After 23 years as a physician assistant, Leslie Clayton remains rankled by one facet of her vocation: its title. Specifically, the word âassistant.â
Patients have asked if sheâs heading to medical school or in the middle of it. The term confounded even her family, she said: It took years for her parents to understand she did more than take blood pressure and perform similar basic tasks.
âThere is an assumption that there has to be some sort of direct, hands-on oversight for us to do our work, and thatâs not been accurate for decades,â said Clayton, who practices at a clinic in Golden Valley, Minnesota. âWe donât assist. We provide care as part of a team.â
Seeking greater respect for their profession, physician assistants are pushing to rebrand themselves as âphysician associates.â Their national group formally replaced âassistantâ with âassociateâ in its name in May, transforming into the American Academy of Physician Associates. The group wants state legislatures and regulatory bodies to legally enshrine the name change in statutes and rules. The association estimates the entire cost of revising the professionâs title will reach nearly $22 million.
Rechristening the P.A. name has spiked the blood pressures of physicians. They complain that some patients will wrongly assume a âphysician associateâ is a junior doctor, much as an attorney who has not yet made partner is an associate. The head of the American Medical Association that the change âwill undoubtedly confuse patients and is clearly an attempt to advance their pursuit toward independent practice.â The American Osteopathic Association, another group that represents doctors, the P.A.s and other nonphysician clinicians of trying âto obfuscate their credentials through title misappropriation.â
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 introduced in statehouses to modify so-called scope-of-practice laws that set the practice boundaries of nurses, physician assistants, pharmacists, paramedics, dental hygienists, optometrists and addiction counselors.
Lawmakers North Carolina dental hygienists administer local anesthetics; Wyoming optometrists â who, unlike ophthalmologists, do not attend medical school â to use lasers and perform surgeries in certain circumstances; and Arkansas certified nurse practitioners to practice independently. The physiciansâ lobby these kinds of proposals in state legislatures, accusing other disciplines of trying to incrementally horn in on things doctors claim only they are competent to do.
Physician assistants, as they are still legally called, have been steadily granted greater autonomy over the years since 1967, when the Duke University School of Medicine graduated four former Navy medics as the nationâs first class of P.A.s. Today they can perform many of the routine tasks of doctors, such as examining patients, prescribing most kinds of medications and ordering tests. In most states, all that usually happens without the need for a physician signoff or having a physician in the same room or even in the same building. The profession is : it wants to abolish state mandates that P.A.s must be formally supervised by physicians or have written agreements with a doctor spelling out the P.A.âs role.
Generally, a P.A. masterâs degree takes 27 months to earn and includes about 2,000 hours of clinical work. By comparison, family physicians usually attend four years of medical school and then do three-year residencies during which they clock about 10,000 hours. (Specialists spend even more time in residencies.) Nearly P.A.s were practicing in 2020 in the U.S. Their median annual pay that year was , slightly above the $111,680 median pay for nurse practitioners, who perform jobs similar to P.A.s. The median annual pay for a family physician was .
P.A.s arenât alone in losing patience with their titles. In August, the American Association of Nurse Anesthetists renamed itself the American Association of Nurse Anesthesiology â its third name since it was founded in 1931. President Dina Velocci said the term âanesthetistâ baffles the public and is hard to pronounce, even when she helps people sound out each syllable. (Itâs uh-NES-thuh-tist in the U.S. and indicates a registered nurse, usually with a bachelorâs degree in nursing, who has then received several more years of education and training in anesthesia.)
The associationâs new name is justified since âweâre doing the lionâs share of all the anesthetics in this country,â Velocci said. âIâm definitely not trying to say Iâm a physician. Iâm clearly using ânurseâ in front of it.â Physiciansâ groups have condemned the change, though the legal title for the profession remains certified registered nurse anesthetist, or CRNA.
Likewise, the P.A.s say thereâs no ulterior motive in altering their name. âChanging the title is really just to address that misperception that we only assist,â said Jennifer Orozco, president of the P.A. association and an administrator at Rush University Medical Center in Chicago. âIt wonât change what we do.â
They say âassistantâ confuses not just patients but also state lawmakers and those who hire medical professionals. When Clayton recently testified before Minnesota legislators about a scope-of-practice bill, she said, lawmakers âjust couldnât get their heads aroundâ the concept of âan assistant who doesnât have a direct supervisor.â The message she said they gave her: âYou guys really need to do something about your title.â
The P.A. associationâs consultants developed more than 100 alternatives, including âmedical care practitionerâ and the widely derided neologism âpraxician.â âPhysician associateâ won out thanks to several advantages. It allowed P.A.s to continue to introduce themselves with the same initials, and it had been flirted with as an alternative throughout the professionâs history to distinguish the most highly trained P.A.s from those with less training. The association even briefly used âassociateâ in its name for two years in the 1970s, and Yale School of Medicine has offered a physician associate degree since 1971.
But a name change alone wonât resolve other disadvantages P.A.s face. In some states, doctors are required to meet regularly with P.A.s, periodically visit them in person if they work at a different location and review sample patient charts on a recurring basis. States generally mandate less oversight for nurse practitioners, making them more appealing to some employers.
âWeâve heard from our P.A. colleagues that theyâre getting passed over for jobs by nurse practitioners,â said April Stouder, associate director of the Duke Physician Assistant Program.
Many physicians offer concerns about patient safety if P.A.s drift too far from their oversight. Dr. Colene Arnold, a gynecologist in Newington, New Hampshire, started her medical career as a P.A., practicing with little supervision. In retrospect, she said, âI didnât recognize the severity of what I was seeing, and thatâs scary.â
Dr. Kevin Klauer, CEO of the osteopathic association, said misdiagnoses by a solo P.A. are more likely than when a physician is involved. âIf you go to Jiffy Lube and you want an oil change and a tire rotation, thatâs what theyâre going to do,â he said. âMedicine is not like that.â
Orozco, the P.A. association president, said such anxieties are overblown. âThey will always collaborate with physicians and really want to keep working in that team-based environment,â she said. Doctors should welcome P.A.s to help fill physician shortages in primary care, behavioral health and telemedicine and free up doctors to focus on complex cases, she added.
âI can have a jet engine mechanic change the tires on my car,â she said, âbut do I need that every single time?â