Physician leaders gather for roundtable (AUDIO)

It is clear to me that Dr. Fox has no or little experience working with PAs-in the ER,in the OR or on the battlefield. Nor does he apparently talk with his colleagues who employ PAs and NPs by the hundreds in their own practices. Many published studies confirm that PAs and NPs provide care equal in quality with that of physicians, for the services that they provide. Of course, PAs only provide services that are delegated to them by their MD supervisors. I assume that Dr. Fox feels that all of his colleagues who supervise PAs and collaborate with NPs have taken on those responsibilities with
"minor leaguers" who provide a "lesser quality of care." I'm disappointed by his condescending attitude, which certainly is not evidence based.

I think Dr. Fox slighted two professions, perhaps without meaning to.
He says that NPs and PAs are like going to see "minor leaguers" and obviously provide inferior care. I can not comprehend how a family physician who represents a specialty who is often looked down upon by other physicians can say this.
Dr. Fox, I have been a PA for 33 years. I was around when the AAGP became the AAFP and I helped in a small way to help organize FPs as I believed they should have their own specialty.
Dr. Fox, what I do I do very well. I have saved lives as well as uncovered diseases no one else did. Hardly minor leagues. Maybe a player who will never get that 20 million dollar a year contract but still if you hit 100 grounders to me, I'll field 99 cleanly. And I'll generally have the fans smiling when my at bat is finished. I know that may not count to you, but it does to them.
Why take a swipe at NPs and PAs? There are no studies that show our care to be inferior and many that show it to be quite good. I know you know that. I also know you believe in the evidence.
NPs and PAs want to work together with physicians. If you want to keep putting us down, don't be surprised if we don't trust you when you attempt to really understand what being part of a team means.
PAs and NPs can help much in the healthcare crisis we are in. We are content to do the routine things well, like the Japanese ball players. And maybe win a Gold Medal along the way.
I am sorry you have a need to be a major leaguer and to keep others in the minors. Not team like at all.
Dave Mittman, PA
Livingston, NJ

Dr. Fox is concerned patients will have "more access to a lesser quality of care." What does a delay in scheduling appointments do to the quality of care delivered? In my experience in acute and long term care and now in primary care I have been lucky to be able to work with physician preceptors who were advocates for the NP role and supportive of the care that I delivered. Together we accomplished a tremendous amount of work we couldn't do alone. I was never made to feel that I was second best. Dr. Fox's comments are disappointing but unfortunately not surprising.

I am sorry Dr. Fox and others in the article including the author of the article (who printed the story in such a biased format) have not had the pleasure of working with the many PA's and NP's across Pennsylvania who have taken care of patients with competence and success for many years. I have worked as a Nurse Practitioner since 1989 in Women's Health, Family Practice and Mental Health. There are very competent practitioners at all levels in every field of medicine. It is in the the spirit of caring for those in need that positive working relationships develop in communities. If I am aware of a sour attitude from any colleague in the communities I have served, I don't refer patients to them. If there is this kind of bashing, biased attitude toward others in the helping fields, how must this physician feel about some of his patients (especially if they don't "obey" as he sees fit)? My concern is that patients should be aware that this unkind, apparently threatened physician does not have enough faith in his own skills to be able to work coesively with other professionals in the health care community. We should all be in this together. Health care is not getting any easier to work and working together instead of against each other will make life better for those we serve.
After all isn't that what it is all about.

Is Dr. Fox reflective of the same physician thinking that gave us the medical society position paper on the ERE proposal? Perhaps they ought to stick to what they know. Just like in this instance where Fox comes across as looking silly, not knowing his subject matter, and letting his bias impact his judgment.

You people have all missed the point. Dr. Fox was not speaking "ill" of PAs or NPs. There is a PA employed at his own practice. His point if you all could actually READ what was said - its there in black and white - was that our Governor's plan will force more physicians out of Pennsylvania and all that we will be left with are PAs and NPs to run "clinics". I, personally, would much rather go to my own doctor's office, where I have an established history, they know me and I know them, and know that I will see the same doctor each time. If my doctor is not in, then I know I will be seeing a qualified and trusted PA. Pennsylvania is only one step up from the bottom of the pile when it comes to retaining quality physicians. Our health care system is becoming dangerously understaffed and under-funded. THAT is the point he is trying to make.

And, YES, there is a difference between what a MD can offer you and what you can get from either a PA or a NP. Just look at the difference between the amount and type of schooling and clinical rotations and training that each profession goes through. PAs and NPs do play an important role in health care today, however, they should never be the sole replacement of a medical doctor.

However, the offensive comment about NPs and PAs was NOT in the printed version of the story, which was edited for length. Go back and listen to the audio version for the whole conversation. I was also wondering what the fuss was about before I went beyond the printed version of the roundtable discussion.

Those of us who have responded can read. We also interpret. Insulting the intelligence of others does not make for good relations or make your point more valid. The training is changing and the amount and type of training is advancing. There are differences, but that does not make one better or worse than the other. Each has his/her place. Positive working relationships are necessary now more than ever. Hopefully future articles can explain rather than criticize the current established providers and their roles. I am surprised CAKE is reluctant to share their name as the rest of us have.

I am not a medical doctor, but I know that something has to be done to keep doctors in this state. In medical schools throughout the country, there is hesitancy to come to PA. I have heard many issues re medical malpractice. Whether this is real or not, does matter because there is the perception that this IS an issue. Rendell and legislators need to tackle this issue before it becomes any more significant. Getting an appointment with a medical doctor in a timely fashion is becoming next to impossible and medical care for the poor is disgraceful. There needs to be serious discussion about this serious issue for all Pennsylvanians.

Medical issues wrote:

I am not a medical doctor, but I know that something has to be done to keep doctors in this state. In medical schools throughout the country, there is hesitancy to come to PA. I have heard many issues re medical malpractice. Whether this is real or not, does matter because there is the perception that this IS an issue. Rendell and legislators need to tackle this issue before it becomes any more significant. Getting an appointment with a medical doctor in a timely fashion is becoming next to impossible and medical care for the poor is disgraceful. There needs to be serious discussion about this serious issue for all Pennsylvanians.

I agree with you, and I think this is the point that Dr. Fox was trying to make. If the governor gets this plan pushed through we'll lose even more qualified medical doctors and be forced to go to clinics to see either severely overworked doctors or the acronym brigade. I don't want that, and I don't think enough people realize how close to that we are getting in this state.

My point about not reading what was actually said is still a valid one. Either you are reading and just getting upset by a perceived insult to your profession that isn't really there (ie...too thin skinned) or you lack a certain degree of reading comprehension.

That's great that you have your masters degree in nursing science and that you took a few extra courses in "womens health" or some other "speciality" - THAT STILL DOESN'T MAKE YOU EQUAL TO A MEDICAL DOCTOR! That is the point of this matter. You and others in your profession should never be a replacement for a medical doctor. I would hope that you know that. Yes, you can see patients, maybe work out a preventitive care plan, do the basics, and then refer them to a qualified doctor for actual diagnosis and treatment. You know, first line of defense, but not the ultimate goal line.

Obviously you have the comprehension problem. I am not in the medical profession. Period. I am relating this because I DO READ and I know what it takes to get to see a medical doctor...a real medical doctor from personal experience. I have had many discussions about this issue with medical students. This perception is real and I do not believe that a serious discussion that includes all the stakeholders has been in place. By stakeholders, I do not mean only the AMA. The AMA is only one piece of the problem. This discussion needs to include insurance companies, lay people, employers, legislators, attorneys, judges, and others. This should not be a "take side" issue, but rather a real opportunity to discuss all aspects of the status of health care, the doctor shortage, insurance issues, patient responsiblity, health cost, preventative care, age related health care and responsiblity, etc. This kind of symposium and subsequent action are long overdue. At least the presidential candidates are talking about this, but what about PA? We need leadership and as I said, it can't come just from the AMA and doctor perspective.

You can't "just think" what someone else was trying to say. You need to know. Dr. Fox needs to answer to the comments not have you "just thinking" for him. Studies are showing NP's and PA's out preform MD's in many areas. Their jobs are not just working out a preventative health care plan and passing it on to an MD. Get educated! These providers are doing front line and advanced care in primary care and speciality care practices. Times have changed. Your knowledge needs to get up to speed and you need to stop being so defensive! We are not insulted by your ignorance nor or we threated by it. Name please?

I have not seen my doctor for my physical in probably 7 years. I do not even know if she is still my doctor of record. It is kind of sad that health care has come to this, but it is what it is. I do not believe that I am receiving the same level of care as if I would see my doctor.

Frankly speaking wrote:

I have not seen my doctor for my physical in probably 7 years. I do not even know if she is still my doctor of record. It is kind of sad that health care has come to this, but it is what it is. I do not believe that I am receiving the same level of care as if I would see my doctor.

If you feel more comfortable with your doctor, then by all means make an appointment with her. You should ALWAYS have the option of seeing your doctor, but you need to be sure to call early enough to get an appointment, or be willing to wait for an open appointment on the doctor's schedule. If the NP or PA you are seeing now is aware of your discomfort, he/she should be sure to have the receptionist make your next appointment directly with the doctor.

Outside of a few situations in VA hospitals where an NP or PA may be your PCP, I'm not sure why you would be unable to see your doctor for 7 years. If that is the case, you should have your PCP changed to a doctor if that is what you prefer.

If you are in a rural area where the only clinic is staffed by a PA or NP, and you are unable to travel to a bigger city that has a doctor, then all you can do is ask the PA or NP to be sure to review your chart with his or her supervising physician the evening after your visit (as opposed to within 10 days as required by Pennsylvania state law.) We would all like more doctors to practice out in the country, but until we make medical education more affordable in the USA, the doctors will choose to practice where they can make the most money to pay their student loans, and they will prefer specialties to primary care.

If you are going to a regular outpatient office for care, and you are scheduling a routine physical, there is no reason why you cannot call early enough to make an appointment with the doctor herself. An acute visit is another matter; if the doctor has no openings, the receptionist will offer you an appointment with the NP or PA so you will not have to wait. If you feel the receptionist is deliberately keeping you from seeing the doctor for some reason, you should ask the doctor to call you directly to discuss this. If at that point the doctor is unwilling to put you on her schedule (when she has an opening, of course) then you need to find another doctor.