The Physician's Assistant

I've noticed a common trend, probably in place for some time. Putting P.A.'s (physicians assistants) at the front line of clinical work to sort through the bulk of patients. There are advantages and disadvantages to this situation. Also, in many or even most cases, for the purposes of this writing, RN-C's (Registered Nurse, Certified), are effectively interchangeable with PA's in terms of quality, demeanor, and purpose that I discuss below.

PA's make on average half the amount of a physician. From a business perspective, the clinic can bill the usual amounts, and make double the profit (generally speaking). Patients are relatively unaware that their "doctor" is a PA, or just accept the illusion of a PA as their "doctor". Their schooling and background differs, though the rules, liabilities, and expectations remain essentially the same.

In my personal experience, I've found working with PA's is a more enjoyable, personable encounter. They seem to vest more of themselves into bothersome issues. They also do not seem as pressured, or rushed (though always very busy). The perception they appear to convey is that they are patient-oriented, not profit-focused. Facial expressions used by most physicians can be described as smug, disdain, or contempt. PA's I find to be warm, caring, attentive, and focused.

The rigid box of reputation and liability physicians are subject to also applies to PA's. However, they seem more graceful when operating within the imposed limits. They are perhaps not as flexible to venture into the fuzzy grey out-of-the-box area that an experienced, seasoned physician may walk. Conversely, PA's seem to consider the concept of How We Can, vs Why We Can't, as physicians seem to get stuck in, exploring options that are akin to "smelling the roses", versus "being chased by a rolling boulder". Outrun or get-out-of-the-way. Amazing what taking a moment to breath does in terms of quality.

The applied quality of How We Can appears to be highly determined by a patients' presentation and tenacity. PA's will likely take a more conservative approach, initially offering mild solutions, OTC recommendations, and sensible advice, before kicking into high gear to get the job done right. Most physicians, on the other hand, require a great deal of verbal convincing, going through unnecessary Rx's and treatments, ping-pong referrals, and anecdotal evidence before reluctantly advancing moderate treatment plans. Where physicians seem to need a firetruck's worth of alarms and crisis to provide advanced care, PA's can put some grease into those squeaky physician gears.

Overall, I find PA's to be a friendlier, more capable resource than most physicians. Reduced pressure makes a lot of difference.