I just want to blast it out there from the get go.
YOU WILL NOT BE NUMBER ONE!!

Most of the people that I know that are PA’s or aspiring PA’s have an internal drive to be the very best at what they do. They take pride in success. They work hard at becoming increasingly knowledgeable in their chosen field. They were overachievers in school. They are without a doubt very intelligent people.

In a nutshell they have been number one. Always pushing for that top spot in the class. Always had their hand up to answer questions. Spent more time in the library to ace the test. Like I said number one.

The bad news for you is that becoming a PA, automatically demotes you to number two. That is the highest rank you can possibly achieve as a PA. No matter how much you work, study or push; you will remain number two.

It is important for you to understand this before you go off and commit yourself to becoming a PA. It’s by design, this number two business. As a PA you are dependent upon a supervising physician in order for you to hold a job and function as a PA. PA’s do not hold a license to practice without a supervising Physician. That supervising physician will always be the number one.

I bring this up because I found this aspect of becoming a PA seriously overlooked by my graduating class and PA school. I don’t want you to get hit blindside with this very hard reality when it is too late. The fact is that no matter how good your relationship is with your supervising physician; at some point in time you are going to have a disagreement about the care of a patient. And that is when it will hit you, you are number two. Even if you are the lone provider in a rural clinic and some hired gun comes in once a week to sign off on charts, he is still the number one.

This is one of the main reasons animosity exist between some PA’s and their supervising physicians. The PA starts to feel resentment towards the doc and starts in with the “I know more than they do”, “they don’t know my patients”, blah, blah, blah. Ultimately as the relationship between PA and supervising physician degrades, so does the patient care. Now, by getting all worked up at not being the number one you are directly hurting the people that you have dedicated your life to help. (Nice work)

So how do we as PA’s and you upcoming PA’s overcome this issue?

Number 1: CHILL OUT! You heard me, chill it. What I mean is this. You need to realize on the front end that you are the number two. If you can’t be comfortable with this, seriously do your future patients a favor and move on to another career.

Number 2: When you are looking for a position as a PA make sure when you interview with the Doc, that you interview the Doc. You need to discuss how conflicts involving patient care are to be resolved. Ask if they will simply change your course of treatment or will they discuss it fully with you, giving you an opportunity to explain your medical reasoning for a certain treatment plan. Ask how the Doc feels about PA’s being integrated team members of the practice.

Number 3: When you first start a new job, run a good number of cases by the supervising physician. I know you want to be out there Top Gunning it, but if you spend some time with the supervising physician early in the relationship discussing cases it will give you time in a non-confrontational environment to see the Docs thought processes about certain patient scenarios. It will also give the Doc some time to get comfortable with your decision making. By doing this each of you will learn what to expect from the other.

Number 4: Understand this! As you work in a clinic and start to develop your own patient load, you will be number one to those patients. This is especially true for those PA’s that work as sole providers in rural clinics. Your patients probably don’t even know anybody comes in and signs charts. Your patients have no clue who the man behind the curtain is. They don’t even want to look; they just want to see the wizard.

The take home message is this; it’s easy to understand how some PA’s can get aggravated by this, but it’s even easier to avoid. By trying to address this early in the relationship you can avoid this devastating PA pitfall. Your clinic and your patients depend on a truly cohesive relationship between the number one and the number two.

  1. trishx3 says:

    On point with this one! The only way to succeed is to have a good relationship with your SP, if you have that you’ll be great partners in the practice! I see it everyday in my job.

    • qfwm2001 says:

      No question trish, this is a big downfall of many young pup Physician Assistants. They are eager to get out there and start working, but don’t take the time to make sure the practice will be agood fit for them.

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