Talk:Physician assistant/Archive 3

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Archive 3

The article is confusing and doesn’t make it clear that these people are not real doctors

I’ve never heard of this profession before. It doesn not exist in the country i live in. The article is very confusing and doesn’t make it clear beyond doubt that these people are in fact not doctors. I had to google it and read a bit about the subject to really understand the real role of this profession therefore rendering the article effectively useless. Maybe add a topic about the on going debate about the actual role of these people and the health insurance firm’s lobby towards precarization of american health care to reduce cost and increase profit. 186.228.227.24 (talk) 04:54, 21 December 2022 (UTC)

I think your point of view is really valuable as you'd never seen this article before and you didn't know what PAs are. Perhaps a sentence in the lead clarifying that PAs are not doctors is warranted. Dr. Vogel (talk) 13:20, 21 December 2022 (UTC)

Absolutely not, for the simple reason that it's not true. Many PAs are doctors, and I will be in seven months, barring something untoward happening. I won't be a physician, a holder of an MD or DO degree, nor licensed in my state as a physician or surgeon, but I will be the holder of a doctoral degree in the medical field.

Now, if we want to replace "mid-level provider" with "non-physician medical practitioner", I think that would be a very positive change. Mid level is widely considered pejorative (Phillips, William R. MD, MPH. PA: Provider or professional?. JAAPA 35(12):p 8, December 2022. | DOI: 10.1097/01.JAA.0000892744.97285.d3) even though WHO apparently uses it. Non-physician medical practitioner seems to kill two birds with one stone: It's accurate, clear, and neutral. The "mid level" verbiage can be covered in the body somewhere rather than featuring in the first sentence of the lead. Jclemens (talk) 19:48, 21 December 2022 (UTC)

@Jclemens, how does that work? In the UK, if you're a PA and you want to be a doctor, you have to go to medical school. Dr. Vogel (talk) 02:50, 22 December 2022 (UTC)

It's semantics. The regulated term in most U.S. states is "physician"--anyone with a doctoral degree can introduce themselves as a doctor, even in medical contexts, as long as they don't claim to be a physician. California doesn't allow this, and a Nurse Practitioner was recently fined by the state for posting "Dr. Such-and-such" advertising. PAs are late to the party here--when I was in PA school >10 years ago, my former Physical Therapist now DO preceptor was not happy that a physical therapist holding a DPT had left him a voicemail introducing himself as "Dr. so-and-so." It gets worse--naturopaths are billing themselves as "naturopathic physicians" and podiatrists as "foot and ankle surgeons."

Now, somewhere about 5% of PAs in the US do end up going back to medical school, but I'm not going to be one of them--Even if I wanted to take that economically-questionable step, I'm simply too old to survive residency's sleep deprivation. Besides, I'd have to shutter my practice, which would be devastating for some of my patients.

So you'll note that one thing I didn't say I would be doing is introducing myself to patients as "Dr. Clemens"--enough of them call me that already, no matter how many times I correct them. They'll just be less wrong once I have an earned doctorate. Jclemens (talk) 03:23, 22 December 2022 (UTC)

@Jclemens, thank you for taking the time to explain this, I had no idea that the system in America was so complicated. In the UK, you almost never hear the word "doctor" as a noun to refer to anyone who hasn't gone to medical school. If you say "Dr. Smith", the person may be a doctor or have a PhD (or both), but if you say "Sam Smith is a doctor" that almost invariably means that Sam has gone to medical school.

We can't rely on the word "physician" to do the job. For at least 3 reasons: 1) it's far less common than "doctor" (at least in the UK), 2) a lot of people may confuse it with "physicist" (believe it or not, it's happened several times to me that I said "physician" and somebody thought I meant "physicist", and 3) there is a distinction between physicians and surgeons, i.e. when somebody becomes a surgeon you don't tend to call them physicians anymore.

I was able to follow your explanation because I have a reasonable amount of background knowledge about this. But I worry that we're not making things clear enough for lay members of the public reading the article. Dr. Vogel (talk) 23:57, 23 December 2022 (UTC)

Food for thought, indeed. While US/UK vocabulary seems to be blending (Personally, I despise vaccination being referred to as a 'jab', but I'm sure we Americans have polluted UK-English with far worse), we do need to be able to be both accurate and understandable in each English-speaking context. As a side issue, lots of the terminology applied to PAs is considered pejorative and demeaning among US PAs, like the term "mid-level provider": even though attested, it is somewhat devoid of intrinsic meaning. Mid-level between what and what? Hence, you're going to see a preference for terms like advanced practice provider, or non-physician provider in lieu of mid-level. There's also political issues like who gets to be on a hospital board or medical staff, and what non-physician medical professionals get to be included. Do pharmacists? Optometrists? Physical therapists? Patient transporters? Obviously I'm being facetious on that last bit, but there's a lot to go into. Then there's the level of collaboration--Israeli PAs, who aren't covered in our article yet, only work in ERs cross-staffed as physicians. I work in a context where I've never personally met any of the doctors with whom I collaborate--I may see them on Zoom weekly, and be able to text them as needed, but it's a very different level of collaborative care. In my case, I'm entirely dealing with an outpatient clinic, and most of what I do is care of long-term injured workers, which is a pretty thankless but relatively low-risk facet of medicine. So, I plan on adding more material to the article and reorganizing some of it, in preparation for maybe breaking out some of the bigger nations, like the US, into summary style sub-articles, which may be the best way to address these issues. Jclemens (talk) 01:15, 24 December 2022 (UTC)

Semi-protected edit request on 22 December 2022

Under the Nomenclature section of this page, the official title of the United States Physician Assistant should be changed to Physician Associate.

In accordance with the The American Academy of PAs (AAPA), the official title of the profession in the United States is "Physician Associate." This change occurred on May 24, 2021 when the AAPA House of Delegates passed a resolution affirming “physician associate” as the official title of the PA profession by a majority vote of 198 to 68. While this is the official title nationally, utilization of this title may vary on the state level based on state bylaws and policies. Historian (talk) 17:16, 22 December 2022 (UTC)

Thank you for bringing this up. In the UK we call them "physician associate". If that's going to be the name in America as well, is there any reason why we can't move this article to the title "physician associate"? Dr. Vogel (talk) 00:00, 24 December 2022 (UTC)

The US is in a weird middle-ground. All the state laws and most of the organizations still have "Physician assistant", while the official name of the profession has been changed by its professional organization (the AAPA), it's not enshrined in law at either the state or federal level yet. I think it would be reasonable to state that physician associate is at the UK level, and aspirationally in the US, but that physician assistant is normative in US and Canadian law. Jclemens (talk) 01:18, 24 December 2022 (UTC)

 Done Aaron Liu (talk) 22:00, 2 January 2023 (UTC)

References

Semi-protected edit request on 29 January 2023

please change mid level provider to advance practice provider. Physician assistants/associates do not offer mid level care. 2600:6C67:237F:75DE:E58D:53D0:4607:89C2 (talk) 20:36, 29 January 2023 (UTC)

 Not done: please provide reliable sources that support the change you want to be made. ScottishFinnishRadish (talk) 20:42, 29 January 2023 (UTC)

As much as I agree that the term is perceived as pejorative, it's a WHO definition. Jclemens (talk) 22:44, 29 January 2023 (UTC)

Semi-protected edit request on 9 February 2023

Mid-level provider is not an appropriate description and should be changed. See supporting document

https://www.aapa.org/wp-content/uploads/2018/12/How_to_Talk_about_PAs_FINAL_December_2018.pdf 2603:8001:2900:71C4:CF4:8F90:81D6:6BA8 (talk) 03:11, 9 February 2023 (UTC)

 Not done for now: the AAPA is likely a biased source on this question, and the current description is used by several of the sources already linked in the article. Can you provide a more neutral source? small jars tc 17:26, 9 February 2023 (UTC)