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Letters to the Editor

Readers respond to Anna Tielsch-Goddard's guest editorial, "Another Thorn on the Rose," with their own ideas about alternatives to the "midlevel" label.


As a PA entering his 38th year of practice, I read the guest editorial “Another Thorn on the Rose” by Anna Tielsch-Goddard, RN, MSN, CPNP-PC (Clinician Reviews. 2011;21[12]:cover, 2) with great interest. I too feel that the title I carry is clumsy and easily misunderstood. I detest being referred to as a “midlevel” provider for the same reasons Ms. Tielsch-Goddard cites.

I am required to wear a name­tag at work. It reads:

Bud Isbell, PA-C
Staff Clinician

I believe the title clinician sums up PAs very well. Yes, physicians are clinicians; however, they have their title of doctor. That leaves us free to claim the title that so accurately describes us. I am not a “midlevel.” I prefer not to be called a physician assistant; I am a clinician.
Richard “Bud” Isbell, PA-C, Brownwood, TX

I entirely agree with Ms. Tielsch-Goddard’s observations. Besides being a practicing PA in internal medicine, I am also the clinical director of a large multispecialty rural health clinic (which also maintains its own hospital).

My “MD supervisor” likes to quip that he was busy considering whom to take to the senior prom while I was starting my practice. He and most of the others look to me for guidance and consult. I do virtually all the examining, treating, bedside, acute care, and minor operative work and cover in the ED as supervisor when necessary, as well as plan the daily groundwork, sign most of the paperwork, organize staff meetings, etc. So who is the “midlevel” here?

Furthermore, I attended my studies in a medical school setting, sharing the same classes with the MD students, being taught by the same professors, and taking the same exams. In my final year, I took the usual MD courses and did clinicals. I don’t know how it is done these days, but I graduated with the equivalent of an MD yet was still called a PA.

Is the title a political thing or is it real? I have never been able to answer that question. I do know one thing, though. The PA and the so-called “midlevel” designations have always advanced an immediate wall between me and my patients; I have to spend time every day breaking it down in order to do my work efficiently. In the many years I have been practicing, that represents a lot of valuable time wasted.

I will be retiring in the near future, so a name change would be of little consequence to me. But if the profession is really intent on attracting the best and the brightest (especially at a time when they will be most needed on the front lines), a name change will be an extremely significant element in the undertaking! The cost involved will be well worth the investment in the long run.
Larry Rafey, PA-C, Bonifay, FL

I understand Ms. Tielsch-Goddard’s frustration with names and titles. I have thought about this long enough and contemplated many title options, and this is what I came up with. I will be brief.

Medical doctors are called MDs, and PAs work with and are associated with them (at least somewhat). Therefore, why not make the title medical doctor associate (MDA)? I always tell my patients, “I am Doctor Smith’s associate.” My patients accept this title without problems.

The title MDA covers it all. It tells the patient that you work in association with a certain doctor and that the patient is going to get the care that the doctor would have given, without compromise.

This title also tells the patient that, because you are working in association with a doctor, consultation with the supervising MD is probable. This gives the patient some confidence in the MDA’s ability—especially on the first visit.
Habib Rashed, PA-C (Oops, MDA?), Merced, CA

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