Why your ‘doctor’ may not be a doctor.

I called my doctor for an appointment a few months ago and was set up with a session with a “physician’s assistant.”

Not a physician — you know, a doctor — which is who I wanted to make an appointment with, which is why I was calling a doctor’s office, a physician’s office, the office of a physician — to set up an appointment with a physician. Apparently all the actual physicians were busy, so I got to see a “physician’s assistant,*  who wore a white coat and had glasses on, since glasses help twenty-somethings with master’s degrees look like physicians.

So, what were my first impressions about the term physician’s assistant: “Is that the person who talks to you when you first come in? The one who makes sure you’re the right person, weighs you and asks you to wear that big house-coat-shape piece of paper with a tie around the neck?” No, nope.

That’s a “medical assistant.” Isn’t the difference obvious?

Well, no.

Instead of getting to see the doctor, you can now see someone who’s got a master’s degree (like, say, many veterinary technicians).

But don’t worry, they can’t do surgery. (Well, at least the basic type of physician’s assistant can’t.)

However, they can do the following: Work independently, exactly like doctors, as far as the average, unquestioning patient in the office is concerned. Diagnose people, without all that pesky additional medical school training. Act in essence like doctors, without a doctor’s many years of training.

This is good for consumers how? When was the last time you said, “I like my doctor, but I just wish he knew a little less, It would be great if had spent a lot less time becoming an expert in his field”?

The history of the PA goes back a ways, and was based on the suddenly fast-tracked training of many doctors during World War II. But as far as we know, it’s not 1944, and we aren’t actively sending huge swaths of our population off to war to be injured each week, and we’re not sending boatloads of our trained physicians overseas.

But how are we helped, as a population, by fewer of the smartest people treating us? Is less education for, ahem, “healthcare providers” ever better for anyone?

A person with a master’s degree. That’s who was treating me that day, on her own, with no doctor or nurse practitioner in sight. That’s the training you usually get at an urgent care medical facility when, say, you have a broken toe and need someone to send you for an X-ray.

Which is a great thing, since it’s better than you, your mom or the guy at 7-Eleven saying you need an X-ray and sending you to a hospital.

The new motto can be: “Medical ‘care’: When it hurts and you, your mom, and the guy at 7-Eleven aren’t quite sure what to do.”

This approach to medical care smacks of a classic bait-and-switch scam, plain and simple. You ask for a doctor, they say you can’t see her now, or for a few days, but how about an assistant who acts an awful lot like a doctor?

If I walk into a fancy restaurant, I have a reasonable expectation that I won’t be told the bus boy is cooking all the food tonight. If I call the fire department, I don’t want a couple of interns showing up with a truck.

Here’s a Merrian-Webster definition of bait-and-switch: “The ploy of offering a person something desirable to gain favor, then thwarting expectations with something less desirable.” Yes, a doctor’s care when you are feeling sick. That is desirable. An assistant’s care? Well, it may have value, but it’s simply not the same thing.

My worry is that most patients coming in to see the “doctor”/physician’s assistant are not all that aware that they are seeing the stand-in. The understudy, who is sent in to distract you while the office is short-staffed.

A doctor goes to a medical school for four years after graduating from college. After that, there are years of internship and residency. This is not a short and simple path. It is not comparable to a master’s degree program.

Does putting out many PAs with less education make sense, rather than training more people as doctors — the same people? This is real news. These are real questions that need to be answered. By consumers. The medical offices now count on us just going along with the game and accepting that these PAs are the same as regular doctors. They certainly come cheaper in the marketplace. A typical PA currently makes $100,614 as a median annual salary, according to Salary.com, while a generalist physician makes a median salary of about $195,000 annually.

PA programs were developed as a way to help staff VA hospitals in the 1960s. Modeled on the crazy-fast training that was developed for doctors near the front lines in World War II. It’s a cheaper way to treat people who are getting free care. Now, it’s a gentle deception being slowly and quietly rolled out for consumers who don’t ask many questions — or make too much of a fuss.

The specific job title really gets to me, too. “Physician’s assistant” implies that this is perhaps an apprentice, that someday the PA’s duty as an underling will magically end and he will emerge fully formed as a doctor. But, no. The program stops after about three years. (Like, say, middle school.)

So, what are some alternate names that might work for this job? An un-doctor. An un-physician. A nondoctor. An M.D. Not? A physician lite.

Many of us used to be upset if we were sent to see an osteopath (D.O.), a real doctor who goes to school for many years, but not at what some of us think of as the regular medical school.

But a PA? Offered as a doctor equivalent with little explanation? The receptionist might as well be saying this: “Instead of seeing the doctor today, you will see Aunt Gladys, who as you know has done a lot of reading on Web M.D. Or would you like to see Uncle Frank, who’s a fan of Quora ad MayoClinic.com?” Yes, I exaggerate, but it pretty far-fetched to ask to see a physician and be told you can see someone who, well, is not a person who went to a medical school.

You can see them faster, but it’s still an ersatz version of a visit with the doctor. It’s doctor’s visit-ish.

See, I didn’t call the office to see “a team” led by an assistant. I called to see a doctor.

And until that appointment, that’s what I thought I was paying for.

3 Comments

  1. Ginger cogburn

    “. . . after that, there is at least a year of residency.” Is the only bit with which I disagree. One year post-med school graduation is considered internship. Depending on your specialty—whether family practice, psychiatry, or neurosurgery—in U.S. today, residency training including first year internship, requires an additional 4 (most commonly) to 7 years AFTER 4 years of med school, which is after college degree. Just sayin. The discrepancy is even greater than your article mentions.

    Reply
    1. JillConsumerJillConsumer (Post author)

      Good points. I will make a correction today. Thanks for reading and commenting.

      Reply
  2. JillConsumerJillConsumer (Post author)

    What’s your take on physician’s assistants filling doctors’ roles when they aren’t medical school graduates? Comments are welcome.

    Reply

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