Arrogant PA's

I agree, we have one who definately has some sort of complex. He thinks he should be a doc, but he's not, so he swaggers around and acts arrogent, and puts down the docs he works under.

Working with any of the docs in our ER is never a problem; however, we have a couple of really arrogant PA's who can make life miserable. Any suggestions on dealing with them? (Personally, I think they have an inferiority complex).

They can be difficult. I suppose if you really want to make a point, you could say, "Let me run that past a doctor..." But that would just foster hostility, wouldn't it?

When i took ACLS there was a PA who "corrected" the teacher (a paramedic) and others in the class (mostly RN's). Also had to tell some stories about having to correct mistakes by the nurses at his work. Quite a few of his "corrections were incorrect, or nitpicky and just seemed like a way to show off what he knows. It was kind of funny. There is always someone like that no matter what the degree. Interesting thing was that the MD who was there seemed far more humble and willing to learn from others.

When I was in nursing school, had ti bring the husband to the ER. His care was compromised because the PA acted like an a$$ and wouldnt let the MD do the procedure we were requesting. She was hateful. Tried ignore our wishes, and to make us "pay" for causing so much trouble for her, she did something similar to what we were requesting but was much more painful.

Talk a/b a serious complex.......

Well, I think it would be FAIR to note that EVERY "group" of providers has a few that do NOT reflect positively on their profession.

I have worked with GOOD and BAD MD's, DO's, PA's, NP's, CRNA's, RN's, Paramedics, CNA's, EMT's, DMD's, DDS's, PCT's - well, EVERYBODY.

But to focus on the PA set I will note that when they are GOOD - they are amazing. But, in the interest of being fair - when I have had to work with the dreadful "few" (Thank God!) that have some type of issue (attitude, patient care, etc.) -

* I'm as good as any doctor. Just ask me!

* Yes, I can order you around and you (you inferior RN) WILL have to follow my orders! (On an ambulatory 28 F with diarrhea - a SSE - no, kidding. And NO enema :))

* Yes, I do need all the tests - I can order them and I have - never mind that I am going to treat ANYWAY - you are just a nurse and that means you should never question me! Throat rapid strep, additional throat culture, soft tissue neck x-ray and CBC - all on a 9 year old with obvious strep - history, brother c/it, smelled like strep, fever, non toxic appearance - that got injected in the ED and course of oral meds for his sore throat!

* Yes, I do need the lower leg doppler. Diabetic 50ish M with obvious mild infection on shin from a cat scratch - It could be a DVT - IT is red, warm - You never know! Had to call in US tech, made a 7 hour ED stay for a neg doppler study and then gee, we should give some IV antibiotics!

I know, I am just a nurse - but, when the PA's are in urgent care and stick to being reasonable and prudent - it works great. When they turn every case into Major ED because of ________ it makes me want to SCREAM.

I never could figure out if it was a SUPERIOR attitude or an INFERIOR attitude. But, they can just drive a good ER nurse mad! I think a good PA that works within the ED and focuses on making the system work, provide good care and be reasonable - well, they are wonderful assets. Thankfully, by a 3:1 ratio I have had good over bad. But, when you look up and THAT ONE is on your schedule - and then you know that the SHIFT is gonna suck, patients are going to be backed up all shift AND if you try to question it just makes it worse - so......

Anyway, sorry for the long post - must be some type of post traumatic stress disorder from the bad PA's I've had to work with!!!!

I can go one better, when I had my tkr done in January, the OS billed $18.500,and received insurance compensation of about $3500only, the PA billed $12,500,(supposed to be 1/4of OS)and got$10.800. HE(PA was out of network) When I reported and asked about this to the OS office, they had no idea who this PA was, or who billed for him. In addition, nobody else had ever bothered to aske, and whenbillling clerk went to office manager, (CEO) he said perhaps OS would rather bePA> The billing service for the PA said that the also had a network of retired doctors who worked for them and did surgery assist about 5--10 times a week for extra money.

Hey.. PA student here and would love the opportunity to answer some questions if you guys have em. I try to keep an eye on new threads in the RN forums that have something to do with complaints about docs or PAs so I can get an idea of what NOT to do. But often.. I hear complaints and think... well, I can see why the doc or PA did that or what they were thinking.

Just like I have no idea what it is like to be a floor or ER nurse and the stress and thought process that you guys go through.. It is hard to evaluate a PA or Doc on the job they are doing if you arent a PA or Doc or NP. Missed diagnosis is a common reason to be sued and we are taught (especially in emergency medicine) to always rule out the worst case scenario. We are also taught to consult docs when necessary.. and I bet it happens a lot when you guys might not be looking. But we have worked hard, and the thought of losing our license or getting sued because we didnt get ONE test is very scary.

All in all, there were some good posts by you guys... that pointed out some valid concerns about different personalities and different roles in healthcare.. Unfortunantly it isnt always easy to see the other side. Which is why I am posting here and will invite an awesome PA who is a little more eloquent in his writing to also answer some questions.

We CAN get along.. and just like in my other jobs and social situations... lots of the time conflicts are nothing more than misunderstandings. but I appreciate ya'lls honesty.

p.s. in regards to billing.. yes, PAs can first assist in surgery and when they do, they get 85% of the assist fee a doctor would get.

Thankfully, I have no issues with the PAs I work with. One cardio PA is so awesome that he comes in and does a teaching for the nurses once a month on various Cardiology topics. He explains why the "obvious" meds, tests or treatments are or are not done, and it's given us all a lot of education and insight.

They can be difficult. I suppose if you really want to make a point, you could say, "Let me run that past a doctor..." But that would just foster hostility, wouldn't it?

I like this one immensely.

Its a good point too, that I should have mentioned because it was brought up a couple of times.

It would NOT be wrong to question a PAs orders to a supervising MD.. if you have already asked the PA and still are concerned. Sure, depending on the PA it might upset them a little bit but it shouldn't.. Because as PAs, if we aren't doing something very similar to what our supervising MD would do.. then we probably aren't doing the right thing. Same goes for almost any provider.. If you aren't doing what the majority of your peers would do in the same circumstances then you are doing the wrong thing. So, I personally wouldn't be offended, you're just looking out for your patient in the same way Im looking out for them.

But, lets also not forget the laws, at least where I am at a PA order is the same as a MD order so, treat it the same way and question it in the same way you would an MD order. Sure, PAs are new and different and they aren't docs.. but that doesnt mean we shouldn't all be treated with the same respect we'd want for ourselves.

Great responses! One of the PAs that I'm having a problem with periodically adds orders to the T-sheet that should have been ordered in the first place (but he forgot!), and then swears they were there all the time and I must have "missed it". Another simply refuses to communicate with the nurse about his plan, and we find out quite by accident that the patient is being admitted, transferred, whatever - we're the last to know (unless of course you're 20-something and blonde, then he's only too happy to talk to you). Basically they're just real jerks - our female PA is wonderful.