Name Shame
Posted by Harrison ReedComment

If Satan wants to torture me in the fiery depths of hell, he should have me complete an endless parade of online job applications. As graduation approaches, I spend more and more time on a job search that often leaves me slamming my face onto my keyboard. There are several annoyances—no place to enter “first available start date,” no option to indicate that I will be graduating, but haven’t yet (I didn’t drop out!) But one of the most troubling and widespread offenses occurs every time I click “search jobs.”

I found there are just too many ways to refer to my profession and that many are misleading or erroneous. Wait, don’t panic. This is not going to be a “PA name-change” rant or a tirade about the possessive “’s” that some people still stick on the end of “physician.” This is about the various terms people use to describe a group of clinicians comprised mostly of physician assistants (PAs) and nurse practitioners (NPs).

I’m not sure why PA/NP requires an alternate term. But whatever the reason, the following terms have gained some popularity and should be banished:

PA/NP Descriptor Hall of Shame

Physician extender: Let’s start with the worst offender, and not just because it assaults the eardrum (and the palate). This term implies that a PA or NP is increasing the reach or length of their colleague/supervising physician. The PA/NP is described as a blind tool that, in the hands of a physician, can be useful to increase his efficiency. The problem is most people store their brain in their skull, not their “right hand.”

Anyone who is familiar with, and values, the PA training and practice knows that we don’t follow algorithms or wait around for orders. PAs that practice at the full breadth of their license and skills constantly make decisions that require critical thinking. Perhaps someone looking to hire a “physician extender” should go to Wal-Mart and buy a step stool.

Midlevel provider: This term doesn’t grate with the same unpleasant tones of someone fired from a marketing job, but I find it much more confusing. I can’t figure out which levels the PA/NP is supposed to be between. Are we in the middle of a nurse and a physician? Certainly not. Nursing and medicine work under two different models and have entirely different training, hierarchy and, most importantly, function. The PA has an immense amount of clinical duties in common with physicians and virtually none with RNs.

While a strict hierarchy may work well in academia—nurses commonly have a bachelor’s degree, PAs generally a master’s and physicians a doctorate—it is dangerous to try to translate that into a clinical ranking. In modern medicine, even a three-tier system would be a misleading oversimplification. Today, many professions with various academic credentials work collaboratively: Social workers (master’s), pharmacists (doctorate), physical therapists (depends) and many others work together without establishing superiority. We shouldn’t relate PAs/NPs to a caste system that no longer exists.

Nonphysician provider: This term is less common than the others but more ambiguous. I can’t argue the term’s accuracy; PAs/NPs are certainly not physicians. It may work well in the hospital’s legal department, but it doesn’t do anything to inform us about the position or job. It literally could encompass anyone at the hospital providing healthcare who isn’t a physician. While this isn’t the worst offender, it is lazy and vague and that is enough to earn my condemnation.

The fact is, all of these terms were created to do a worse job of naming a group of providers that already have names. They are needless at best and, at worst, erroneous and offensive. If a job can be done by either a PA or an NP, the terms “PA/NP” and “PA or NP” work pretty well. Let’s retire these incompetent replacements.

Harrison Reed is the Director for Student Communications for the Student Academy of the American Academy of Physician Assistants and a second-year PA student at Yale University. Read more on his blog, PA-Ssed Out.

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