Physician assistants prefer ‘associate.’ Doctors suspect a power grab : Shots

Leslie Clayton, a physician assistant in Minnesota, says a name change for her profession is long overdue. “We don’t assist,” she says. “We provide care as part of a team.”

Liam James Doyle for KHN


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Liam James Doyle for KHN


Leslie Clayton, a physician assistant in Minnesota, says a name change for her profession is long overdue. “We don’t assist,” she says. “We provide care as part of a team.”

Liam James Doyle for KHN

After 23 years as a physician assistant, Leslie Clayton remains rankled by one facet of her vocation: its title. Specifically, the word “assistant.”

Patients have asked if she’s heading to medical school or in the middle of it. The term confounded even her family, she says: It took years for her parents to understand she does more than take blood pressure and perform similar basic tasks.

“There is an assumption that there has to be some sort of direct, hands-on oversight for us to do our work, and that’s not been accurate for decades,” says Clayton, who practices at a clinic in Golden Valley, Minn. “We don’t assist. We provide care as part of a team.”

Seeking greater understanding for and appreciation of their profession, physician assistants are pushing to rebrand themselves as “physician associates.” Their national group formally replaced “assistant” with “associate” in its name in May, transforming into the American Academy of Physician Associates. The group hopes state legislatures and regulatory bodies will legally enshrine the name change in statutes and rules. The total cost of the campaign, which began in 2018, will reach nearly $22 million, according to a consulting firm hired by the association.

Doctors are pushing back

But rechristening the PA name has spiked the blood pressure of physicians, who complain that some patients will wrongly assume a “physician associate” is a junior doctor — much as an attorney who has not yet made partner is an associate. The head of the American Medical Association has warned that the change “will undoubtedly confuse patients and is clearly an attempt to advance their pursuit toward independent practice.” The American Osteopathic Association, another group that represents doctors, accused PAs and other nonphysician clinicians of trying “to obfuscate their credentials through title misappropriation.”

In medicine, seemingly innocuous title changes are inflamed by the unending turf wars between various levels of practitioners who jealously guard their professional prerogatives and the kind of care they are authorized to perform. Just this year, the National Conference of State Legislatures catalogued 280 bills introduced in statehouses to modify scope-of-practice laws that set the practice boundaries of nurses, physician assistants, pharmacists, paramedics, dental hygienists, optometrists and addiction counselors.

Lawmakers allowed North Carolina dental hygienists to administer local anesthetics; permitted Wyoming optometrists — who, unlike ophthalmologists, do not attend medical school — to use lasers and perform surgeries in certain circumstances; and authorized Arkansas certified nurse practitioners to practice independently. Meanwhile, the physicians’ lobby aggressively fights these kinds of proposals in state legislatures, accusing other

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‘A Hard Stop’: How Harvard’s Dental College Graduated Every single Scholar Despite a Pandemic Shutdown | News

In March 2020, the Harvard Faculty of Dental Medicine went completely remote all students were being despatched residence, and the Harvard Dental Clinic — exactly where pupils generally hone their expertise doing the job with clients — was shut down other than for crisis care.

“We went from a entire clinic and then to a tricky cease: 100 miles per hour to zero,” mentioned German O. Gallucci, chair of the restorative dentistry and biomaterials sciences office.

With the shutdown, 3rd- and fourth-calendar year dental learners — whose curriculum is based mostly on medical apply and working experience — were being reduce off from observing patients. Although fourth-yr college students had concluded most of their specifications, 3rd-12 months college students in the Course of 2021 faced the problem of conference their graduation and competency standards irrespective of lessened scientific availability, according to Sang E. Park, HSDM’s associate dean for dental schooling.

“I have to say that it was the most tough course — the Class of 2021 — that I had to be graduating on time in my 20 yrs of getting dental school,” Park said.

Inspite of this, just about every member of the Course of 2021 graduated on time or early, a feat the school’s dean, William V. Giannobile, credits to school customers likely earlier mentioned and outside of to aid students full their demands.

“What the faculty did is they ‘sacrificed’ their college observe time to open up up the clinics to the college students,” he explained in an Oct job interview. “And then they labored three evenings per 7 days, and also on Saturdays, to offer that schooling.”

Customers of the Course of 2021 mentioned in interviews they have been at first worried about the unexpected discontinuation of their clinical education, but impressed with how the faculty responded — 1st, by adapting its curriculum to on-line for the initially several months of the pandemic, and later slowly returning college students to medical exercise in man or woman.

“I’m so glad I went to a faculty like Harvard where, honestly, they cared so substantially about helping us graduate,” said Ashiana Jivraj, a 2021 HSDM graduate who was a third-12 months student when she was sent residence.

Russell H. Taylor, a lecturer in restorative dentistry and biomaterials sciences, acknowledged that furnishing distant instruction in a specifically fingers-on area this sort of as dentistry was tough.

“There’s a large amount of abilities that you need to have to observe and you will need to do underneath supervision when you’re setting up out, since it is a quite fingers-on and a very visible career, far too,” he reported. “There’s a lot of tactile, visible items that you just cannot just assign a looking through for, always.”

‘Solving a Big Puzzle’

Coming up with a digital curriculum that designed the greatest use of students’ and college members’ time, whilst making sure that college students could meet dental competency specifications for the duration of the shutdown, was “like solving a large puzzle,” according

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Yelp rankings of clinical services may perhaps expose area health and fitness inequities

December 03, 2021

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Disclosures: &#13
Neither Merchant nor Stokes report any appropriate monetary disclosures. Make sure you see the examine for all other authors’ applicable monetary disclosures. &#13


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Counties with vital wellbeing treatment services that had reduce rankings on Yelp also experienced bigger mortality premiums, information showed.

“Patient experience and pleasure with well being care are significantly identified as crucial steps of wellness treatment top quality, but details on these aspects are much less greatly collected,” Daniel Stokes, MD, a researcher with the Penn Drugs Middle for Electronic Well being and an interior medication resident at UCLA Overall health, and colleagues wrote. “Patient working experience could also be related with county-degree mortality, but these associations have not nonetheless been nicely explored.”

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The scientists performed a retrospective, populace-based mostly, cross-sectional analyze of Yelp efficiency reviews for 95,120 necessary health care services in 1,301 U.S. counties from Jan. 1, 2015, to Dec. 31, 2019. Crucial wellness treatment facilities were outlined as people that made available companies that Marketplace health insurance coverage strategies need to deal with: ambulatory affected individual services unexpected emergency products and services hospitalization being pregnant, maternity and new child treatment mental health and substance use disorder solutions, like behavioral wellness treatment method prescription drugs rehabilitative and habilitative expert services and equipment laboratory services preventive and wellness solutions and long-term sickness management and oral and eyesight care for children.

The findings, published in JAMA Community Open up, indicated that at the county stage, a one-issue improve in a indicate Yelp ranking was joined to a signify age-modified lessen of 18.05 fatalities for each 100,000 people today (P < .001). The mean county-level rating of the analyzed facilities across the study period, with one being the worst and five being the best, was 2.9 stars.

The researchers also noted that words related to time, such as “minutes,” “hours,” “finally,” “waiting” and “schedules” words to describe payment, including “money,” “insurance” and “pay” and words related to interactions with other people, such as “rude,” “tell” or “told” appeared more frequently in one-star reviews in counties with high mortality. On the contrary, words such as “friendly,” “nice” and “staff” were used more frequently in five-star reviews in counties with high mortality.

In a press release, Stokes said the results show that “how patients feel about the care they are receiving has an impact on how they engage with health care and, in turn, their own health and well-being.”

“Ideally this democratization of information can help us to improve health care for all and reduce our blind spots,” Raina Merchant, MD, director of the Penn Medicine Center for Digital Health, said in the release.

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