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Member
Join Date: May 2005
Posts: 3
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resaerch paper due 7am (pa-md team in medicine)
Quality health care has long been a major concern for millions of Americans. Dealing with the wide variety of issues it presents can create an environment of controversy. One of these issues is the use of non-physician health care providers like the physician assistant (PA). For most people, what greases the wheels of the medical machine is of little importance relative to the personal care given to them and their family. Many things can have a direct affect on the level of care a person receives. It is not uncommon to hear a patient complain about how long they had to wait to see a doctor. That could mean the one hour wait in the office or the sometimes months long wait to get an appointment. Another time related issue is the short duration of the actual contact between doctor and patient. Doctors too are aware of the problems these time constraints create. For this and other reasons many medical doctors are becoming disillusioned with the profession. One evolving solution to these problems is the advent of the physician assistant (PA). “The first PA program was created at Duke University (Durham, NC) in 1965” (Pediatrics 1050-1053). Over the last 30 years, the profession has expanded its roll to include many medical tasks. For example, a P.A. can order tests, prescribe drugs, diagnose, and even perform minor surgical work. Because of the level of education they receive, and the fact that they operate under the supervision of a medical doctor, the PA should continue to be a vital cog in the health care machine, thereby easing time restrictions, boosting moral of doctors and patients, and providing excellent care.
Long waits for short visits is a concern for both doctor and patient. In some cases it can take months to get an appointment. In Lawrenceville, GA, the wait to see a county psychiatrist is about two months, and if that appointment must be rescheduled for any reason it could be another two months before treatment is received. Other studies report that in Boston, the average wait for a new patient to see a cardiologist is 37 days, and for an obstetrician-gynecologist the wait is 45 days (Hobson 48-53). This means that in time sensitive cases many people are not able to see a doctor in time to get the benefit of an early diagnosis. It has become rare to have an appointment scheduled for 2:00 P.M. actually begin at that time. Patients can be required to wait for up to several hours depending on the situation. When an appointment is finally secured and the mind numbing time sitting in the waiting room has expired, a brief encounter with the doctor is at hand. Katherine Hobson says in U.S News & World report that:
That’s where the real squeeze comes in – the average 17 minute office visit may not be sufficient to get enough information to diagnose the problem and talk about the ever growing list of health issues they’re supposed to bring up, from screening for skin cancer to advocating exercise and a healthful diet to being alert to signs of domestic abuse or addiction. That’s doesn’t even count the time to answer patients questions about drug ads they’ve seen or information they’ve researched on the internet. Worse, those meager 17 minutes may be with a different doctor every few years, because when employers switch insurers, or people change jobs, their old doc often isn’t part of the new plan. (48-53)
Doctors are required, by insurance companies, to ask for very specific information to insure prompt and accurate payment. Patients, for their part, have become quite well informed. Information gathered from the internet or obtained from other sources has created a large community of inquisitive visitors filling the exam rooms (Fischman 44-47). This eats up valuable time; this time could be better spent discussing things like habits, home and work environment, or other information that might be relevant and which may provide a chance for the doctor to interject with helpful information. Josh Fischman says, “Research has shown that a good conversation that thoroughly explores problems and possible treatments means better health” (44-47). Better health is the number one goal for both doctor and patient. In Urology Times, Karen Nash reports that Ronald P. Roper, MD, of Marietta, GA, says:
I could do their [PA’s] duties if I could devote the time to it, but I’d much rather see a complicated oncological case than do a routine infection case,” he said. “I’m much better off, and so are the women. They are much better treated by my nurse PA than by me. She talks to the patient more and longer than I would be able to about those problems. (qtd The Roll of the Nurse)
This means that, as stated by The American Academy of Physician Assistants(AAPA) on their web site, “In many primary care practices, the presence of PA’s allows patients to be seen promptly, knowing that their routine problems will be handled effectively and that the expertise of the physician is available if needed.” This leads to the next reason why PA’s should remain a staple in the health care field.
PA’s operate under the supervision of a medical doctor at all times. This means that a physician is ultimately responsible for the decisions made by a PA in his employ. The commitment to the level of safety and quality of health care this policy creates is supported by the AAPA. Their web site says it like this, “The AAPA believes that the physician – PA team relationship is fundamental to the PA profession and enhances the delivery of high quality health care. As the structure of the health care system changes, it is critical that this essential relationship be preserved” (The Physician – PA team). Quality health care is the primary concern of the PA, the doctor, the patient, and the government. One study, sited on the AAPA website, but carried out by the federal government reported that, “Within their areas of expertise, and within appropriate training and supervision, (emphasis added) these practitioners may provide medical care similar in quality to that of physicians at less cost.” Another investigator, Rachel Sobel, writes “Research has shown that many nonphysician (sic) providers perform safely, (sic) or at least as safely as physicians do, in their expanded rolls” (54). Because the PA operates under the watchful eye of a registered physician they tend to be a very safe way to provide high quality health care. However, good supervision alone would not qualify a PA to practice without creating controversy. They also receive an education comparable to a physician.
Most PA school applicants hold a bachelors degree. Upon entry into a PA program, students are instructed by physicians, PA’s, and others according to a curriculum following the medical school model” (AAPA web site). PA’s are trained in biochemistry, pathology, human anatomy, clinical pharmacology, disease prevention, and medical ethics. The PA will then do clinical rotations in many areas including primary care medicine, inpatient medicine, surgery, obstetrics and gynecology, geriatrics, emergency medicine, psychiatry, and pediatrics. In addition to this extensive schooling and on the job training, PA’s must pass a national certification given by the National Commission on Certification of Physician Assistants. This test is limited to graduates of accredited PA programs only. Every two years PA’s are required to complete 100 hours of continuing education, and every six years they must pass a recertification examination (U.S. Department of Labor). The AAPA web site says, “Because they [PA’s] train using similar curriculum, training sites, faculties and facilities, physicians and PA’s develop a similarity in medical reasoning during their schooling that eventually leads to a homogeneity of thought in the clinical workplace.” The intensive training given to PA’s allows doctors to utilize the PA to relieve some of the stress of her job. This is very important to quality health care because medical doctors are becoming less happy in their jobs each year, and lower job satisfaction leads to fewer doctors working fewer hours with less enthusiasm.
Time was that being a doctor was viewed as the best job one could have. The rewards were many. Some valued the close relationships they built with patients. Others viewed the career as prestigious, and looked forward to the relatively high income. Many doctors valued the autonomy which came with the high level of education they possessed (Hobson 48-53). One thing all doctors wanted and still want is to heal. However, many doctors are finding that the job, in the current environment, does not allow them to build relationships with patients. Rachel K. Sobel speaking on this issue said “At the same time I would have been blind not to notice a weakening of that bond and the ugly cynicism seeping into my chosen profession” (54). The prestige of being a doctor is still some what in tact, but lower reimbursements from insurance companies are reducing income. The autonomy doctors once enjoyed is being usurped by managed care and fear of malpractice (Hobson 48-53). It doesn’t take long for young doctors-to-be and first year graduates to pick up on these changes. Rachel K. Sobel says “Friends who had started med school a few years ahead of me already gave off a sense of aloofness and fatigue (54). She also comments on recent graduates saying “As I trained on the hospital wards, I was surrounded by unhappy, jaded residents – med school graduates doing their first stints as working doctors” (Hobson 48-53). Even with a strong desire to heal, these issues offer a strong deterrent when making choices about training to become or remaining a doctor. Katherine Hobson reports that “A nationwide survey by the Henry J. Kaiser Family Foundation found that 87 percent of doctors say the over all moral of the profession has gone down in the past few years, and nearly 60 percent said their own morale had declined” (48-53). The point is that doctors need help to handle the growing number of issues that modern medicine is placing on them, and PA’s are the solution. A frightening quote in U.S News & World Report makes the impact clear it reads, “In a county that will demand more and more from its healthcare system as the population ages, this is only going to get worse – and your doctors problems may become yours (emphasis added)” (Hobson 48-53).
i still need to write the conclusion
i would like to know about any changes i should make thanks
i already found some issues with tense
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