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A title fight pits physician assistants against doctors

Jordan Rau, Kaiser Health News on

Published in Health & Fitness

After 23 years as a physician assistant, Leslie Clayton remains rankled by one facet of her vocation: its title. Specifically, the word “assistant.”

Patients have asked if she’s heading to medical school or in the middle of it. The term confounded even her family, she said: It took years for her parents to understand she did more than take blood pressure and perform similar basic tasks.

“There is an assumption that there has to be some sort of direct, hands-on oversight for us to do our work, and that’s not been accurate for decades,” said Clayton, who practices at a clinic in Golden Valley, Minnesota. “We don’t assist. We provide care as part of a team.”

Seeking greater respect for their profession, physician assistants are pushing to rebrand themselves as “physician associates.” Their national group formally replaced “assistant” with “associate” in its name in May, transforming into the American Academy of Physician Associates. The group wants state legislatures and regulatory bodies to legally enshrine the name change in statutes and rules. The association estimates the entire cost of revising the profession’s title will reach nearly $22 million.

Rechristening the P.A. name has spiked the blood pressures of physicians. They complain that some patients will wrongly assume a “physician associate” is a junior doctor, much as an attorney who has not yet made partner is an associate. The head of the American Medical Association warned that the change “will undoubtedly confuse patients and is clearly an attempt to advance their pursuit toward independent practice.” The American Osteopathic Association, another group that represents doctors, accused the P.A.s and other nonphysician clinicians of trying “to obfuscate their credentials through title misappropriation.”

In medicine, seemingly innocuous title changes are inflamed by the unending turf wars between various levels of practitioners who jealously guard their professional prerogatives and the kind of care they are authorized to perform. Just this year, the National Conference of State Legislatures catalogued 280 bills introduced in statehouses to modify so-called scope-of-practice laws that set the practice boundaries of nurses, physician assistants, pharmacists, paramedics, dental hygienists, optometrists and addiction counselors.

 

Lawmakers let North Carolina dental hygienists administer local anesthetics; permitted Wyoming optometrists — who, unlike ophthalmologists, do not attend medical school — to use lasers and perform surgeries in certain circumstances; and authorized Arkansas certified nurse practitioners to practice independently. The physicians’ lobby aggressively fights these kinds of proposals in state legislatures, accusing other disciplines of trying to incrementally horn in on things doctors claim only they are competent to do.

Physician assistants, as they are still legally called, have been steadily granted greater autonomy over the years since 1967, when the Duke University School of Medicine graduated four former Navy medics as the nation’s first class of P.A.s. Today they can perform many of the routine tasks of doctors, such as examining patients, prescribing most kinds of medications and ordering tests. In most states, all that usually happens without the need for a physician signoff or having a physician in the same room or even in the same building. The profession is pressing for more: it wants to abolish state mandates that P.A.s must be formally supervised by physicians or have written agreements with a doctor spelling out the P.A.’s role.

Generally, a P.A. master’s degree takes 27 months to earn and includes about 2,000 hours of clinical work. By comparison, family physicians usually attend four years of medical school and then do three-year residencies during which they clock about 10,000 hours. (Specialists spend even more time in residencies.) Nearly 150,000 P.A.s were practicing in 2020 in the U.S. Their median annual pay that year was $115,390, slightly above the $111,680 median pay for nurse practitioners, who perform jobs similar to P.A.s. The median annual pay for a family physician was $207,380.

P.A.s aren’t alone in losing patience with their titles. In August, the American Association of Nurse Anesthetists renamed itself the American Association of Nurse Anesthesiology — its third name since it was founded in 1931. President Dina Velocci said the term “anesthetist” baffles the public and is hard to pronounce, even when she helps people sound out each syllable. (It’s uh-NES-thuh-tist in the U.S. and indicates a registered nurse, usually with a bachelor’s degree in nursing, who has then received several more years of education and training in anesthesia.)

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