As I move through training and become exposed to more and more APPs, I do so within the context of the changing landscape of medicine. I did residency in a place where there weren't a lot, and I am now doing fellowship in a place where there are more. In doing this I've been forming comparisons between how it used to be and how it is, but instead of focusing on how things are different I have focused on how they are the same. So I wanted to see if we could get a discussion going in the room about this.
What's the same -and what is the main problem in medicine IMO- is that we see too many patients. Hospitals are too full. Censuses (censes?) are too high. Teams are stretched thin. In Raiders of the Lost Ark there's a quote, "It's not the years, it's the mileage." To adapt that for our situation: it's not the hours, it's the workload.
What I'm seeing is APPs shouldering huge amounts of this workload. Sometimes there are triage systems in place for the types of cases they will get, but more often it is just whoever is open to take a case. You can't give someone such a high workload without expecting them to be able to make some independent decisions, so naturally that becomes part of the job.
So my hypothesis is a mind-numbingly simple one and I'm embarrassed it took me so long to think of it: if you treat someone like an independent clinician, they are going to want to be treated like an independent clinician.
You want someone to run a case behind the curtain in the OR for 99% of the surgery? Yeah they're going to feel and want to be seen as anesthesiologists. You want someone to open, close, and assist through the entirety of the case, and then round on the patient for periop care? Yeah they're going to feel and want to be seen as junior surgeons. You want someone to see 5 consults a day? Yeah they're going to feel and wanted to be seen as consultants.
Medical societies here and there keep explicitly writing this message, to paraphrase, that physicians are the most capable at independent practice and for patient safety. Yet the implicit message is completely the opposite of that. So this is not PAs and NPs wanting to be something they aren't. It's them wanting to be something they are already mostly being! Imagine having the title "physician assistant" only to find you are doing 90% of what a physician does. Do you feel like an assistant? How can we blame them for no longer liking that title?
I'm sorry for the long missive, but its borne out of utter resentment for the administrators trying to squeeze so much work out of all of us. And in doing so, we have these strange little issues pop up that end up breeding dissent in this unique workplace.
"Admins" is a nebulous boogeyman term. I don't know that it's their fault. But I'll tell you one thing, somebody is happy about all this. They are happy about getting someone to do 90% of the work for 50% (or less) of the cost. But instead of using that model to make work easier on us, they use it to get us to work more and generate more profit. We as docs aren't happy about that. The APPs aren't happy. Patients certainly aren't happy. Whoever feels like this is just a fine situation, that's who should be held responsible.
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