I like to read. I always have, and I’m sure I always will. I read almost everything that I come across. I often find myself reading the articles on this site. Some I agree with and some I don’t, but I like that part of the site too. I read, and I learn and I’m informed, and I gain knowledge, but then something always seems to happen. I always wind up reading the comments section, and it always leaves me feeling the same way with the same thought: “What has happened?”

I’m a physician assistant, so I obviously read a lot of articles that pertain to my profession. Again, some I agree with and some I do not. What I never agree with is the comments section. Thread after thread of pure venom from all sides. What has happened to us? There is a war going on between physicians, physician assistants and nurse practitioners and I simply cannot understand why this is even an issue. When did we all become so arrogant and prideful that we rip each other apart from behind the keyboard? When did we stop caring about the patients? When did we stop caring about learning?

Mostly what I have come across on this site is bitterness and burnout and anger. Physician assistants and, even more so, nurse practitioners fighting to become something that we are not. Let’s just put this out here once and for all and be done with it: we are not independent practitioners, and we shouldn’t pretend to be. On the physician side, from what I can tell especially those in primary care, there is some sort of fear that they are being overtaken by those they deem unworthy to practice medicine and from bureaucratic administrators who are constantly forcing new rules into their practices.

Why are we fighting each other? Has all of this animosity achieved anything other than more hostility? Has patient care been bettered while we tear each other down in forums and blogs? No, and if you think it has you are fooling yourself. This is not what medicine is about. When did we all become so overwhelmingly arrogant that we put our own ambitions and pride in front of what really matters, the patient?

At what point do we stop all the bickering and infighting and start working together as a team. PAs and NPs need to stop trying to push the boundaries of our scope of practice. We are intelligent; we are well trained but we have our role to play, and that role need is as an extender of the physician. On the flip side, to all of the physicians who want these professions gone, just come to terms that this is not going to happen. Mid-levels are here to stay, and the job market is rapidly expanding.

This is because when both sides work together it is cost-effective and it is good for the patient. Which is the whole point right? If it isn’t, why are we even doing this? This entire them against me mentality has gotten us absolutely nowhere. When the physician and mid-level collaborate as a team, the way it was always meant to be, both sides will benefit as will the patient.

I work in emergency medicine and my supervising physician (the medical director of our department), and I work together on a daily basis. There is a mutual respect and trust between us because we both fully understand our roles. I am very good at my job; one of the reasons that I’m good at it is because I know my own limitations. I can handle the majority of cases on my own, including the complex ones, but I know when I need help, and I’m humble enough and trust my physician enough to seek guidance when I have those patients. This is how it is supposed to work.

Instead, what I see day after day from this blog are mid-level providers trying to act like something they are not and insecure physicians berating anyone they believe is encroaching on their territory. We need to stop. We need to work together as a team and take care of people. If we care more about our titles and our own insecurities than the patient, then we shouldn’t be doing this in the first place.

I’ll see you in the comments.

Wes Johnson is a physician assistant.

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