioner is still the terminology used by the PA Faculty in the UK, so this is included in the Scope of Practice (UK) section. This section corrected errors and added citations. Tannim101 (talk) 20:21, 10 April 2023 (UTC)

This is a bit far afield, but hopefully it helps explain the disconnect: PAs are new to the UK. The most senior PAs have been functioning there for not yet two decades: you don't yet have a cadre of senior PAs who have dedicated 30, 40, or more years to the profession. In the U.S. PAs have been around for five decades and change. With NO pathway from PA to MD (take the MCAT, send in your transcripts, and apply for admission as an MS-1...) many PAs have learned to become niche specialists. In general medicine, an MD will likely always maintain a larger fund of knowledge, but it's not particularly difficult for a PA to specialize in a certain area and after a year or two of full-time work be able to run circles around a non-specialty-trained MD in the area. I work in a couple of rather low prestige specialties, so MDs are not clamoring to enter them. If there was an on-the-job pathway for PAs to become physicians, you'd see many take it, but instead, PAs specialize so they can carve out a niche where they're not treated as replaceable parts. Jclemens (talk) 06:23, 11 April 2023 (UTC)

The lead's current form seems unencyclopedic. We wouldn't begin the article on Apple with "An apple is a fruit that many prefer over a banana..." Nor would we begin, "an apple is a non-banana fruit..." The lead should introduce what a topic is, and summarize the main points of the article. What do we think are the key points about "Physician's assistant"? I might suggest (A) They are clinicians, (B) they are defined by having a certain credential that is obtained through X schooling/certification, and (C) their status and scope of practice differs with locality. I find these profession articles are often challenging to write because it's difficult to find decent sources that describe the profession in general. Ditto recent statistics, etc. But let's please not use this article to litigate the (ceaseless, tiresome) disagreements between physicians and PAs (or the organizations that represent each). I'll do some light editing to the lead. Happy to discuss wording, etc. or help look for sources if folks are interested in improving this article. Ajpolino (talk) 03:19, 4 May 2023 (UTC)

Preferred

I've personally never heard a patient say that they prefer PAs. Most don't care, and a few don't want to see them. If the claim in the lead sentence is about healthcare payers, or people in a specific country, or whatever, then that should be made clearer. WhatamIdoing (talk) 02:57, 3 May 2023 (UTC)

Are you in a position where you would expect to hear that? The article says about 25% of Americans queried prefer PAs to MDs/DOs for various reasons. Do you have a capacity to access the article? If not, I can forward it.

Obviously, that needs to be actually cited down lower in the article, but it's a citation-based reaction to the US/UK and PA/MD difference of opinion on how PAs should be represented. To the folks from the UK, who only just got PAs, I don't begrudge you not understanding the model and where it's headed, but I have absolutely no interest in the entire profession being falsely labeled non-doctoral (thousands of PAs have earned doctorates in many fields and disciplines) or having the status of 'medical professional' disputed (average PA compensation is running at about $120k/year now) by editors who haven't got a global perspective on the profession. Furthermore, MDs editing the article to make PAs appear less competent or capable has elements of conflict of interest. Fact is, in the United States, PAs and Nurse Practitioners are replacing primary and specialty physicians, and the AMA and other physician organizations are trying to thwart a profession that provides many or most of the same services equally safely at far less cost. Jclemens (talk) 07:41, 3 May 2023 (UTC)

I don't feel that that sentence and that sourcing are desirable for this article, even though in my experience in many cases PAs are as well trained and better at interacting with patients. The article opens saying, "A Physician Assistant or Physician Associate (PA) is a type of health care provider. They may be preferred[by whom?] over and perceived as in some ways superior to medical doctors in primary care. According to the source, it should say "preferred by some Americans...", and especially so since the next sentence is speaking globally which adds to the impression that the "preference" and superiority are found world over. It should either be skipped or substituted with something like this from here: [2]

Conclusion: PAs are operational in 15 nations; their acceptance appears successful and satisfaction with their care largely indistinguishable from physicians. Findings from this analysis highlight one theory that when patient's needs are met, satisfaction is high regardless of the medical provider. Sectionworker (talk) 15:59, 3 May 2023 (UTC)

I think folks around me would be happy to be treated by either as well, and haven't given it much thought. Regardless, I don't think the "many prefer" bit makes for good encyclopedic writing. As I allude to above, we're aiming to clearly describe what a PA is, and summarize the main points of the article. The "25% prefer" thing would be a great intro to a position piece titled "PAs are saving American healthcare, and Americans are here for it." Here it just sounds like you are (understandably) fed up with the AMA line. But this isn't really the place to convince people of a position. Just to gently inform. Ajpolino (talk) 03:50, 4 May 2023 (UTC)

If this were Wikipedia:Biomedical information, I think we would all agree that such a source would have to be prefaced with "According to one survey in 2014, some people in the US prefer..."

@Jclemens, I don't think that anyone is disputing that PAs are Health professionals, aka Health care provider#Individual providers. The salary doesn't matter; the difference is just that PAs are licensed and get paid and amateur caregivers aren't licensed and don't get paid. PAs are every bit as much healthcare providers as physicians – and just like phlebotomists and veterinary techs, too. (It's a really broad term.) The only real question is which article should be linked in the first sentence. Having looked at them, either article works for me.

On the broader question, I think that a first sentence that says something like "PAs are HPs that can diagnose and treat diseases" would help distinguish PAs from HPs that have a narrower scope of practice. WhatamIdoing (talk) 14:18, 4 May 2023 (UTC)

I can live with that phrasing. It's the repeated emphasis on "not a doctor" that seems to me to be UNDUE weight. Jclemens (talk) 16:48, 4 May 2023 (UTC)

I don't think we should be referring to "doctors" at all in this article. MOS:MEDLANG says we should "Avoid using the potentially ambiguous term doctor to refer specifically to physicians or surgeons. Avoid using doctor or physician in ways that incorrectly exclude other licensed healthcare professionals, such as nurses, physician assistants, and midwives." WhatamIdoing (talk) 16:27, 5 May 2023 (UTC)

And how you feel about "medical doctor" instead of "physician"? Because I think that, for the general public, "doctor" or at least "medical doctor" is a lot more clear than "physician". Dr. Vogel (talk) 23:17, 5 May 2023 (UTC)

I don't think there are any ideal solutions. "Physician" also isn't great because the UK makes a distinction between physicians and surgeons. It'd be easier to write this in German, which refers to these healthcare providers by their work (=Artzt) instead of by their academic achievements (=Doktor). WhatamIdoing (talk) 02:27, 6 May 2023 (UTC)

And when working for a surgeon, PAs really are assistants in fact, rather than just in name. It's a confusing profession at the best of times! Jclemens (talk) 03:59, 6 May 2023 (UTC)

Discussion of second paragraph of lead

This paragraph needs work, IMO. It begins by saying that in North America PAs can diagnosis illnesses, etc. I don't know about Iceland, but looking for info on Mexico I found a site in which a woman said she was from Mexico, and she had never heard of PAs while she lived there. Then the next sentence reads, " In the United States and Canada, PAs are certified by their respective certifying bodies." It is not sourced. I don't find that sentence particularly meaningful or informative. Perhaps somethi ng from this site [3] or similar would be better. Thoughts? Sectionworker (talk) 20:09, 4 May 2023 (UTC)

I think the entire lead needs to have a worldwide perspective, rather than focusing on any particular country, not even the U.S., which I know and love and which pretty much originated the PA profession as we know it. This is why I'd used relative terminology such as "physicians are trained better than PAs in their country", which is true worldwide, while "physicians are trained better than PAs" is not. Jclemens (talk) 00:16, 5 May 2023 (UTC)

Perhaps "physicians go through more extensive training" would be better than "trained better"? Sectionworker (talk) 01:44, 5 May 2023 (UTC)

Sure, again within the caveat of "in their own country." Otherwise it's an apples to oranges comparison. Jclemens (talk) 06:27, 5 May 2023 (UTC)

I improved the lead and added the following (intro sentence moved and some was retained)

The educational model was initially based upon the accelerated training of physicians in the United States during the shortage of qualified medical providers during World War II. Since then, the use of PAs has spread to at least 16 countries around the world. In the US, PAs may diagnose illnesses, develop and manage treatment plans, prescribe medications, and serve as a principal healthcare provider. In many states PAs are required to have a direct agreement with a physician. In the UK, PAs were introduced in 2003. They support the work of the healthcare team, but are dependent clinicians requiring supervision from a physician. They cannot prescribe medications nor request ionising radiation investigations (e.g. x-ray). PAs are widely used in Canada. The model began during the Korean war and transitioned to the present concept in 2002. Skills and scope of privileges are similar to those in the US.

Everything that I added was deleted by Dr. Vogel saying it was not an improvement. Jclemens and I agree that we should try to be more worldly in our information. I noted that I objected to using the term North America when I found no information on Iceland or Mexico. I find it disheartening that an editor should take no part in the discussion and then object to my well sourced addition. I have reverted his edit and he may bring it to talk for discussion. Sectionworker (talk) 23:43, 10 May 2023 (UTC)

My mistake. I intended to undo the misspelled change to the first sentence of the lead, and because that'd been the first of all your edits, I accidentally reverted all your changes. Dr. Vogel (talk) 07:09, 11 May 2023 (UTC)

About the issue of making it more international, if we're going to keep the whole thing as one article, then that's definitely the way to go. But because there is so much variation, I have always wondered whether we should have 2 articles, for assistant and associate. Dr. Vogel (talk) 07:12, 11 May 2023 (UTC)

You did not say "fix spelling". You said "not an improvement". Now you say you have edited for a misspelling and for clarity. Why do you think that the wording " that recieves postgraduate education in medicine", that you have now removed, is unclear? You did not object to it until I moved it (accidently along with the misspelled word receives), from elsewhere in the lead. Sectionworker (talk) 15:50, 11 May 2023 (UTC)

We've established that "doctor" has different connotations among the anglosphere--is postgraduate education the same way? I think it might. Aren't regular masters' degrees simply graduate degrees, and higher-tier masters' degrees (LL.M., Ed.S., Th.M, etc) considered postgraduate degrees? Jclemens (talk) 18:36, 11 May 2023 (UTC)

Yes, I believe so. And apparently the AMA and the APs are both not very happy with the existing title. [4] Sectionworker (talk) 14:38, 12 May 2023 (UTC)

References

United Kingdom

This has been expanded to include the Scope of Practice position statements which are current in the UK. The main one is included in a collapsed table to save space. TheMouseMen (talk) 16:03, 8 March 2024 (UTC)

"budot" typo

Unsure what budot is supposed to be, but it's clearly not supposed to be "budot"- any idea what it should be? Harryoe the engineer (talk) 19:44, 2 May 2024 (UTC)