Despite the positive inroads and contributions that physician assistants (PAs) and nurse practitioners (NPs) have made over the past decades, consistently surpassing patient satisfaction and industry expectations with cost-effective, high-quality, patient-centered care, we still face professional opposition. 

Our impact on the health-care delivery system has been demonstrated and validated. In recent years, other countries seeking to reap the benefits of team-based health-care models have exported and implemented the PA concept. 

So what barriers seem to be stalling PAs and NPs from coming full circle professionally?

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1. Atrocious self-marketing. We have come a long way in terms of gaining recognition among the different stakeholders (physicians, politicians, patients and payers) with whom we interact. Yet without a clearly delineated and focused marketing campaign, we’re destined to remain poorly understood and unaccepted as partners.

2. Acceptance of a subservient role. From the beginning, our professional relationship with physician counterparts was supposed to be one in which physician assistants and nurse practitioners operated as an extension of the services physicians provided. Nowadays, the semantics game is in full force, and many of our physician partners view professional our relationships as one of  “master/servant,” characterized by a lack of collaboration, support and acceptance. It appears that we have been losing turf battles and, consequently, professional leverage. 

An example of this conflict can be found in a letter from James Brown, MD, JD, a family medicine physician who became a plaintiff’s malpractice attorney, published in The Wall Street Journal . Brown wrote that PAs have “lower[ed] the level of primary-care medicine,” and proposed closing all PA schools to help resolve this issue. Obviously this physician is not interested in forging the alliances or fostering the partnerships with other health-care providers that so many of his colleagues have come to appreciate and used to build their practices. 

It’s distressing and disheartening to hear the misperceptions of some physicians regarding non-MD clinicians. Often relayed under the guise of “protecting the unsuspecting patient,” I have noticed a recent surge in shortsighted sentiments similar to Dr. Brown’s. This subtle form of monopolization and practice control seem to be aimed at eroding our hard-won credibility in the healthcare industry. 

It is my hope that the American Medical Association, as well as PA and NP professional organizations, will continue to work to promote synergy and educate those who are uninformed about or opposed to the partnership between physicians and non-physician health-care providers.