THE FUTURE IS NOT QUITE SO BRIGHT …
While I enjoyed the futuristic visions of Randy Danielsen in his editorial “2025: A Health Odyssey” (Clinician Reviews. 2012;22:cover, 22, 27-28), I find two of his predictions unlikely to occur.
First, I do not believe the average patient will be able or willing to accept a full role in the health care team. For all the patients who have adopted the idea of preventive care, there are still many who have no interest or willingness to modify their lifestyle choices or cooperate with their health care provider. Some of the nicer areas of the country may be able to fulfill Dr. Danielsen’s fantasies, but there will still be many that will require something resembling today’s archaic model. I believe it will take many more years before we can educate the populace and create the sensible and efficient environment imagined.
Second, Dr. Danielsen is living in a fantasy world if he truly believes all it takes is “a simple stroke of a pen” to effect a name change for the profession. The legislative repercussions, public education efforts, and other expenditures of time and energy would be massive and prolonged—not to mention the financial burden that would have to be borne by the profession. I have found that most patients either know us simply as “PAs” and accept us regardless of what the initials stand for, or oppose the midlevel practitioner concept and would reject NPs and PAs even if we were titled Grand Poobahs of Medical Wisdom and Excellence. Many patients can’t even spell practitioner or assistant.
A name change, in reality, would be of little benefit to the profession (except to soothe the egos of a few unhappy physician-wannabes), and would waste time, money, and effort that would be better spent on other endeavors, such as educating the general public as to what a PA or an NP is and can do. I supported the title change to associate when I entered training in the 1970s but see no need for it in today’s environment. While this title change may yet occur, it will come at a great cost and with great difficulty, not a fantasy stroke of a pen.
Still, overall, I found the article interesting and appealing. I hope that we are able to create a health care environment resembling it within my lifetime. If it weren’t for the interference of the insurance companies protecting their own interests and excessive profits, and the politicians (of all parties) who would rather fight than do their jobs and work to help their constituents, health care could someday move much closer to this ideal. Let us all do our best to help it come to pass.
Rick Boldman, PA, Lake Orion, MI
I LOVE MY JOB, TITLE AND ALL!
In response to the ongoing discussion of PAs, NPs, and job titles, here are my thoughts: I love being a nurse practitioner, and I am proud to be called an NP. I also have a physician assistant license, and I love being that too! I don’t mind the title at all. In fact, I think any effort to change our “brand” would undermine more than 40 years of efforts to establish our professions’ identity.
I understand the frustration of many of my comrades. I, too, am unhappy with the prejudice I often sense from physicians, hospital staff, and even patients—and it seems slower than a snail’s pace to get legislation passed to free us of unnecessary limitations on our practice. But through it all, I feel so lucky that as an NP/PA I am allowed to touch others’ lives in such an important way.
For those who seek clarification of our status through title, I would ask them to review how they came to the conclusion that changing a title would somehow achieve the status they feel is necessary. Every suggestion for a title change that I have seen to date would not, in my opinion, convey a message to patients that NPs and PAs are anything other than “midlevels.” Quite truthfully, even if some title could be identified and agreed upon, would it change the way patients view our profession or qualifications to care for them? My 23+ years of experience in primary care says no. But more importantly, during those same years, I was able to establish a medical practice collegially with a physician partner, which has flourished in spite of my title.
NPs and PAs: if you’re involved in direct patient care, I don’t think it serves any purpose to fret about what they call you. Once a patient knows that he or she can trust you … he/she will.
MDs: If you’re concerned that a change in title for NPs or PAs might somehow mislead patients, perhaps you should remember that it was MDs who created both the NP and PA professions, because they recognized that eventually there weren’t going to be enough primary care physicians. They proved to many skeptics that about 80% of primary care could be handled by medical professionals—such as nurses, medics, and emergency technicians—with additional medical training.
The problems that all medical providers are facing, in the end, are not about title, duties, or reimbursement. The main problem is simply that the American people deserve the best medical care in the world, and we don’t have enough providers to maintain the level of medical services they require. We will fail in our sacred charge if we don’t work together to solve this problem.
Whatever your title, I urge you to remember how fortunate you are to be in the position you are in. Sure, you worked hard to achieve that position. But is the title you were given after your long struggle the real “prize,” or was it the opportunity to participate in such a noble profession?
Matt Freitas, FNP-C, PA-C, Modesto, CA