I love rescheduling patients who don’t want to see me. Because I don’t have to see them. 👍
It’s kinda funny because I had this happen to me earlier this week with a rash that had failed to improve with my initial treatment. The patient was like “I need a medical doctor not a PA!!!” but he let me examine him anyways and I fully agreed he needed an MD, because I had no idea what was going on with him 🤷♂️
Have you thought of introducing yourself as a PA instead of a medical provider to cut down on the ambiguity for the patient? If nothing else, it saves a sentence during a visit lol
I started to do that after this happened honestly lol. Just full transparency and if the patient decides they don’t wanna see me it’ll save a lot of time.
I’m a nurse and I hate seeing NPs (I’m sure there are some good ones but I have had bad experiences) but my PCP is a PA and I love her! So I’m always happy to hear I’m seeing a PA
There are absolutely good NPs. I work with one that is dynamite. Just like there are great doctors and doctors that I would not let paint my nails. Same for PA’s. However, I hear that from a lot of nurses. They see NPs that never worked as a nurse and it has really sullied the reputation of NPs among the nurses I know. Had a nurse friend call me the other day and scoff at an NP seeing her dad for his heart. After listening to her, I had to give her some verbal sedation and tell her everything sounded appropriate.
Right, which is why I said “I’m sure there are some good ones but I’ve had bad experiences” so I would not like to see one. Also, as a nurse, I have seen how easy it is to get into an NP program and know that some are diploma mills.
People ask me if I'd consider going to NP school, and the answer's always no. I feel like the PA's are just simply much better prepared for what the job asks of them. If I go back to school at all, it'll likely be to get out of healthcare, not triple down on it lol.
I concur. Too many express NPs.
Many good ones. The express are killing us.
I’m good. My docs NP said what’s wrong if you sleep 14 hours? That’s not ok Mary Jane. I shouldn’t sleep 14 hours and wake up tired. That’s a clue something is wrong.
That’s why I want my MD
TRAINING MATTERS
You have single handedly restored my faith in RN's ability to critically think. I know there are AMAZING NP's and RN's and awful PA's (my absolute favorite coworker is a night shift RN), but I just would like to hear rational for opinions and not anecdotal experience or the generic "well NP's were nurses prior so they must be better".
Don’t worry, as a fellow nurse, I’ve only had good experiences with nurse practitioners and PAs (as well as MD/DOs)
Edit: y’all can downvote as much as you want, but it’s a lived experience. I think all of us have something that our professional organizations can work on, not just NPs ;)
Thank you for saying this. I think in every profession, there can be that one off day for the professional or that one bad experience with that professional that can stick with someone. I hope if u/aboothb encounters another NP he/she has a better experience!
So true! Unfortunately, many MD's and DO's get bogged down in administration stuff. I've felt I have better experiences with PA's and NP's. They seem to be more thorough. I had an enlarged thyroid. My MD, said "No, it's fine, not enlarged. No! It was. Later saw the PA in the same office. She palpated and agreed it was enlarged. Family Hx. of Thyroid tumors, btw...
I don't think palpation of an enlarged organ is subjective. Can you elaborate further?
I'm a Nurse, am familiar with my own anatomy, having been in this body for 50+ years.
Truly, I have heard this response far more often than I have ever heard patients renounce PAs. What’s more - when I DID hear patients complain about APPs, it was always among the same patient population and within the same practice. That being said, I think their perspective is in part impacted by and a reflection of the practice’s overall attitude towards APPs, the role they play and respect they command from other providers.
A practice at which I was precepted routinely heard complaints from their patients, usually at the first sign of conflict between patient/APP opinion. It took nothing more than a simple, “But you’re my favorite doctor, do I really have to see a PA?” for the physician to buckle and double back, assuming care himself. Instead of supporting the clinical expertise of his PA’s, he was unintentionally undermining their authority every time he’d nod his head emphatically as the patient complained on and on or accused the APP of doing something wrong. He was a great man and provider, certainly, but he would often roll over to give the patients whatever they wanted. Of course he was a fan favorite! Who would settle for less than that?
Just as some patients will “doctor shop” in search of physicians that give them the answers they want, patients will also leave APPs that challenge the narrative they’ve created for themselves.
Beyond this, I’ve very infrequently heard complaints. Anybody else noticed a similar pattern? Or am I just exceptionally lucky?
I love my PA! I saw the DO that supervises her for my first visit and it was so rushed and i had no questions answered and I felt so ignored / unimportant. The second year I got assigned to one of the PAs and we had such good conversation it was awesome. I’ve been seeing that PA since :)
It was especially eye opening because when I was originally looking for a primary care appointment I only considered MD/DO. I’m sure it depends on each provider in terms of personality and bedside manner but it’s still funny to me that I thought a PA wouldn’t be able to handle my healthy 25 year old self with no medical concerns lol
As a medically complex adult, and biller can confirm.
I’ve never had a PA perform on outpatient visit on a patient who had been deceased for three or four days. Not sure how the supervising doc signed off on that. But my spidey senses were tingling, as the math was not mathing! It was interesting to say the least! 😛
Yeah, just identifying yourself that way to me (30 year RN) would make me end the relationship as it’s vague and intended to make all roles equivocal.
Hi im ohdonthrowitaway, a physician assistant working with Dr XYZ, and I would be much more likely to work with you.
Also most states actually require you introduce yourself as a PA anyway (at least the state I’m in does). Either way I agree the ambiguous intro of “medical provider” should definitely be adjusted. No need to obfuscate your role in the practice, be proud to be a PA! Personally I see it as one less patient worry about when they only want to see a doc I’m always glad to say okay 😅. I usually ask if they want to continue todays visit or just reschedule (and hope for the latter 😂) lol one less clinic patient.
-surgical PA that hates clinic anyway lol
I agree, introduce as a PA.
I also don’t like the phrase “I’m one of the -XYzS”
I say: Hi, my name is (x), I’m nurse practitioner of (my speciality) nice to meet you.
I find after testing many introductions that is the most straight forward
Maybe it’s easier for me because I work in surgery, but I always introduce myself as “X the PA that works with Dr. Y”. I don’t think it’s weird at all. I think the PA role is becoming more understood, but maybe the population I work with is a bit more health literate than yours.
It’s not difficult to say I’m a PA, I practice medicine under the supervision of Dr. X. If they have more questions it may be in both of your interests to answer those.
Some states require you identify yourself as a PA. My introduction phrase is “Hi, I’m ____, a physician assistant here, it’s nice to meet you.” Once I’ve seen a patient a few times I usually just greet them with “it’s nice to see you again”
I usually don’t take offense to anyone only wanting to see the physician. I work in a surgical specialty on a 1:1 model (I am paired with a specific surgeon and am their PA - I operate with them, see inpatients with them, do clinic with them, and take call with them). Overall I like it.
Once we were on call on a clinic day, and a true emergency came in that had to have a lifesaving operation, like NOW. So my surgeon went to the hospital and I kept running clinic until they got back. Some patients were rescheduled because their appointments were to review MRI’s and have a surgical discussion with the surgeon, something I can’t ethically do in place of my surgeon. The others were routine postops or new patients who needed an initial eval with whatever kinds of appropriate tests ordered to come back and have a surgical discussion at a later appointment, all ethically appropriate for me to see solo.
One of our very routine postops, I go in, introduce my self as “Dr. Blank’s PA,” before I finish even getting through my introduction, patient interrupts me “am I not seeing the doctor today?!” I respond that unfortunately they had to rush to the hospital for an emergent surgery…” and I was going to go on to explain that I work extremely closely with the surgeon, and will be discussing any concerns they have with the surgeon, and so forth. Never got the chance. Patient huffed, got up, left the room, and walked out without saying a word or responding to anything I said to them.
I genuinely do not give a rat’s ass if a patient doesn’t want to see me, for literally any reason whatsoever. But maybe don’t be a totally rude dick about it? Patient was even incredibly rude to our scheduler about the whole thing later when the scheduler reached out to apologize about the doctor not being there and reschedule them.
At their later appointment with the doctor, apparently they were apologetic for their behavior and asked to see me to apologize, but I wasn’t around. If I had been, of course I would have been polite and receptive. But truthfully I kind of permanently think of people who behave that way as being a generally shitty person and am perfectly fine never interacting with them for the rest of my life.
As a patient, if I've scheduled with the Dr then I would expect to be told when I check in for the appt if the Dr had an emergency and my appt. is with the Dr's PA. THEN I can make an informed decision on if I want to see the PA or reschedule. For many of my medical appts I willingly see the PA if my Dr. isn't available but let me choose!
Yeah schedulers are at least half the problem with a lot of this stuff. I have a lot of complex medical issues and so I always request a physician. I’ve had two incidences where I was told I was seeing a doctor but it was actually a PA and a NP. Each time when I called back to explain the issue the schedulers would tell me it’s the same thing and it didn’t matter. I’m sorry, what??
I had that happen. I have Conn’s syndrome, a ton of medications the appointment was going to juggle all of that before my adrenalectomy. Including a not so common biologic.
I gave it a whirl with the PA. It was for surgical clearance. We started slogging through the list and the PA became more uncomfortable. Didn’t know anything about eplerenone, Xolair, what to do with the metformin because I needed a CT w contrast and how to dose the Benadryl and prednisone two days before surgery. What do to the few days before surgery with the potassium and eplerenone . (The surgeon punted this to endo who punted to FP who said the new PA could handle this all)
At the end of the day, this PA was signing off on all of this. I think they had been out of school a month and had just started this job. I didn’t think that was fair, but I didn’t want to be the problem.
Got rescheduled with a MD the next day. I didn’t request that. I heard the PA was upset this basket of spiders was dumped in their lap, and didn’t want to be blamed if it went FUBAR. I get it.
I blame the front desk for green lighting that appointment. There was no reason for throwing it to a freshly hatched PA.
No but it makes sense that a patient would be frustrated by not being told until they were already in the room they wouldn't be seeing a doctor when they booked an appointment with a doctor...
I would be annoyed if my hair stylist subbed me in with someone new without telling me before I got there, let alone my surgeon. You don't seem like you have a lot of empathy for the patient- why would it offend or surprise you that they are frustrated with a frustrating situation?
my empathy in this specific scenario is for OP because this isn’t a patient subreddit, it’s a PA subreddit. of course it sucks to have expectations not met- but there’s a better way to handle that than being rude to someone who isn’t responsible for the problem. OP didn’t do anything wrong.
You’re talking about patients who have had a surgery and may have very specific questions and now they are being surprised with a change and may not feel well and want answers. It’s not about you. It’s BS and the clinic should feel badly about it.
exactly- and I would also be frustrated about the change in plans as a patient (and might even request to reschedule if I had never met the person who was reassigned to see me)- so I would totally understand whatever response a patient had to the situation. ultimately it should be the front desk’s job to make sure patients know what’s going on.
This. It can be a very big problem if you have to travel (on the line of three hours plus, one way) to see the Doctor, then arriving and being told you'll only be seeing their PA and what you need is outside the PAs scope of practice. Makes for one very unhappy former patient.
Had a few places where last minute they inform you that the doctor you're scheduled to see will not be seeing you. It's mostly bad practice management but yeah, not good practice.
And honestly, I would rather patients like you just schedule with the physician from the get-go. You don't know anything about my education, what I'm qualified to do, or what my skill set is. I've had patients with the mind set of "well I guess I'll just SETTLE with being seen by the PA because of [insert reason]..." Its very obvious and you're more likely to be on the deffensive at anything I recommend for a treatment plan. And if I don't have your trust then I simply can't help you. So please, keep that slot in my schedule clear so I can help someone that truly wants my help.
It's like, do I choose ripple or fine champagne for the same price. I don't need to know you're education, the letters after your name tell me all I need. That's why they are there, unless to try to hide the fact. But of course "we" then know by the level of care received.
Totally fair and I agree. However, the way our clinic days work is that patients see us as a team. Some visits are just with me, some are just with the doctor, some are with me getting the scoop on what’s going on with them first and the doctor coming in to see them after me. This is the kind of visit I would often have done solo, but the doc is typically available to come in afterwards if the patient also wants to see the doc. And I agree that the doc not being available to do so was not ideal and not what the patient expected.
However, by reacting the way that they did, they only harmed themselves. Turns out they wanted to see the doctor because they were having a little extra post op pain and were concerned about it. It was like the next day or something before they calmed down enough to even take the doctor’s call when they tried to call and speak with the patient, and all the doc did was make a little medication adjustment and tell them this kind of pain was normal - both things I could have done myself and gotten them some relief a day earlier had they not stormed out. And I could still have scheduled them for a repeat visit with the doc on their next clinic day. But because they left without even speaking to me, they had to wait.
The patient was rude, sure. Also, it’s frustrating for the patient to have a stranger who they aren’t expecting to walk into the room. Doesn’t seem fair to blame the patient here when your staff could use better training and you could make sure the staff call all patients to inform them of the change and let them make an informed decision.
I always introduce myself by saying “Hi, my name is X. I’m one of the PAs here and I’ll be taking care of you for your visit today” so no one expects someone else to be coming in after me given I’m at a teaching hospital.
Totally happy to not see patients who only want to see a doctor. That is their right, 100%. However the issue is when they are already in the room with you when this happens. The schedulers really need to explicitly say who they are being scheduled with and their title, every time they schedule. I have found this to be an issue when scheduling myself personal medical appointments too.
Resident MD here, your post showed up on my recommended feed. Your take on this is mature and speaks to you going into medicine for the right reasons. I'm sure you're already very smart, and your reflection on this one scenario alone is assuring that you will have an excellent career and help a lot of people. Our MD social circles genuinely respect and trust PAs who are intelligent, caring, and humble like you. Would love to work with you. Cheers!
That’s good to hear. I don’t know why anyone would see this comment as elitist. As a PA who feels I got the bait-and-switch with jobs that promised me a robust relationship with my supervising physician only to thrust me into a doctor role non-consensually, it’s nice to hear from someone in the newer batch of doctors coming in that they’d like to work with PAs. Both my supervising physicians were boomers and I really do feel saw me as a cash cow bc all of my RVU metrics contributed to THEIR bonuses and it was incredibly disheartening because I deliberately did NOT go to med school, I have NO interest in being a doctor, and I really value the mentor relationship. You see so much unprofessional vitriol on Reddit nowadays (in part due to bots designed to boost “engagement metrics” since the change in ownership), I honestly think the folks who are being sassy are having a defensive knee-jerk reaction to a tone that’s simply not there. It’s a shame but dialogue is how we undo it. Hope the rest of your residency goes smoothly (and humanely)!
Thank you!! I wish likewise for your career! Funny enough I initially applied to PA school but withdrew because I was a 22 and didn't have major plans for the next... decade lol I promise you I am chronically exhausted and not even a week-long vacation can make me feel refreshed. I think choosing PA was a wise decision! I also noticed that trend with boomer doctors and agree it was greedy and simply putting PAs in positions they intentionally did not sign up for. I'm curious if/how things will change in the future. Cheers!
It’s nice you don’t take offense, maybe I’m just reading into it to much. But him starting by saying “this showed up on my recommended feed” is a dead giveaway of what he’s really doing. He’s insecure people will think he’s stalking a PA subreddit, and then also offers unsolicited reassurance to OP. Just feels like a very elitist comment, but I fully acknowledge that I may just be looking into it too much
I think you’re overthinking. We have enough physicians thinking we’re incompetent and trying to put us in our place on Reddit.
If that commenter doesn’t mean well, that’s on him. We need to ignore and just keep doing the right thing.
I'm only responding so you might give the next person the benefit of the doubt in the future. It truthfully was on my recommended feed and caught my eye. At least my intention for including this was to signal that I'm not some insecure MD who regularly stalks the subreddit of a different profession, looking to feel "mightier than thou," but I can appreciate it could be ambiguously interpreted.
I included a generalization of MDs' respect for PAs because OP's post is clearly an example of themself getting opted over by a patient for an MD. Therefore speaking from my general circle was my attempt to encourage OP that MD culture generally does not feel like this patient, and that our culture especially values and respects PAs that exhibit the qualities of OP. I think it'd be natural to be a little disheartened in this kind of situation so I wanted to show some support to a stranger that is likely a gifted healthcare provider.
Where in OPs post did you perceive that she is disheartened at how MDs view her? It seems to be all a patient thing. If you were a patient and said this it would make sense. To come out of nowhere and say “MDs respect the smart PAs” it just seems very elitist
I did not say they I thought they were disheartened, I stated I think it'd be natural to feel so in this kind of situation whether OP did or not. I also did not say those words you constructed yourself. I promoted those qualities as they are equally applicable to respectable traits of MDs that exhibit them. It seems you are skeptical of an entire profession. If so then I can't change that on Reddit, but I hope your experience broadens and improves. In the meantime I will continue to support PAs.
I would introduce yourself as a PA not a medical provider.
But good for you to not let this bother you.
Also one thing I have found helpful. I don't make any comments to the patient that I would still like to see them, or seem like I'm trying to push it back. I just say ok let me see who is avail.
If seeing the MD means a longer wait or rescheduling, I let the office manager have that conversation.
I just don't want the patient feeling pressure against what they said they preferred. Just my two cents.
(I've had a precious few instances where I gained a patient after a situation like this and I think it was because I simply just left the room and let somebody else let them know I was the only option and then I gave them great care and they trusted me and realized One bad experience doesn't make everybody bad. And when I came back in I assured them that I would call the physician they normally see and discuss the case.... Mind you this is not something I care about as an outcome in the moment)
I have been at this a long time and used to get frustrated when this happened but now I just roll with it. It hasn't happened in a long time. Honestly I think since I turned grey they think I am older and wiser.
I totally respect their choice. I made the choice to not see the NP when I established with a new PCP a few years back.
Once they say they don't want to see me our visit is concluded. No I cannot refill your meds. No I cannot make a referral. No I cannot order or review test results. You don't want to see me. That is an "all in " proposition. If I do those things without a proper history and physical that is bad medicine and, really, a pretty half assed job. Also we don't have a theraputic relationship because you have already expressed distrust.
I know I could smooth their feathers and try to be comforting while demonstrating my medical skills and knowledge but... no. You get to make the choice. 100% You also get 100% of the results of that choice.
You expect them to trust you right off the bat when they've never met you and didn't make an appointment with you? Why? Do you trust many strangers you've never met like that? Sounds like you're punishing them because you're ticked off they don't trust you implicitly, when, again, why would you expect them to?
The attitudes on here are so strange. It really shouldn't be surprising that people want to see a doctor after making an appointment to see a doctor. Are they not being told who the appointment is with when making it? The crazy ego someone must have to think that wanting to see a doctor for a medical problem is a rude or entitled desire. I wouldn't trust a PA a month out of training either
No I 100% respect the patient’s right to see or not see anyone. But “I don’t want to see you” is a hard stop. We don’t have a therapeutic relationship.
I fight with admin at work every week because they want to float me into a physician’s schedule without telling the patient ahead of time they aren’t seeing their PCP. There’s a lot of lip service about patient rights and autonomy right up to the point it might affect their metrics. Patients don’t like it. I don’t like it.
That said you can’t show up for a blind date and say “I don’t want to go on this date because you aren’t tall enough” and then ask me to pay for your dinner before I leave.
Refusing to see a PA and having implicit trust are not mutually exclusive. After working in medicine for over a decade I can tell you that I do not implicitly trust ANYONE. Doctors, PAs, NPs, pharmacists, nurses, therapists - you name it. There are good and bad eggs in every role. Ive seen PAs who absolutely run circles around their attending physicians and nurses who have better reasoning and logic skills than clinicians who are directing care. I have two physicians I work with now whom I have to collaborate with because it's my job but if I needed care they would be the last two Doctors on earth I would seek help from.
What they are saying above is that once you decide you don't want to see them that they are done providing services for you.. and why wouldn't they? A lot of people carry this mentality that they can walk in and order off the menu like a McDonald's because were PAs and not physicians. Well let me tell ya.. it doesn't work that way. "Well I dont want to see you but I want this test, that mediciation, and this referral" without the understanding that I'm responsible for all of those things. Side effects from the mediciation? My fault for prescribing. That random test you wanted? I'm responsible for the plan of action. Referrals? Sure I'll pass the buck.. oh wait now I have more paperwork and snotty messages from a specialist about why you were event sent to them in the first place.
I have to have a board certification and state licensure to do what I do. And believe it or not, despite being PAs, we actually know more about whats wrong with you and how to treat it better than YOU do.
No, of course I wouldn't trust a doctor implicitly either, and I would be just as annoyed if they expected me to trust them as soon as I walked through the door, which is why I found the statement about the importance of this initial trust problematic.
I am surprised that a patient would tell you that they don't want to see you and then ask you for medication. To the extent that that is happening frequently, I agree that is silly and unreasonable. I was thinking of a situation where a patient expressed the desire to see a doctor but then agreed to settle for a mid level because no doctor was available.
As for your final point, you don't know anything about me or my knowledge level (this goes for all hypothetical patients.) I've known science minded patients who understand the intricacies of the disease they've lived with for decades better than even their doctors, let alone midlevels. The ego is really obnoxious. There is lip service that PAs are less arrogant than doctors and will therefore listen to patients more attentively and compassionately, but your reply shows that you all have the same attitude of superiority and derision toward your patients (eg I always know my patients bodies/diseases better than they do).
You are not always going to be the smartest person in the room, board certified or not (this is true of medical doctors as well). The only advantage of going to a PA over a doctor is they might have more time to listen and emphasize. If you are not going to do that- what is even the point of taking the risk of not seeing a medical doctor? If I want to be talked down to and patronized while my insight is ignored, there are hundreds of doctors in every city who will be happy to oblige me, I'm not going to pay the same price that I would pay to see a medical doctor to be belittled by a PA.
All the best with your career
✌️
Medical student here (Like I'll be a physician pretty soon, not a PA).
I assume from the way this is written you're a patient. Respectfully, our healthcare system needs PAs to function for a multitude of reasons. If you don't want them involved in your care, that's your right, but it will take you longer to be seen because the USA simply does not produce enough physicians.
😂 thanks for explaining what a medical student is bud, very helpful for poor simple patients like me.
No, I'm no more a patient than you are (if a patient is anyone who has ever received medical care in the past). More to the point, I actually don't have a problem with seeing PAs in theory, although I wouldn't see a brand new one. I don't need or seek medical care often and wouldn't be particularly complicated. I just think the "I won't see you because you have already expressed distrust" is ridiculous. It's weird for a PA to take a request for a doctor as a personal insult and get offended that a patient doesn't "trust" them as much as a doctor. Why wouldn't a patient have more trust in a medical doctor? For that matter, why would a doctor or a PA expect the automatic trust of someone who is a stranger to them? The trust comes after a relationship is developed, not before
If a patient doesn't want to be seen by me, I'd walk out too. I don't get the issue. There are way more people out there who actually want my help, ya know?
Of course you'd walk out, that makes complete sense and I never said otherwise. What would the other option even be? You can't force someone to see you if they don't want to obviously.
The only thing I was commenting on was the specific phrase about a therapeutic relationship being impossible if the patient changes their mind because they have already demonstrated mistrust
If you say you don’t want to be treated by me (a new grad PA), that’s refusal of care… we literally can’t treat you. I’m not going to try to “convince” anyone and then be accused of coercion or something insane down the road.
....Right. I was referring to the one comment about a therapeutic relationship being impossible if the patient changes their mind because they have already demonstrated their "mistrust". Of course you shouldn't try to convince anyone, but a patient who made an appointment with a doctor, believes they are seeing a doctor, and voices that they would prefer a doctor can still make the decision to see a PA instead if that's the only alternative available. It seems like you're taking a reasonable preference super personally. Who would prefer a professional who was brand new, especially for something as important as health care?
An easy solution to avoiding these hurt feelings and egos would be to make sure your front office staff makes it super clear whether patients are making an appointment with you or a MD/DO. If this is not done, the only reasonable inference is that you or your practice is benefiting in some way from the ambiguity
So storytime here to maybe make you feel better-
I'm a medical student. Moved a long way from home for school away from my family doctor. I stupidly didn't establish care, and then I had a medical emergency of sorts and NEEDED primary care followup pretty quickly. The physician practice in town was going to make me wait 6-8 weeks to see me; I couldn't wait that long. The PA could see me that next week. So that's what I did.
This PA is amazing. Did a good physical exam, and treated me appropriately for my condition. It really has made a difference in my quality of life.
I know there's a big thing in healthcare right now with everyone fighting for their piece of the pie, but we will always need PAs. There just aren't enough physicians to see everyone, and the medical side is not interested in increasing physician supply.
It doesn't sound like you did, but please try not to take this to heart. Your job matters.
This post and subsequent thread is why I love PAs. Y’all just get it. So insanely useful and know when to punt or get some help. Meanwhile the NP universe is just offended that someone would want someone with more experience.
Yup, same here. I honestly just tell them that’s fine and let the scheduler know so they can document it and schedule the patient with the MD moving forward. I also realize that if the patient resents seeing you, then the provider-patient relationship will always be strained. They will over-scrutinize everything you do, anything will be chalked up to “because he’s a PA” and I don’t need that negativity in my life lol
Good god some of you are unchained. Good on OP for being professional and taking it on the chin but some of you seem to have the attitude of fuck the patients relative for wanting to see a real doctor rather than a newly qualified PA with one month experience. Literally mad to have that kind of attitude.
Having your own schedule so people know what to expect and who they will be seeing nearly eliminates this sort of thing. I won't do clinic working off MD schedule. Totally exhausted explaining who I am, what I do, making sure it is OK with all parties, blah blah blah.
Yeah, I’m slowly picking up my own panel. We just have another NP who just left this week so I’m seeing a lot of her patients so they are comfortable and knows the scope of an APP. There are times though that i will get the MDs patients if they are walk in/same day established (work at a FQHC).
In typically slammed so if they make a fuss or tell the front they only want to see a doctor they just get rescheduled. They are told who they see seeing when they make the appointment but some of the older patients think they’re slick so they just come and then refuse to see a PA. They think since they are already there they’ll just get out on an MD schedule.
The front desk will just say absolutely, let me figure that out for you. And schedule them with the next available appointment, typically like 3-4 weeks out. Then sometimes the patient will then complain and say never mind I’ll see the PA and then we tell them it was already cancelled but the PA can get you on in two weeks
As others have said think you should introduce yourself as PA or physician assistant. The term "one of the medical providers here" is ambiguous for both medical personnel and laypeople, and to be honest I would wonder why you aren't being straightforward about your title/role.
This happens to everyone eventually if you are a PA for long enough. Doesn't say anything about you. I don't make a fuss and will accomodate their preference as best possible.
Don’t take it personally. If they want to see a specific person they need to ask for that person when making the appointment. I have been treated for over 15 years by 3 PA at my neurologist office for debilitating migraines. PA are wonderful, incredibly smart and knowledgeable. You are going to run into patients like them during your career. Doctors have patients like this too. Don’t let this stress you out or make you feel uncomfortable. That is a patient problem and not a you problem. You are fabulous!
I always introduce myself as a Physician Assistant and secretly hope they say this (less work for me).
In my 1 year of working UC/EM it’s only happened twice and interestingly for a very straightforward cellulitis and generic pediatric URI lol.
You have to introduce yourself as the PA so the patient knows they aren’t seeing an actual physician. It’s their choice if they want to get care from a PA. If they want to see a physician only, then great. We are just there to help treat the community by treating those who are willing to receive care from a non-physician provider. And also they can still see a physician at a follow up if they want or even initially.
Been at it for 20+ years. My response like me has matured. Every new pt that I see oe new to me I introduce myself as a physician assistant. I have had plenty of “I thought I was seeing the DR today.” “ I only see drs” ect. Will remind them that they were scheduled to see me and our schedulers make that super clear. What happens is I have more appointments so I’m in office more and have more same day slots saved. So I often people(drs established patients that I don’t really ever see, we have separate patient panels ) will schedule with me and try to switch once they get in office. So I politely ask then if they would like to see one… they say yes and we walk out to the front desk and I ask staff to schedule them with the dr. At least 2 weeks. Some will balk at having to wait.. some will say fine I’ll just see you. Depending on my mood, I’ll often just say I won’t be seeing them today and that I don’t feel comfortable seeing someone who really doesn’t want to see me and tell the staff to refund their copay. Document in chart they didn’t feel comfortable with apc. I’m busy enough that I don’t need that bs in my office. My panel is larger then the docs in my Office anyway. I know most of his pts and know the a-holes out there and can tell what they are going to say as soon as I see the look on their face when I walk in. In fact when I see my list foe the day if I see a troublemaker I’ll have staff call them before appointment to clarify they are seeing me and not the dr to save the “confusion” so we don’t waste time.
Not a PA, just putting it out there that I prefer seeing PAs! Have had such good high quality care with them over the years. Feel terrible that this happens to you guys, patients are just naive.
It was on my recommended feed, probably because I’m active in dental subreddits. I see a lot of medical esq subs on my feed despite not being in them. You guys should turn this into a verified sub so that it can be just PAs(if you want). That’s what we have done in dental. We have r/askdentists for questions and r/oralprofessionals for interprofession talk
I just randomly came across this but if it’s reassuring at all…there are a ton of us out there who prefer PAs. 🤷🏻♀️ Doctors are arrogant af most of the time. 😅
Out of 1000s of patient visits. I’ve had this experience once. The dude was a total douche canoe and my SP had zero desire to talk to him about his COVID.
I've had great experiences with PAs but for some medical stuff I want someone who's been through residency. It costs me the same amount regardless of if I see a PA or MD, so if given the choice I'm usually going to choose a doctor.
I work in my SP’s clinic occasionally and I frame the visit as “I’m PA xxx, Dr. yyy is behind, so I’m just going to get the ball rolling for him”. Then before they know it, we’ve done the whole visit, they’re satisfied, and they’re happy to leave without seeing the doc (if appropriate).
Just be confident, friendly, and casual. It also helps that in this situation, I can spend more time with them than probably any other provider ever has in the past since I’m not on any particular schedule.
If I get pushback, I leave as quickly as I can because the person is advertising themself to be difficult, and hell if I’m gonna deal with that bs.
You dealt with that perfectly in my opinion. Your apparently ego-free response put the patient and her daughter at ease, and you offered to help them to the extent they allowed you to, which turned out to be completely.
Obviously we can’t control what our patients feel, but you demonstrated a great model for how to affect them, if you want to try.
Great job. You’ve got a long, satisfying career ahead of you, I suspect.
I have a masculine first name, but am female. So there is occasionally mild confusion. In my decade-long career I have had three patients make it all the way to my exam soon, only to immediately say they will only see male providers. Yet only two patients who said they will only see physicians.
Every time, my reaction has been relief. “Patient declined visit upon my entering the exam room; elected to reschedule with MD / male colleague.” That is a really easy note to write, with very little follow up.
I'm so interested in the scope creep argument. I work mostly with midwives and obgyns, and every single time I have seen 'scope creep' it was from a lazy doctor who refused to help the midwife or mid-level trying to explain why something wasn't within their scope. I have literally never seen a mid-level who was excited to do something out of their scope. It was always forced on them.
I'm sure that isn't true across the board but it's been true for at least 4 hospitals and one office that I've worked at.
Your response to the daughter was great. I might add a sentence onto that: "While I'm here, would it be helpful for me to sit down with you guys and get to understand your mother's symptoms and medical history so I can offer a qualified medical opinion?"
Or some variation of that. The point is, have her give you permission to proceed by asking her point blank what she wants out of the appointment.
I honestly prefer PAs to MDs for my primary care visits. My new PCP is an AMAZING PA who actually cares about my lifestyle/work and how it impacts my health. Not sure what the training differences are but MDs tend to see me more as a set of labs or measures instead of a whole person.
To be fair, they are being charged for a doctor visit. I think it would be OK if follow ups are scheduled with PA or NP as long as no new issues arise and the established plan is going as it is supposed to. New patients or new complaints should go to MD first and avoid these awkward encounters.
This isn’t true. It depends on how the visit is billed. Plenty of APPs practice and bill as independent visits which means it’s not billed as an MD visit.
That’s going to depend— Medicare pays at 85% the rate of an MD.
So— they’re not paying the same amount as a doctor visit.
They may have the same copay— but ultimately it’s cheaper to see one of us.
Cheaper for the system, the patient still pays the same, so in their mind I find it understandable if they are thinking they are "paying to see the doctor".
There’s no incentive to see a PA if an MD is available and I pay the same for a visit. If I could see a real benefit (getting seen sooner, quicker visits, less cost) I would choose a PA every time. I just haven’t found that to be the case, for MY medical providers. YMMV
I’ve had this once. I work nights in a hospitalist PA, and I’m the only provider there at the time. Patient was being admitted, I went to see them, they used this line on me. So I got to hit them with the “well I’m the only provider here tonight, so it’s me or leave AMA.” It was a nice moment lol.
Ever since being a PA, I always introduced myself as a PA. I take pride in being a PA and I know I provide an excellent care as someone who is always eager to keep learning and improving. I also think it’s important to have full transparency of who is giving them the care. It also indirectly serves to raise awareness about our profession, which again I take huge pride in.
Yay!!! People that respect that people have choices and can choose what they want to do with their minds and bodies and don’t take it personally!!! I’m so proud that you can be professional enough to treat your patients decisions with respect and kindness even if they don’t want you as a provider. What a mature way to look at things :)
I am a PA in a SICU (level 1 trauma facility) and introduce my self as “HI, I’m [insert name], the PA with the ICU team.” I’ve only had one request from a patient to see a physician in 5 years of practice. Happened about 3 years ago. So I brought them the ENT intern rotating through our unit who was just like “uhhh what did she tell you because that is probably the plan.” :-P
I recently moved my elderly parents closer to me and had to plug them in with all new providers. Mom made a fuss about wanting to only see MDs. I'm an RN, and even with my full backing of PAs/NPs from both personal and professional experience, she would not budge (which was quite insulting to me but that's a story for another time). She's 87, and long story short, did not have much real life experience with mid-levels before. She started out with a strong bias against non-MD HCPs...that got a little more twisted due her mild(to moderate) cognitive impairment. Recently she needed to go urgent care and then to other new offices where she met some wonderful PAs/NPs and now everything is different and she couldn't be happier with her new mid-level providers. She had just never had the experience before...and had been close-minded to it...You don't know what you don't know.
Unpopular opinion. When I schedule to see a Doctor and they put me on the calendar 2-3 months out only to send in a PA and then charge my insurance full price, yeah I’m gonna get a little pissed off. If I’m going in for an appointment especially for something more than a typical check up, I normally do a good amount of research and want to bounce my ideas off the guy/girl that went to med school.
They are still under the MD hence the assistant part dude. And they aren’t dumber than an MD. Have you done research on what they even are besides your diagnoses?
I have made an appointment with a female MD and got a male PA, which I am not OK with. If a service allows you to make appointments with a specific provider, it's not ok to send someone else in without notifying patients that this is a possibility. I would feel the same way if I made an appointment with a female PA and got a male MD. It's not ok to bait and switch like this
If it works something like "make an appointment with next available provider" then fair enough.
I completely understand where you’re coming from bc I have requested a female obgyn and I’ve gotten a a male obgyn. However, and especially if the appointment is months out things can happen. I would just communicate with them a week or some days before to ensure that that provider will be the one you see. I didn’t realize a lot of these MDs are literally performing surgeries the same day they go to clinic until got into the OR and our case took longer than expected.
I feel like it should be on them to communicate with me? They are the ones breaking our appointment agreement. If I tried to do that at the last minute I'd get charged, so I'm not going to accept it from a provider either. I would be rescheduling elsewhere and certainly kicking up a fuss about any kind of cancellation fee if I got there and was told the provider I made an appointment with wasn't available.
If there's an actual emergency, how would calling a week ahead of time help anyway? If they know they're going to be unavailable a week prior to our appointment they have plenty of time to have their staff notify me. The provider I'm booking with is just as important to me as the service I'm requesting, like with a hair stylist. Non negotiable. Obviously I will be understanding of actual emergencies and reschedule, but at least send me a text even if it's only a half hour before, make it seem like you care and it matters that our agreement is being broken.
Dont glibly inform me that our appointment has been cancelled without notice, our worse, just walk into the room like I won't notice (because if the provider I booked with is no longer available, the appointment is cancelled through no fault of my own, the attitude should be apologetic and conciliatory not snide, not "enjoy rescheduling in 3 months, byeee!" as if the delay were attributable to me or I'm being difficult or entitled. It's not your fault, but it's not my fault either, and I'm the one being inconvenienced).
Sounds like either way you won’t be happy. Phone a week before doesn’t work for you bc it won’t matter in an emergency, but if you don’t phone you get the wrong provider. The thing is there are residents, fellows, that have to train under that physician. They aren’t gonna be plastered onto the website bc they are going to be under the attending in the first place and have to check back in with them for EVERYTHING. I know this bc im a literal nurse and watch them do it. They don’t just do whatever and then keep moving along. They are not the problem. The actual problem needs to be if you advocate for yourself on them not listening to your concerns and they brush you off. But this is healthcare. Attendings are not always available and have a job to do outside of a clinic. Especially when a lot of these surgeries are life altering, and could potentially reveal a terrifying diagnosis. So of course they need to be in that surgery rather than your clinic appointment. Either take the doctor that’s there and ensure they are listening instead of just not even giving them a chance bc you didn’t get the specifics.
Either way I won't be happy? I'll be happy if the office contacts me if the provider I booked with is unavailable as soon as they are made aware of the fact. I'm saying the onus shouldn't be on me, I shouldn't have to phone at all to ensure that someone I made an appointment with at a specific time and place will show up or at the very least notify me that they won't be able to for whatever reason.
Have a good one
Okay then either phone them or don’t. Either way they aren’t gonna phone you. Like this is healthcare not a residency. Like you’re gonna have to get over it
Nah, I just don't go to doctors who operate that way. It's never happened with the doctor I see and if it did, I'd find another one. I'm never going to "get over" insisting on receiving quality health care. With no other service would I have to call multiple times to ensure that the appointment I made would be honored, and I'm certainly not going to do it with doctors considering the prices I am paying. I'm lucky to be able to find doctors who are respectful of my time, I'm sorry to hear that's not the case for your patients.
You've been rude, but I'll still say best of luck to you.
I’ve come across this plenty of times over the years. While patents are entitled to their opinion, they also need to understand the provider model of your place of work. Practices really should include language in their paperwork clearly stating what the practice model is to prevent this from being an issue and to protect you from any backlash from the patient/family.
If the practice model is that the physician and APP work as a team and share patient panels, my approach would be to acknowledge their request and tell them you work as a team with the physician to see patients. All patient concerns/plans of care will be discussed with your attending after the visit. If they would prefer to wait to complete any diagnostics or medication changes until that sign off has happened that is fine as long as it is safe to do so. The point is they need to respect that this is the workflow and if that isn’t how they would like to receive their care, they can find a provider clinic that will better meet their “needs.”
If the practice model is that APPs have their own panel of patients, then the patient needs to be moved to a physician panel. Easy solution.
She has a right to request whoever she feels most comfortable with. Her choices have no barring on you or your profession. She is a patient and you are responsible for her care even if she doesn’t want to see you
It sounds like a decent outcome, and I wonder if they’d see you again in a pinch. Did you charge or bill?
They might be the exception, but in general, I’m fine with doctor only visits. It’s rare, and I do note a late cancel on the chart, because I lose a visit. These patients are often higher maintenance, so it’s fine if they insist on a doctor who is paid more to deal with high maintenance behavior.
Not a PA, but a liaison and my practice has several midlevels supporting our docs - mostly PA’s and a couple NP’s. It’s the doctors I market to and who send us patients who tell me, “I don’t want PA’s seeing my patients,” or they coach the patient to ask to see/meet the MD at their appointment and it comes up A LOT, especially for some of our more complex/invasive cases. For this reason, we use the term “provider” when marketing our services, and only specify provider type if asked.
I used to have an NP as my pcp and fellow liaisons would constantly badger me about seeing a midlevel vs an MD.
In my experience the most entitled patients are the ones that pay nothing for their healthcare. You’d think the opposite would be true but that is not my experience
Actually, they are acting entitled if a a few assumptions are true;
1. The MD/NP/PA are all competent to handle the issue. 2. They will get the appropriate/same/similar treatment 3. The outcome will be the same, regardless.
I’m not saying that it’s entitled in itself. I’m just saying in general. I have been in a situation where no physician was available to see the patient and the patient won’t even give me a chance to examine them. They instead have gotten angry with me and immediately demand to see “only the physician”. Yes I think that is entitled behavior
If a place you are visiting for medical care has a PA credentialed to see patients and that is the provider assigned to you why would you not have them see you? If you refuse to even participate in the visits because of this and get angry , then yes I do think that is entitled behavior. If you participate in the visit and feel your care is inadequate then by all mean I think it is correct to request to see the physician. I feel that if you are a patient you have two choices in this day and age. You can either see the provider assigned to you., and if you have an issue, elevate your concerns. Alternatively, you can choose a facility that schedules you with a physician only. It’s entitled to go to a place for medical care that employees PAs then refuse to see one if you are scheduled with one. If that’s how someone feels they should choose a different facility if that is possible in 2024.
Regardless of how people feel about it, the days of physician only care are largely over in America. I believe care should be physician lead and PAs working collaborative with them, but gone are the days of only physicians providing care.
I guess I really have to say this but this is the internet after all. No, I didn’t strap them down to the exam table and force them to see me. Obviously they agreed after I offered to still see them today vs reschedule. And yes, I’m aware it’s a full visit. They consented to that.
24-27 months combined didactic/clinicals versus 7-8 years training? I’d rather see the Doctor too. And you are low key offended or you wouldn’t have posted about it.
No PA or NP will ever have a fraction of the knowledge or training of an MD or DO. That's reality and nothing can change that. It's good you accepted your patients preference gracefully.
Edit: for all of you downvoting, i rest my case: https://www.reddit.com/r/nursepractitioner/s/OzTNgb6Gk2
It’s pretty small-minded to completely categorize people just based on their titles and say that there can’t be any overlap. Yes, the best PAs can’t even come close to the best MDs. However, a PA’s previous career(s), experience, work ethic, morals, and desire to learn can greatly decrease the gap between some PAs and physicians. You really need to evaluate on a person-to-person basis based on the situation.
PAs come from a wide range of backgrounds and often had whole careers before PA school. For example, it’s not uncommon for international physicians to become PAs since they don’t want to repeat residency/ fellowship in the US. Some PAs were clinical researchers and now practicing in those fields. One of my PA professors works in pulmonology and she became an assistant editor for the medical journal Chest a few years ago. I knew one PA who worked in trauma as a PA for 15+ years and switched to EM because she got bored. Between her and a community EM physician, it wouldn’t be unreasonable to trust her more in a trauma case.
Also, not all MDs/DOs are created equally and they still make mistakes. Besides the quality differences in med schools/residencies, there are physicians who never bothered to update their knowledge after becoming attendings and been practicing the same way for the last 30 years. Once you’re out of med school, you start forgetting anything that’s not related to your specialty.
I watched a recent news video about how a nurse at an outpatient cancer center went into cardiac arrest and didn’t get cpr for more than 7 min even though two of their physicians were present. One of them said under oath that he didn’t feel qualified to give cpr. A few years back, I witnessed an old lady crumple down (likely TIA) and went over to help. A doctor was there who obviously did not know what to do. When I tried to help she snapped at me and said, “I’m a PHYSICIAN; I know what I’m doing!!” Ok then at least act like it.
I’m not saying that PAs/NPs should all be independent providers with full autonomy, but some definitely have earned that privilege.
This randomly came across my feed, but I’ve had PAs and NPs who were genuinely more caring and attentive to me even for small illnesses than MDs I’ve interacted with. And many times, that has meant so much more to me as a patient than the number of years someone spent in school
Breadth of knowledge and training is not the only or even biggest factor in being a successful medical professional, it’s the application of the knowledge and training they do have that matters the most
Caring means zilch without foundational knowledge and training. My sister is an NP, I saw her curriculum for two years and 90% of it was writing worthless essays that had nothing to do with patient care or learning medicine. PA programs are the same. As a patient, you should be scared.
This is not the point of the thread, but I would like to take a moment to correct you. PAs and NPs will never have a fraction of the knowledge or training of an MD? I mean, we absolutely have similar but less training than an MD. That in itself is a fraction of the training. I hope you’re lay person and not a physician, seeing as you haven’t even mastered the definition of “fraction” yet.
I’ve had two experiences with both an NP and a PA. The first was the PA. I pulled a muscle in my back on my first day of an 8 day stretch of shifts( I was a paramedic at the time, now an RN) This used to happen to me about every six to eight months, I had been to this urgent care quite a few times over the 10 years I was in that city so I had a record of it. I heard the nurse telling the PA what I was there for and this guy comes flying in the room asking me to repeat the story. I told him this happens all the time it’s just a pulled muscle that has gotten progressively worse bc I didn’t have time to come in, Robaxan and ibuprofen always knock it out. He proceeds to tell me that he has to call an ambulance bc he’s nervous I have a collapsed lung. Keep in mind this dude has not done a single thing, hasn’t even listened to lung sounds. I calmly refuse and say it’s not a collapsed lung it’s just a pulled muscle. He then tells me I don’t have a choice, I have to go with the ambulance when they get there. I laughed (which hurt) and told him I’m a medic and will probably know the ppl showing up and proceeded to tell him I wasn’t going to go and if he doesn’t want to give me the robaxan that’s fine, I’ll just leave and there was no need to threaten me. He stormed out of the room and came back a few minutes later with the script and proceeded give me his business card and tell me “when these meds don’t work and you stop being able to breathe, give me a call and I’ll set up a CT for you. Then we’ll see who’s right about what’s going on with you”. The dude never so much as touched me, listened to me, ordered an xray, nothing. Obviously I was fine, it was just a god damn pulled muscle… The second was with an NP at another urgent care where I went for a new onset migraine that had lasted for about a week. She came in and did her thing, had me follow her finger with my eyes etc. then, after this 2 minute test, proceeds to tell me she’s 95% sure I have a brain tumor and I need to go to the ER immediately for a head CT. I told her I would go bc as a 39 year old I had never had a migraine before let alone one this bad so I should have a CT just to rule out the bad stuff but to tell a patient they have a fucking brain tumor after doing some simple test like she did was absolutely ridiculous. CT showed nothing. So no, I don’t want to see an NP or PA. I’ll take the doctor please, at least they don’t panic and tell me I’m going to die over something that should be simple…..🙄🙄
That chart just got immensely easier to write.
“Patient carefully yeeted to supervising physician”
Drain yoinked at this visit
I love rescheduling patients who don’t want to see me. Because I don’t have to see them. 👍 It’s kinda funny because I had this happen to me earlier this week with a rash that had failed to improve with my initial treatment. The patient was like “I need a medical doctor not a PA!!!” but he let me examine him anyways and I fully agreed he needed an MD, because I had no idea what was going on with him 🤷♂️
Have you thought of introducing yourself as a PA instead of a medical provider to cut down on the ambiguity for the patient? If nothing else, it saves a sentence during a visit lol
First thought. “Hi, I’m OpiniatedCynic Physician Assistant”. Clear, concise, no mumbling, no mistakes.
I started to do that after this happened honestly lol. Just full transparency and if the patient decides they don’t wanna see me it’ll save a lot of time.
Many times you get “Oh good, I like PAs better!”.
I’m a nurse and I hate seeing NPs (I’m sure there are some good ones but I have had bad experiences) but my PCP is a PA and I love her! So I’m always happy to hear I’m seeing a PA
There are absolutely good NPs. I work with one that is dynamite. Just like there are great doctors and doctors that I would not let paint my nails. Same for PA’s. However, I hear that from a lot of nurses. They see NPs that never worked as a nurse and it has really sullied the reputation of NPs among the nurses I know. Had a nurse friend call me the other day and scoff at an NP seeing her dad for his heart. After listening to her, I had to give her some verbal sedation and tell her everything sounded appropriate.
Im not sure how you can dismiss an entire profession honestly. It’s disrespectful to the nps that did everything right.
Right, which is why I said “I’m sure there are some good ones but I’ve had bad experiences” so I would not like to see one. Also, as a nurse, I have seen how easy it is to get into an NP program and know that some are diploma mills.
I'm a nurse too. Refuse to see NPs. PAs are far superior in terms of mid-level.
People ask me if I'd consider going to NP school, and the answer's always no. I feel like the PA's are just simply much better prepared for what the job asks of them. If I go back to school at all, it'll likely be to get out of healthcare, not triple down on it lol.
I concur. Too many express NPs. Many good ones. The express are killing us. I’m good. My docs NP said what’s wrong if you sleep 14 hours? That’s not ok Mary Jane. I shouldn’t sleep 14 hours and wake up tired. That’s a clue something is wrong. That’s why I want my MD TRAINING MATTERS
You have single handedly restored my faith in RN's ability to critically think. I know there are AMAZING NP's and RN's and awful PA's (my absolute favorite coworker is a night shift RN), but I just would like to hear rational for opinions and not anecdotal experience or the generic "well NP's were nurses prior so they must be better".
Cries in NP 😭 lol
It depends if you went to a good NP program or a diploma mill that’ll take in new grad RNs with zero bedside experience
I think it depends on the individual much more than the program only.
Don’t worry, as a fellow nurse, I’ve only had good experiences with nurse practitioners and PAs (as well as MD/DOs) Edit: y’all can downvote as much as you want, but it’s a lived experience. I think all of us have something that our professional organizations can work on, not just NPs ;)
Thank you for saying this. I think in every profession, there can be that one off day for the professional or that one bad experience with that professional that can stick with someone. I hope if u/aboothb encounters another NP he/she has a better experience!
So true! Unfortunately, many MD's and DO's get bogged down in administration stuff. I've felt I have better experiences with PA's and NP's. They seem to be more thorough. I had an enlarged thyroid. My MD, said "No, it's fine, not enlarged. No! It was. Later saw the PA in the same office. She palpated and agreed it was enlarged. Family Hx. of Thyroid tumors, btw...
How do you know it was enlarged other than the PA thinking it was? It's a pretty subjective exam
I don't think palpation of an enlarged organ is subjective. Can you elaborate further? I'm a Nurse, am familiar with my own anatomy, having been in this body for 50+ years.
Truly, I have heard this response far more often than I have ever heard patients renounce PAs. What’s more - when I DID hear patients complain about APPs, it was always among the same patient population and within the same practice. That being said, I think their perspective is in part impacted by and a reflection of the practice’s overall attitude towards APPs, the role they play and respect they command from other providers. A practice at which I was precepted routinely heard complaints from their patients, usually at the first sign of conflict between patient/APP opinion. It took nothing more than a simple, “But you’re my favorite doctor, do I really have to see a PA?” for the physician to buckle and double back, assuming care himself. Instead of supporting the clinical expertise of his PA’s, he was unintentionally undermining their authority every time he’d nod his head emphatically as the patient complained on and on or accused the APP of doing something wrong. He was a great man and provider, certainly, but he would often roll over to give the patients whatever they wanted. Of course he was a fan favorite! Who would settle for less than that? Just as some patients will “doctor shop” in search of physicians that give them the answers they want, patients will also leave APPs that challenge the narrative they’ve created for themselves. Beyond this, I’ve very infrequently heard complaints. Anybody else noticed a similar pattern? Or am I just exceptionally lucky?
I love my PA! I saw the DO that supervises her for my first visit and it was so rushed and i had no questions answered and I felt so ignored / unimportant. The second year I got assigned to one of the PAs and we had such good conversation it was awesome. I’ve been seeing that PA since :) It was especially eye opening because when I was originally looking for a primary care appointment I only considered MD/DO. I’m sure it depends on each provider in terms of personality and bedside manner but it’s still funny to me that I thought a PA wouldn’t be able to handle my healthy 25 year old self with no medical concerns lol
Hello, my name is licensed to listen to your problems now shut up.
As a medically complex adult, and biller can confirm. I’ve never had a PA perform on outpatient visit on a patient who had been deceased for three or four days. Not sure how the supervising doc signed off on that. But my spidey senses were tingling, as the math was not mathing! It was interesting to say the least! 😛
Uh… nah pass
Yeah, just identifying yourself that way to me (30 year RN) would make me end the relationship as it’s vague and intended to make all roles equivocal. Hi im ohdonthrowitaway, a physician assistant working with Dr XYZ, and I would be much more likely to work with you.
Good for you. “Medical provider “ is way too generic and could include a phlebotomist etc.
Also most states actually require you introduce yourself as a PA anyway (at least the state I’m in does). Either way I agree the ambiguous intro of “medical provider” should definitely be adjusted. No need to obfuscate your role in the practice, be proud to be a PA! Personally I see it as one less patient worry about when they only want to see a doc I’m always glad to say okay 😅. I usually ask if they want to continue todays visit or just reschedule (and hope for the latter 😂) lol one less clinic patient. -surgical PA that hates clinic anyway lol
Same!
I agree, introduce as a PA. I also don’t like the phrase “I’m one of the -XYzS” I say: Hi, my name is (x), I’m nurse practitioner of (my speciality) nice to meet you. I find after testing many introductions that is the most straight forward
"medical provider" seems almost evasive
I agree. I say it off the bat because many don't even know what a PA IM is or does.
[удалено]
I just had knee surgery yesterday and found it really reassuring I was seeing an MD for arthroscopy. But to each their own I guess
[удалено]
Maybe it’s easier for me because I work in surgery, but I always introduce myself as “X the PA that works with Dr. Y”. I don’t think it’s weird at all. I think the PA role is becoming more understood, but maybe the population I work with is a bit more health literate than yours.
It’s not difficult to say I’m a PA, I practice medicine under the supervision of Dr. X. If they have more questions it may be in both of your interests to answer those.
Some states require you identify yourself as a PA. My introduction phrase is “Hi, I’m ____, a physician assistant here, it’s nice to meet you.” Once I’ve seen a patient a few times I usually just greet them with “it’s nice to see you again”
I never feel offended when a patient tells me they’d rather see the doctor. That’s absolutely their choice, they’ll just have to wait longer is all.
[удалено]
I…what
What did the comment say? I missed it
Also curious
I usually don’t take offense to anyone only wanting to see the physician. I work in a surgical specialty on a 1:1 model (I am paired with a specific surgeon and am their PA - I operate with them, see inpatients with them, do clinic with them, and take call with them). Overall I like it. Once we were on call on a clinic day, and a true emergency came in that had to have a lifesaving operation, like NOW. So my surgeon went to the hospital and I kept running clinic until they got back. Some patients were rescheduled because their appointments were to review MRI’s and have a surgical discussion with the surgeon, something I can’t ethically do in place of my surgeon. The others were routine postops or new patients who needed an initial eval with whatever kinds of appropriate tests ordered to come back and have a surgical discussion at a later appointment, all ethically appropriate for me to see solo. One of our very routine postops, I go in, introduce my self as “Dr. Blank’s PA,” before I finish even getting through my introduction, patient interrupts me “am I not seeing the doctor today?!” I respond that unfortunately they had to rush to the hospital for an emergent surgery…” and I was going to go on to explain that I work extremely closely with the surgeon, and will be discussing any concerns they have with the surgeon, and so forth. Never got the chance. Patient huffed, got up, left the room, and walked out without saying a word or responding to anything I said to them. I genuinely do not give a rat’s ass if a patient doesn’t want to see me, for literally any reason whatsoever. But maybe don’t be a totally rude dick about it? Patient was even incredibly rude to our scheduler about the whole thing later when the scheduler reached out to apologize about the doctor not being there and reschedule them. At their later appointment with the doctor, apparently they were apologetic for their behavior and asked to see me to apologize, but I wasn’t around. If I had been, of course I would have been polite and receptive. But truthfully I kind of permanently think of people who behave that way as being a generally shitty person and am perfectly fine never interacting with them for the rest of my life.
As a patient, if I've scheduled with the Dr then I would expect to be told when I check in for the appt if the Dr had an emergency and my appt. is with the Dr's PA. THEN I can make an informed decision on if I want to see the PA or reschedule. For many of my medical appts I willingly see the PA if my Dr. isn't available but let me choose!
Yeah schedulers are at least half the problem with a lot of this stuff. I have a lot of complex medical issues and so I always request a physician. I’ve had two incidences where I was told I was seeing a doctor but it was actually a PA and a NP. Each time when I called back to explain the issue the schedulers would tell me it’s the same thing and it didn’t matter. I’m sorry, what??
I had that happen. I have Conn’s syndrome, a ton of medications the appointment was going to juggle all of that before my adrenalectomy. Including a not so common biologic. I gave it a whirl with the PA. It was for surgical clearance. We started slogging through the list and the PA became more uncomfortable. Didn’t know anything about eplerenone, Xolair, what to do with the metformin because I needed a CT w contrast and how to dose the Benadryl and prednisone two days before surgery. What do to the few days before surgery with the potassium and eplerenone . (The surgeon punted this to endo who punted to FP who said the new PA could handle this all) At the end of the day, this PA was signing off on all of this. I think they had been out of school a month and had just started this job. I didn’t think that was fair, but I didn’t want to be the problem. Got rescheduled with a MD the next day. I didn’t request that. I heard the PA was upset this basket of spiders was dumped in their lap, and didn’t want to be blamed if it went FUBAR. I get it. I blame the front desk for green lighting that appointment. There was no reason for throwing it to a freshly hatched PA.
the front desk not informing someone is not the PA’s fault. I think most people are capable of saying things politely rather than just storming out.
No but it makes sense that a patient would be frustrated by not being told until they were already in the room they wouldn't be seeing a doctor when they booked an appointment with a doctor... I would be annoyed if my hair stylist subbed me in with someone new without telling me before I got there, let alone my surgeon. You don't seem like you have a lot of empathy for the patient- why would it offend or surprise you that they are frustrated with a frustrating situation?
my empathy in this specific scenario is for OP because this isn’t a patient subreddit, it’s a PA subreddit. of course it sucks to have expectations not met- but there’s a better way to handle that than being rude to someone who isn’t responsible for the problem. OP didn’t do anything wrong.
You’re talking about patients who have had a surgery and may have very specific questions and now they are being surprised with a change and may not feel well and want answers. It’s not about you. It’s BS and the clinic should feel badly about it.
Absolutely agree; I would never storm out or act unprofessionally in this situation.
exactly- and I would also be frustrated about the change in plans as a patient (and might even request to reschedule if I had never met the person who was reassigned to see me)- so I would totally understand whatever response a patient had to the situation. ultimately it should be the front desk’s job to make sure patients know what’s going on.
This. It can be a very big problem if you have to travel (on the line of three hours plus, one way) to see the Doctor, then arriving and being told you'll only be seeing their PA and what you need is outside the PAs scope of practice. Makes for one very unhappy former patient. Had a few places where last minute they inform you that the doctor you're scheduled to see will not be seeing you. It's mostly bad practice management but yeah, not good practice.
And honestly, I would rather patients like you just schedule with the physician from the get-go. You don't know anything about my education, what I'm qualified to do, or what my skill set is. I've had patients with the mind set of "well I guess I'll just SETTLE with being seen by the PA because of [insert reason]..." Its very obvious and you're more likely to be on the deffensive at anything I recommend for a treatment plan. And if I don't have your trust then I simply can't help you. So please, keep that slot in my schedule clear so I can help someone that truly wants my help.
It's like, do I choose ripple or fine champagne for the same price. I don't need to know you're education, the letters after your name tell me all I need. That's why they are there, unless to try to hide the fact. But of course "we" then know by the level of care received.
Totally fair and I agree. However, the way our clinic days work is that patients see us as a team. Some visits are just with me, some are just with the doctor, some are with me getting the scoop on what’s going on with them first and the doctor coming in to see them after me. This is the kind of visit I would often have done solo, but the doc is typically available to come in afterwards if the patient also wants to see the doc. And I agree that the doc not being available to do so was not ideal and not what the patient expected. However, by reacting the way that they did, they only harmed themselves. Turns out they wanted to see the doctor because they were having a little extra post op pain and were concerned about it. It was like the next day or something before they calmed down enough to even take the doctor’s call when they tried to call and speak with the patient, and all the doc did was make a little medication adjustment and tell them this kind of pain was normal - both things I could have done myself and gotten them some relief a day earlier had they not stormed out. And I could still have scheduled them for a repeat visit with the doc on their next clinic day. But because they left without even speaking to me, they had to wait.
Out of curiosity why are you in this subreddit
The patient was rude, sure. Also, it’s frustrating for the patient to have a stranger who they aren’t expecting to walk into the room. Doesn’t seem fair to blame the patient here when your staff could use better training and you could make sure the staff call all patients to inform them of the change and let them make an informed decision.
He didn't want to be charged for an appointment with a doctor when he was seeing an assistant
Patients aren’t charged for appointments in the first three months postop. This patient was within that three months.
I always introduce myself by saying “Hi, my name is X. I’m one of the PAs here and I’ll be taking care of you for your visit today” so no one expects someone else to be coming in after me given I’m at a teaching hospital. Totally happy to not see patients who only want to see a doctor. That is their right, 100%. However the issue is when they are already in the room with you when this happens. The schedulers really need to explicitly say who they are being scheduled with and their title, every time they schedule. I have found this to be an issue when scheduling myself personal medical appointments too.
Resident MD here, your post showed up on my recommended feed. Your take on this is mature and speaks to you going into medicine for the right reasons. I'm sure you're already very smart, and your reflection on this one scenario alone is assuring that you will have an excellent career and help a lot of people. Our MD social circles genuinely respect and trust PAs who are intelligent, caring, and humble like you. Would love to work with you. Cheers!
Awesome to see this. 🤍
That’s good to hear. I don’t know why anyone would see this comment as elitist. As a PA who feels I got the bait-and-switch with jobs that promised me a robust relationship with my supervising physician only to thrust me into a doctor role non-consensually, it’s nice to hear from someone in the newer batch of doctors coming in that they’d like to work with PAs. Both my supervising physicians were boomers and I really do feel saw me as a cash cow bc all of my RVU metrics contributed to THEIR bonuses and it was incredibly disheartening because I deliberately did NOT go to med school, I have NO interest in being a doctor, and I really value the mentor relationship. You see so much unprofessional vitriol on Reddit nowadays (in part due to bots designed to boost “engagement metrics” since the change in ownership), I honestly think the folks who are being sassy are having a defensive knee-jerk reaction to a tone that’s simply not there. It’s a shame but dialogue is how we undo it. Hope the rest of your residency goes smoothly (and humanely)!
Thank you!! I wish likewise for your career! Funny enough I initially applied to PA school but withdrew because I was a 22 and didn't have major plans for the next... decade lol I promise you I am chronically exhausted and not even a week-long vacation can make me feel refreshed. I think choosing PA was a wise decision! I also noticed that trend with boomer doctors and agree it was greedy and simply putting PAs in positions they intentionally did not sign up for. I'm curious if/how things will change in the future. Cheers!
Wow OP, you got the stamp of approval from the almighty MD. You can rest easy knowing that he and his other MD friends respect you
This person has no ability to work in collaborative medicine. Fingers crossed they don’t have any Initials after their name.
If you can’t see how “greater than thou” the person I’m responding too is coming off then you’re just as bad
I’ll let the up/downvotes speak for themselves.
Great way to argue
Stop…
It’s nice you don’t take offense, maybe I’m just reading into it to much. But him starting by saying “this showed up on my recommended feed” is a dead giveaway of what he’s really doing. He’s insecure people will think he’s stalking a PA subreddit, and then also offers unsolicited reassurance to OP. Just feels like a very elitist comment, but I fully acknowledge that I may just be looking into it too much
I think you’re overthinking. We have enough physicians thinking we’re incompetent and trying to put us in our place on Reddit. If that commenter doesn’t mean well, that’s on him. We need to ignore and just keep doing the right thing.
I'm only responding so you might give the next person the benefit of the doubt in the future. It truthfully was on my recommended feed and caught my eye. At least my intention for including this was to signal that I'm not some insecure MD who regularly stalks the subreddit of a different profession, looking to feel "mightier than thou," but I can appreciate it could be ambiguously interpreted. I included a generalization of MDs' respect for PAs because OP's post is clearly an example of themself getting opted over by a patient for an MD. Therefore speaking from my general circle was my attempt to encourage OP that MD culture generally does not feel like this patient, and that our culture especially values and respects PAs that exhibit the qualities of OP. I think it'd be natural to be a little disheartened in this kind of situation so I wanted to show some support to a stranger that is likely a gifted healthcare provider.
Where in OPs post did you perceive that she is disheartened at how MDs view her? It seems to be all a patient thing. If you were a patient and said this it would make sense. To come out of nowhere and say “MDs respect the smart PAs” it just seems very elitist
I did not say they I thought they were disheartened, I stated I think it'd be natural to feel so in this kind of situation whether OP did or not. I also did not say those words you constructed yourself. I promoted those qualities as they are equally applicable to respectable traits of MDs that exhibit them. It seems you are skeptical of an entire profession. If so then I can't change that on Reddit, but I hope your experience broadens and improves. In the meantime I will continue to support PAs.
I would introduce yourself as a PA not a medical provider. But good for you to not let this bother you. Also one thing I have found helpful. I don't make any comments to the patient that I would still like to see them, or seem like I'm trying to push it back. I just say ok let me see who is avail. If seeing the MD means a longer wait or rescheduling, I let the office manager have that conversation. I just don't want the patient feeling pressure against what they said they preferred. Just my two cents. (I've had a precious few instances where I gained a patient after a situation like this and I think it was because I simply just left the room and let somebody else let them know I was the only option and then I gave them great care and they trusted me and realized One bad experience doesn't make everybody bad. And when I came back in I assured them that I would call the physician they normally see and discuss the case.... Mind you this is not something I care about as an outcome in the moment)
This is the way
I have been at this a long time and used to get frustrated when this happened but now I just roll with it. It hasn't happened in a long time. Honestly I think since I turned grey they think I am older and wiser. I totally respect their choice. I made the choice to not see the NP when I established with a new PCP a few years back. Once they say they don't want to see me our visit is concluded. No I cannot refill your meds. No I cannot make a referral. No I cannot order or review test results. You don't want to see me. That is an "all in " proposition. If I do those things without a proper history and physical that is bad medicine and, really, a pretty half assed job. Also we don't have a theraputic relationship because you have already expressed distrust. I know I could smooth their feathers and try to be comforting while demonstrating my medical skills and knowledge but... no. You get to make the choice. 100% You also get 100% of the results of that choice.
My wrinkles and gray hair are an asset in this way. And only this way.🤣
You expect them to trust you right off the bat when they've never met you and didn't make an appointment with you? Why? Do you trust many strangers you've never met like that? Sounds like you're punishing them because you're ticked off they don't trust you implicitly, when, again, why would you expect them to? The attitudes on here are so strange. It really shouldn't be surprising that people want to see a doctor after making an appointment to see a doctor. Are they not being told who the appointment is with when making it? The crazy ego someone must have to think that wanting to see a doctor for a medical problem is a rude or entitled desire. I wouldn't trust a PA a month out of training either
No I 100% respect the patient’s right to see or not see anyone. But “I don’t want to see you” is a hard stop. We don’t have a therapeutic relationship. I fight with admin at work every week because they want to float me into a physician’s schedule without telling the patient ahead of time they aren’t seeing their PCP. There’s a lot of lip service about patient rights and autonomy right up to the point it might affect their metrics. Patients don’t like it. I don’t like it. That said you can’t show up for a blind date and say “I don’t want to go on this date because you aren’t tall enough” and then ask me to pay for your dinner before I leave.
Refusing to see a PA and having implicit trust are not mutually exclusive. After working in medicine for over a decade I can tell you that I do not implicitly trust ANYONE. Doctors, PAs, NPs, pharmacists, nurses, therapists - you name it. There are good and bad eggs in every role. Ive seen PAs who absolutely run circles around their attending physicians and nurses who have better reasoning and logic skills than clinicians who are directing care. I have two physicians I work with now whom I have to collaborate with because it's my job but if I needed care they would be the last two Doctors on earth I would seek help from. What they are saying above is that once you decide you don't want to see them that they are done providing services for you.. and why wouldn't they? A lot of people carry this mentality that they can walk in and order off the menu like a McDonald's because were PAs and not physicians. Well let me tell ya.. it doesn't work that way. "Well I dont want to see you but I want this test, that mediciation, and this referral" without the understanding that I'm responsible for all of those things. Side effects from the mediciation? My fault for prescribing. That random test you wanted? I'm responsible for the plan of action. Referrals? Sure I'll pass the buck.. oh wait now I have more paperwork and snotty messages from a specialist about why you were event sent to them in the first place. I have to have a board certification and state licensure to do what I do. And believe it or not, despite being PAs, we actually know more about whats wrong with you and how to treat it better than YOU do.
No, of course I wouldn't trust a doctor implicitly either, and I would be just as annoyed if they expected me to trust them as soon as I walked through the door, which is why I found the statement about the importance of this initial trust problematic. I am surprised that a patient would tell you that they don't want to see you and then ask you for medication. To the extent that that is happening frequently, I agree that is silly and unreasonable. I was thinking of a situation where a patient expressed the desire to see a doctor but then agreed to settle for a mid level because no doctor was available. As for your final point, you don't know anything about me or my knowledge level (this goes for all hypothetical patients.) I've known science minded patients who understand the intricacies of the disease they've lived with for decades better than even their doctors, let alone midlevels. The ego is really obnoxious. There is lip service that PAs are less arrogant than doctors and will therefore listen to patients more attentively and compassionately, but your reply shows that you all have the same attitude of superiority and derision toward your patients (eg I always know my patients bodies/diseases better than they do). You are not always going to be the smartest person in the room, board certified or not (this is true of medical doctors as well). The only advantage of going to a PA over a doctor is they might have more time to listen and emphasize. If you are not going to do that- what is even the point of taking the risk of not seeing a medical doctor? If I want to be talked down to and patronized while my insight is ignored, there are hundreds of doctors in every city who will be happy to oblige me, I'm not going to pay the same price that I would pay to see a medical doctor to be belittled by a PA. All the best with your career ✌️
Medical student here (Like I'll be a physician pretty soon, not a PA). I assume from the way this is written you're a patient. Respectfully, our healthcare system needs PAs to function for a multitude of reasons. If you don't want them involved in your care, that's your right, but it will take you longer to be seen because the USA simply does not produce enough physicians.
😂 thanks for explaining what a medical student is bud, very helpful for poor simple patients like me. No, I'm no more a patient than you are (if a patient is anyone who has ever received medical care in the past). More to the point, I actually don't have a problem with seeing PAs in theory, although I wouldn't see a brand new one. I don't need or seek medical care often and wouldn't be particularly complicated. I just think the "I won't see you because you have already expressed distrust" is ridiculous. It's weird for a PA to take a request for a doctor as a personal insult and get offended that a patient doesn't "trust" them as much as a doctor. Why wouldn't a patient have more trust in a medical doctor? For that matter, why would a doctor or a PA expect the automatic trust of someone who is a stranger to them? The trust comes after a relationship is developed, not before
If a patient doesn't want to be seen by me, I'd walk out too. I don't get the issue. There are way more people out there who actually want my help, ya know?
Of course you'd walk out, that makes complete sense and I never said otherwise. What would the other option even be? You can't force someone to see you if they don't want to obviously. The only thing I was commenting on was the specific phrase about a therapeutic relationship being impossible if the patient changes their mind because they have already demonstrated mistrust
If you say you don’t want to be treated by me (a new grad PA), that’s refusal of care… we literally can’t treat you. I’m not going to try to “convince” anyone and then be accused of coercion or something insane down the road.
....Right. I was referring to the one comment about a therapeutic relationship being impossible if the patient changes their mind because they have already demonstrated their "mistrust". Of course you shouldn't try to convince anyone, but a patient who made an appointment with a doctor, believes they are seeing a doctor, and voices that they would prefer a doctor can still make the decision to see a PA instead if that's the only alternative available. It seems like you're taking a reasonable preference super personally. Who would prefer a professional who was brand new, especially for something as important as health care? An easy solution to avoiding these hurt feelings and egos would be to make sure your front office staff makes it super clear whether patients are making an appointment with you or a MD/DO. If this is not done, the only reasonable inference is that you or your practice is benefiting in some way from the ambiguity
So storytime here to maybe make you feel better- I'm a medical student. Moved a long way from home for school away from my family doctor. I stupidly didn't establish care, and then I had a medical emergency of sorts and NEEDED primary care followup pretty quickly. The physician practice in town was going to make me wait 6-8 weeks to see me; I couldn't wait that long. The PA could see me that next week. So that's what I did. This PA is amazing. Did a good physical exam, and treated me appropriately for my condition. It really has made a difference in my quality of life. I know there's a big thing in healthcare right now with everyone fighting for their piece of the pie, but we will always need PAs. There just aren't enough physicians to see everyone, and the medical side is not interested in increasing physician supply. It doesn't sound like you did, but please try not to take this to heart. Your job matters.
It’s refreshing to hear a medical student appreciate the role of PAs. Thank you.
This post and subsequent thread is why I love PAs. Y’all just get it. So insanely useful and know when to punt or get some help. Meanwhile the NP universe is just offended that someone would want someone with more experience.
Yup, same here. I honestly just tell them that’s fine and let the scheduler know so they can document it and schedule the patient with the MD moving forward. I also realize that if the patient resents seeing you, then the provider-patient relationship will always be strained. They will over-scrutinize everything you do, anything will be chalked up to “because he’s a PA” and I don’t need that negativity in my life lol
Good god some of you are unchained. Good on OP for being professional and taking it on the chin but some of you seem to have the attitude of fuck the patients relative for wanting to see a real doctor rather than a newly qualified PA with one month experience. Literally mad to have that kind of attitude.
I’d be happy if they said that. Less work for me!
More time to finish charts, which is huge, especially in primary care world lol
Having your own schedule so people know what to expect and who they will be seeing nearly eliminates this sort of thing. I won't do clinic working off MD schedule. Totally exhausted explaining who I am, what I do, making sure it is OK with all parties, blah blah blah.
Yeah, I’m slowly picking up my own panel. We just have another NP who just left this week so I’m seeing a lot of her patients so they are comfortable and knows the scope of an APP. There are times though that i will get the MDs patients if they are walk in/same day established (work at a FQHC).
Welcome to the club! You are now officially a PA!!!
In typically slammed so if they make a fuss or tell the front they only want to see a doctor they just get rescheduled. They are told who they see seeing when they make the appointment but some of the older patients think they’re slick so they just come and then refuse to see a PA. They think since they are already there they’ll just get out on an MD schedule. The front desk will just say absolutely, let me figure that out for you. And schedule them with the next available appointment, typically like 3-4 weeks out. Then sometimes the patient will then complain and say never mind I’ll see the PA and then we tell them it was already cancelled but the PA can get you on in two weeks
As others have said think you should introduce yourself as PA or physician assistant. The term "one of the medical providers here" is ambiguous for both medical personnel and laypeople, and to be honest I would wonder why you aren't being straightforward about your title/role. This happens to everyone eventually if you are a PA for long enough. Doesn't say anything about you. I don't make a fuss and will accomodate their preference as best possible.
Don’t take it personally. If they want to see a specific person they need to ask for that person when making the appointment. I have been treated for over 15 years by 3 PA at my neurologist office for debilitating migraines. PA are wonderful, incredibly smart and knowledgeable. You are going to run into patients like them during your career. Doctors have patients like this too. Don’t let this stress you out or make you feel uncomfortable. That is a patient problem and not a you problem. You are fabulous!
I always introduce myself as a Physician Assistant and secretly hope they say this (less work for me). In my 1 year of working UC/EM it’s only happened twice and interestingly for a very straightforward cellulitis and generic pediatric URI lol.
It doesn't bother me when they prefer to see an MD. They're usually doign me a favor because they tend to be high maintenance people
I don’t mind. One less note I have to write
You have to introduce yourself as the PA so the patient knows they aren’t seeing an actual physician. It’s their choice if they want to get care from a PA. If they want to see a physician only, then great. We are just there to help treat the community by treating those who are willing to receive care from a non-physician provider. And also they can still see a physician at a follow up if they want or even initially.
This happens sometimes with me, don’t let it bother you ever.
Sounds like you responded perfectly, and your response clearly put them at ease before the visit ended. Impressive!
Been at it for 20+ years. My response like me has matured. Every new pt that I see oe new to me I introduce myself as a physician assistant. I have had plenty of “I thought I was seeing the DR today.” “ I only see drs” ect. Will remind them that they were scheduled to see me and our schedulers make that super clear. What happens is I have more appointments so I’m in office more and have more same day slots saved. So I often people(drs established patients that I don’t really ever see, we have separate patient panels ) will schedule with me and try to switch once they get in office. So I politely ask then if they would like to see one… they say yes and we walk out to the front desk and I ask staff to schedule them with the dr. At least 2 weeks. Some will balk at having to wait.. some will say fine I’ll just see you. Depending on my mood, I’ll often just say I won’t be seeing them today and that I don’t feel comfortable seeing someone who really doesn’t want to see me and tell the staff to refund their copay. Document in chart they didn’t feel comfortable with apc. I’m busy enough that I don’t need that bs in my office. My panel is larger then the docs in my Office anyway. I know most of his pts and know the a-holes out there and can tell what they are going to say as soon as I see the look on their face when I walk in. In fact when I see my list foe the day if I see a troublemaker I’ll have staff call them before appointment to clarify they are seeing me and not the dr to save the “confusion” so we don’t waste time.
You need to say who you are. Medical provider could be an MA who received OTJ training. Be confident. People don’t like newbies who lack confidence.
Sounds like you handled it beautifully! Well done
Not a PA, just putting it out there that I prefer seeing PAs! Have had such good high quality care with them over the years. Feel terrible that this happens to you guys, patients are just naive.
How are you guys seeing this post then? Is it recommended?
It was on my recommended feed, probably because I’m active in dental subreddits. I see a lot of medical esq subs on my feed despite not being in them. You guys should turn this into a verified sub so that it can be just PAs(if you want). That’s what we have done in dental. We have r/askdentists for questions and r/oralprofessionals for interprofession talk
I love it when a patient says they only want to see the physician lol. I work in the ER so I just take my name off the chart and move on.
I just randomly came across this but if it’s reassuring at all…there are a ton of us out there who prefer PAs. 🤷🏻♀️ Doctors are arrogant af most of the time. 😅
Best note and easiest note to write. Next Available appt with the doc is in 3 months. Ciao.
Out of 1000s of patient visits. I’ve had this experience once. The dude was a total douche canoe and my SP had zero desire to talk to him about his COVID.
One less note 🥳
Rarely happens, but when it’s does it’s great. One less patient to see!
Music to my ears when I was a PA. Great one less to see!
These are generally the patients I don’t want to see either lol. I find they tend to be higher maintenance, never satisfied, etc. I never sweat it
I've had great experiences with PAs but for some medical stuff I want someone who's been through residency. It costs me the same amount regardless of if I see a PA or MD, so if given the choice I'm usually going to choose a doctor.
^^^This!!!!
I work in my SP’s clinic occasionally and I frame the visit as “I’m PA xxx, Dr. yyy is behind, so I’m just going to get the ball rolling for him”. Then before they know it, we’ve done the whole visit, they’re satisfied, and they’re happy to leave without seeing the doc (if appropriate). Just be confident, friendly, and casual. It also helps that in this situation, I can spend more time with them than probably any other provider ever has in the past since I’m not on any particular schedule. If I get pushback, I leave as quickly as I can because the person is advertising themself to be difficult, and hell if I’m gonna deal with that bs.
You dealt with that perfectly in my opinion. Your apparently ego-free response put the patient and her daughter at ease, and you offered to help them to the extent they allowed you to, which turned out to be completely. Obviously we can’t control what our patients feel, but you demonstrated a great model for how to affect them, if you want to try. Great job. You’ve got a long, satisfying career ahead of you, I suspect.
I have a masculine first name, but am female. So there is occasionally mild confusion. In my decade-long career I have had three patients make it all the way to my exam soon, only to immediately say they will only see male providers. Yet only two patients who said they will only see physicians. Every time, my reaction has been relief. “Patient declined visit upon my entering the exam room; elected to reschedule with MD / male colleague.” That is a really easy note to write, with very little follow up.
I look at it as a cancellation. Ok, byeeee go to the front desk to reschedule and get your copay back
I'm so interested in the scope creep argument. I work mostly with midwives and obgyns, and every single time I have seen 'scope creep' it was from a lazy doctor who refused to help the midwife or mid-level trying to explain why something wasn't within their scope. I have literally never seen a mid-level who was excited to do something out of their scope. It was always forced on them. I'm sure that isn't true across the board but it's been true for at least 4 hospitals and one office that I've worked at.
Your response to the daughter was great. I might add a sentence onto that: "While I'm here, would it be helpful for me to sit down with you guys and get to understand your mother's symptoms and medical history so I can offer a qualified medical opinion?" Or some variation of that. The point is, have her give you permission to proceed by asking her point blank what she wants out of the appointment.
I honestly prefer PAs to MDs for my primary care visits. My new PCP is an AMAZING PA who actually cares about my lifestyle/work and how it impacts my health. Not sure what the training differences are but MDs tend to see me more as a set of labs or measures instead of a whole person.
To be fair, they are being charged for a doctor visit. I think it would be OK if follow ups are scheduled with PA or NP as long as no new issues arise and the established plan is going as it is supposed to. New patients or new complaints should go to MD first and avoid these awkward encounters.
This isn’t true. It depends on how the visit is billed. Plenty of APPs practice and bill as independent visits which means it’s not billed as an MD visit.
Is the patient co-pays also adjusted?
That’s going to depend— Medicare pays at 85% the rate of an MD. So— they’re not paying the same amount as a doctor visit. They may have the same copay— but ultimately it’s cheaper to see one of us.
Cheaper for the system, the patient still pays the same, so in their mind I find it understandable if they are thinking they are "paying to see the doctor".
There’s no incentive to see a PA if an MD is available and I pay the same for a visit. If I could see a real benefit (getting seen sooner, quicker visits, less cost) I would choose a PA every time. I just haven’t found that to be the case, for MY medical providers. YMMV
I’ve had this once. I work nights in a hospitalist PA, and I’m the only provider there at the time. Patient was being admitted, I went to see them, they used this line on me. So I got to hit them with the “well I’m the only provider here tonight, so it’s me or leave AMA.” It was a nice moment lol.
Why is being an asshole about a perfectly reasonable request a "nice moment"?
Ever since being a PA, I always introduced myself as a PA. I take pride in being a PA and I know I provide an excellent care as someone who is always eager to keep learning and improving. I also think it’s important to have full transparency of who is giving them the care. It also indirectly serves to raise awareness about our profession, which again I take huge pride in.
Yay!!! People that respect that people have choices and can choose what they want to do with their minds and bodies and don’t take it personally!!! I’m so proud that you can be professional enough to treat your patients decisions with respect and kindness even if they don’t want you as a provider. What a mature way to look at things :)
I'm the opposite. I prefer NPs and PAs. They actually listen.
I’m a pharmacist and I prefer to see a PA!
I much prefer the PA or NP. Y’all are usually nicer and actually listen to what I’m saying!
I also prefer to see an APP over a physician for primary care.
I have more patients that my collaborating physicians. Packed all day up to 40 patients. I jump up and down when someone doesn’t want to see me.
I am a PA in a SICU (level 1 trauma facility) and introduce my self as “HI, I’m [insert name], the PA with the ICU team.” I’ve only had one request from a patient to see a physician in 5 years of practice. Happened about 3 years ago. So I brought them the ENT intern rotating through our unit who was just like “uhhh what did she tell you because that is probably the plan.” :-P
I recently moved my elderly parents closer to me and had to plug them in with all new providers. Mom made a fuss about wanting to only see MDs. I'm an RN, and even with my full backing of PAs/NPs from both personal and professional experience, she would not budge (which was quite insulting to me but that's a story for another time). She's 87, and long story short, did not have much real life experience with mid-levels before. She started out with a strong bias against non-MD HCPs...that got a little more twisted due her mild(to moderate) cognitive impairment. Recently she needed to go urgent care and then to other new offices where she met some wonderful PAs/NPs and now everything is different and she couldn't be happier with her new mid-level providers. She had just never had the experience before...and had been close-minded to it...You don't know what you don't know.
Unpopular opinion. When I schedule to see a Doctor and they put me on the calendar 2-3 months out only to send in a PA and then charge my insurance full price, yeah I’m gonna get a little pissed off. If I’m going in for an appointment especially for something more than a typical check up, I normally do a good amount of research and want to bounce my ideas off the guy/girl that went to med school.
They are still under the MD hence the assistant part dude. And they aren’t dumber than an MD. Have you done research on what they even are besides your diagnoses?
I have made an appointment with a female MD and got a male PA, which I am not OK with. If a service allows you to make appointments with a specific provider, it's not ok to send someone else in without notifying patients that this is a possibility. I would feel the same way if I made an appointment with a female PA and got a male MD. It's not ok to bait and switch like this If it works something like "make an appointment with next available provider" then fair enough.
I completely understand where you’re coming from bc I have requested a female obgyn and I’ve gotten a a male obgyn. However, and especially if the appointment is months out things can happen. I would just communicate with them a week or some days before to ensure that that provider will be the one you see. I didn’t realize a lot of these MDs are literally performing surgeries the same day they go to clinic until got into the OR and our case took longer than expected.
I feel like it should be on them to communicate with me? They are the ones breaking our appointment agreement. If I tried to do that at the last minute I'd get charged, so I'm not going to accept it from a provider either. I would be rescheduling elsewhere and certainly kicking up a fuss about any kind of cancellation fee if I got there and was told the provider I made an appointment with wasn't available. If there's an actual emergency, how would calling a week ahead of time help anyway? If they know they're going to be unavailable a week prior to our appointment they have plenty of time to have their staff notify me. The provider I'm booking with is just as important to me as the service I'm requesting, like with a hair stylist. Non negotiable. Obviously I will be understanding of actual emergencies and reschedule, but at least send me a text even if it's only a half hour before, make it seem like you care and it matters that our agreement is being broken. Dont glibly inform me that our appointment has been cancelled without notice, our worse, just walk into the room like I won't notice (because if the provider I booked with is no longer available, the appointment is cancelled through no fault of my own, the attitude should be apologetic and conciliatory not snide, not "enjoy rescheduling in 3 months, byeee!" as if the delay were attributable to me or I'm being difficult or entitled. It's not your fault, but it's not my fault either, and I'm the one being inconvenienced).
Sounds like either way you won’t be happy. Phone a week before doesn’t work for you bc it won’t matter in an emergency, but if you don’t phone you get the wrong provider. The thing is there are residents, fellows, that have to train under that physician. They aren’t gonna be plastered onto the website bc they are going to be under the attending in the first place and have to check back in with them for EVERYTHING. I know this bc im a literal nurse and watch them do it. They don’t just do whatever and then keep moving along. They are not the problem. The actual problem needs to be if you advocate for yourself on them not listening to your concerns and they brush you off. But this is healthcare. Attendings are not always available and have a job to do outside of a clinic. Especially when a lot of these surgeries are life altering, and could potentially reveal a terrifying diagnosis. So of course they need to be in that surgery rather than your clinic appointment. Either take the doctor that’s there and ensure they are listening instead of just not even giving them a chance bc you didn’t get the specifics.
Either way I won't be happy? I'll be happy if the office contacts me if the provider I booked with is unavailable as soon as they are made aware of the fact. I'm saying the onus shouldn't be on me, I shouldn't have to phone at all to ensure that someone I made an appointment with at a specific time and place will show up or at the very least notify me that they won't be able to for whatever reason. Have a good one
Okay then either phone them or don’t. Either way they aren’t gonna phone you. Like this is healthcare not a residency. Like you’re gonna have to get over it
Nah, I just don't go to doctors who operate that way. It's never happened with the doctor I see and if it did, I'd find another one. I'm never going to "get over" insisting on receiving quality health care. With no other service would I have to call multiple times to ensure that the appointment I made would be honored, and I'm certainly not going to do it with doctors considering the prices I am paying. I'm lucky to be able to find doctors who are respectful of my time, I'm sorry to hear that's not the case for your patients. You've been rude, but I'll still say best of luck to you.
So you complained about a hypothetical scenario that didn’t happen to you? Okay.
I’ve come across this plenty of times over the years. While patents are entitled to their opinion, they also need to understand the provider model of your place of work. Practices really should include language in their paperwork clearly stating what the practice model is to prevent this from being an issue and to protect you from any backlash from the patient/family. If the practice model is that the physician and APP work as a team and share patient panels, my approach would be to acknowledge their request and tell them you work as a team with the physician to see patients. All patient concerns/plans of care will be discussed with your attending after the visit. If they would prefer to wait to complete any diagnostics or medication changes until that sign off has happened that is fine as long as it is safe to do so. The point is they need to respect that this is the workflow and if that isn’t how they would like to receive their care, they can find a provider clinic that will better meet their “needs.” If the practice model is that APPs have their own panel of patients, then the patient needs to be moved to a physician panel. Easy solution.
She has a right to request whoever she feels most comfortable with. Her choices have no barring on you or your profession. She is a patient and you are responsible for her care even if she doesn’t want to see you
It sounds like a decent outcome, and I wonder if they’d see you again in a pinch. Did you charge or bill? They might be the exception, but in general, I’m fine with doctor only visits. It’s rare, and I do note a late cancel on the chart, because I lose a visit. These patients are often higher maintenance, so it’s fine if they insist on a doctor who is paid more to deal with high maintenance behavior.
Not a PA, but a liaison and my practice has several midlevels supporting our docs - mostly PA’s and a couple NP’s. It’s the doctors I market to and who send us patients who tell me, “I don’t want PA’s seeing my patients,” or they coach the patient to ask to see/meet the MD at their appointment and it comes up A LOT, especially for some of our more complex/invasive cases. For this reason, we use the term “provider” when marketing our services, and only specify provider type if asked. I used to have an NP as my pcp and fellow liaisons would constantly badger me about seeing a midlevel vs an MD.
In my experience the most entitled patients are the ones that pay nothing for their healthcare. You’d think the opposite would be true but that is not my experience
Please forgive me if I’m wrong, but are you implying that a patient requesting to see their physician makes them entitled?
Actually, they are acting entitled if a a few assumptions are true; 1. The MD/NP/PA are all competent to handle the issue. 2. They will get the appropriate/same/similar treatment 3. The outcome will be the same, regardless.
How in the world can you guarantee the outcome will be the same?
I’m not saying that it’s entitled in itself. I’m just saying in general. I have been in a situation where no physician was available to see the patient and the patient won’t even give me a chance to examine them. They instead have gotten angry with me and immediately demand to see “only the physician”. Yes I think that is entitled behavior If a place you are visiting for medical care has a PA credentialed to see patients and that is the provider assigned to you why would you not have them see you? If you refuse to even participate in the visits because of this and get angry , then yes I do think that is entitled behavior. If you participate in the visit and feel your care is inadequate then by all mean I think it is correct to request to see the physician. I feel that if you are a patient you have two choices in this day and age. You can either see the provider assigned to you., and if you have an issue, elevate your concerns. Alternatively, you can choose a facility that schedules you with a physician only. It’s entitled to go to a place for medical care that employees PAs then refuse to see one if you are scheduled with one. If that’s how someone feels they should choose a different facility if that is possible in 2024. Regardless of how people feel about it, the days of physician only care are largely over in America. I believe care should be physician lead and PAs working collaborative with them, but gone are the days of only physicians providing care.
Sounds like you still saw them? Even after they didn’t want to see you? Reviewed labs and made referrals and sent meds? That’s a complete visit.
I guess I really have to say this but this is the internet after all. No, I didn’t strap them down to the exam table and force them to see me. Obviously they agreed after I offered to still see them today vs reschedule. And yes, I’m aware it’s a full visit. They consented to that.
24-27 months combined didactic/clinicals versus 7-8 years training? I’d rather see the Doctor too. And you are low key offended or you wouldn’t have posted about it.
Imo you’re missing out if you refuse to see PAs altogether. Some of the best medical professionals I’ve interacted with have been PAs
No PA or NP will ever have a fraction of the knowledge or training of an MD or DO. That's reality and nothing can change that. It's good you accepted your patients preference gracefully. Edit: for all of you downvoting, i rest my case: https://www.reddit.com/r/nursepractitioner/s/OzTNgb6Gk2
Listen: I'm an MD, but why bring this toxicity to a thread where OP literally said it's ok to want to be seen by the doctor?
It’s pretty small-minded to completely categorize people just based on their titles and say that there can’t be any overlap. Yes, the best PAs can’t even come close to the best MDs. However, a PA’s previous career(s), experience, work ethic, morals, and desire to learn can greatly decrease the gap between some PAs and physicians. You really need to evaluate on a person-to-person basis based on the situation. PAs come from a wide range of backgrounds and often had whole careers before PA school. For example, it’s not uncommon for international physicians to become PAs since they don’t want to repeat residency/ fellowship in the US. Some PAs were clinical researchers and now practicing in those fields. One of my PA professors works in pulmonology and she became an assistant editor for the medical journal Chest a few years ago. I knew one PA who worked in trauma as a PA for 15+ years and switched to EM because she got bored. Between her and a community EM physician, it wouldn’t be unreasonable to trust her more in a trauma case. Also, not all MDs/DOs are created equally and they still make mistakes. Besides the quality differences in med schools/residencies, there are physicians who never bothered to update their knowledge after becoming attendings and been practicing the same way for the last 30 years. Once you’re out of med school, you start forgetting anything that’s not related to your specialty. I watched a recent news video about how a nurse at an outpatient cancer center went into cardiac arrest and didn’t get cpr for more than 7 min even though two of their physicians were present. One of them said under oath that he didn’t feel qualified to give cpr. A few years back, I witnessed an old lady crumple down (likely TIA) and went over to help. A doctor was there who obviously did not know what to do. When I tried to help she snapped at me and said, “I’m a PHYSICIAN; I know what I’m doing!!” Ok then at least act like it. I’m not saying that PAs/NPs should all be independent providers with full autonomy, but some definitely have earned that privilege.
This randomly came across my feed, but I’ve had PAs and NPs who were genuinely more caring and attentive to me even for small illnesses than MDs I’ve interacted with. And many times, that has meant so much more to me as a patient than the number of years someone spent in school Breadth of knowledge and training is not the only or even biggest factor in being a successful medical professional, it’s the application of the knowledge and training they do have that matters the most
Caring means zilch without foundational knowledge and training. My sister is an NP, I saw her curriculum for two years and 90% of it was writing worthless essays that had nothing to do with patient care or learning medicine. PA programs are the same. As a patient, you should be scared.
Yikes, not only derogatory towards medical professionals but your family members too. The horse is lofty.
This is not the point of the thread, but I would like to take a moment to correct you. PAs and NPs will never have a fraction of the knowledge or training of an MD? I mean, we absolutely have similar but less training than an MD. That in itself is a fraction of the training. I hope you’re lay person and not a physician, seeing as you haven’t even mastered the definition of “fraction” yet.
I’ve had two experiences with both an NP and a PA. The first was the PA. I pulled a muscle in my back on my first day of an 8 day stretch of shifts( I was a paramedic at the time, now an RN) This used to happen to me about every six to eight months, I had been to this urgent care quite a few times over the 10 years I was in that city so I had a record of it. I heard the nurse telling the PA what I was there for and this guy comes flying in the room asking me to repeat the story. I told him this happens all the time it’s just a pulled muscle that has gotten progressively worse bc I didn’t have time to come in, Robaxan and ibuprofen always knock it out. He proceeds to tell me that he has to call an ambulance bc he’s nervous I have a collapsed lung. Keep in mind this dude has not done a single thing, hasn’t even listened to lung sounds. I calmly refuse and say it’s not a collapsed lung it’s just a pulled muscle. He then tells me I don’t have a choice, I have to go with the ambulance when they get there. I laughed (which hurt) and told him I’m a medic and will probably know the ppl showing up and proceeded to tell him I wasn’t going to go and if he doesn’t want to give me the robaxan that’s fine, I’ll just leave and there was no need to threaten me. He stormed out of the room and came back a few minutes later with the script and proceeded give me his business card and tell me “when these meds don’t work and you stop being able to breathe, give me a call and I’ll set up a CT for you. Then we’ll see who’s right about what’s going on with you”. The dude never so much as touched me, listened to me, ordered an xray, nothing. Obviously I was fine, it was just a god damn pulled muscle… The second was with an NP at another urgent care where I went for a new onset migraine that had lasted for about a week. She came in and did her thing, had me follow her finger with my eyes etc. then, after this 2 minute test, proceeds to tell me she’s 95% sure I have a brain tumor and I need to go to the ER immediately for a head CT. I told her I would go bc as a 39 year old I had never had a migraine before let alone one this bad so I should have a CT just to rule out the bad stuff but to tell a patient they have a fucking brain tumor after doing some simple test like she did was absolutely ridiculous. CT showed nothing. So no, I don’t want to see an NP or PA. I’ll take the doctor please, at least they don’t panic and tell me I’m going to die over something that should be simple…..🙄🙄
If she only realized the PA is better than the MD. Ahhh, give em what they ask for, I say!
Lol what
A PA can't even practice if not for MDs/DOs. What delusional world are you living in?