Mittman, of Livingston, N.J., has been a PA since 1975, spending much of his clinical time in an inner-city family practice. He was one of the first PAs in the Air Force Reserve and worked to shatter many barriers for the PA profession. Dave has served on the board of the American Academy of Physician Assistants (AAPA), as president of the New York State Society of PAs, and as treasurer of the Association of Family Practice PAs. Mittman has also had a successful career in medical communications and publishing, as the co-founder of Clinician Reviews Journal and the Clinician 1 web community for PAs and NPs.
1.What’s the biggest barrier to practicing medicine as a PA today?
I would say it’s the arbitrary barriers that vary from state to state. While some states do not require any countersignatures, some require 25% of all PA charts co-signed. Why would any PA practice there? Especially someone good, and with experience? What physician would want to work with those rules? Another arbitrary barrier is ratios on the number of PAs that physicians can work with. Some states are 2:1, 3: 1, or 4:1. NPs in many states do not require any ratios, which puts the hiring of PAs at a disadvantage.
2. What is your most vivid memory involving a patient who could not afford to pay for healthcare (or meds or tests, etc.) and how did you respond?
My personal stories are not tear-jerkers, just a primary care PA going out of his way to save samples for patients who could not afford them or ask a physician specialist to see someone for a reduced fee.
I would rather say I was very impressed with the work of two NPs highlighted on a recent “60 Minutes” segment who have an old mobile home and are on the road treating people for free. They see some real pathology, as these are the sickest people. They work on grants and donations. That’s real commitment to health care.
3. What do you most often wish you could say to patients, but don’t?
Regarding your health — it’s all up to you. Yes, we physicians, NPs and PAs who are treating you can help, but if you smoke, or are obese, or balk at exercise, we don’t have any magic. We do have magic for some very high-level illnesses (think cardiac transplantation) but you don’t want to meet those magicians. Start living healthier today and there is a team of professionals ready to stand with you and help you do that.
4. If you could change or eliminate something about the healthcare system, what would it be?
So much. Politically I would recognize that healthcare is best given by teams of professionals; all of whom have expertise in different areas, and care deeply about their profession. I would allow NPs and PAs to enter residencies to formally continue their educations and train with physicians — especially in the specialties. On the clinical side, we need tort reform — we don’t need Press-Ganey [patient satisfaction] scores, and please get the insurance company clerks out of the day-to-day decisions of medicine.
5. What is the most important piece of advice for PA students or PAs just starting out today?
I hope this does not sound too “hokey,” but I was in family practice for years: To be successful there, you need to love people. You see too much to get jaded about, and have to realize everyone has quirks and no one is perfect. You have to be able to get a kick out of people. It makes it so much more fun and all worthwhile.
6. What is your “elevator” pitch to persuade someone to pursue a career in medicine?
I don’t have one. If I have to talk you into it, you are not the right person. Find something else to do.
7. What is the most rewarding aspect of being a PA?
You get to make a profound difference in people’s lives. If you care, most people see it and let you into their lives a bit. Sometimes you are the only person they tell their fears to. They allow you to hear their darkest secrets and then to take a journey with them to help make their lives better. How could you not feel blessed doing that?
8. What is the most memorable research published since you became a PA and why?
It would have to be the Institute of Medicine (IOM) study recently done on the NP profession. The IOM study helped out our NP colleagues immensely in their quest for professional recognition. It opened the eyes of the entire nation positively. As a PA leader, I would love for the IOM to look at PAs also.
9. Do you have a favorite medical-themed book, movie or TV show?
My favorite book has to be “House of God,” as I read it in my clinical “internship” year of PA training. I worked with those residents. What an amazing book.
“ER” was my favorite medical show for many reasons. ER had a PA character on it and was also the first show that showed medical and nursing professionals as complex people. It showed we were human, took our work home, loved, lost, and had the same hurts as everyone else. It showed some of us care too much and some of us could care less.
10. What is your advice to other medical professionals on how to avoid burnout?
Being a clinician cannot be “all that you are”. You need to be as good a spouse, as good a dad, as good a volunteer as you are a PA, NP or physician. Family must come first, and you have to take time to vacation. The world won’t end if you go away for a week.
Lastly, have a colleague available who you can talk with who will give you honest feedback. Not on the diagnosis and treatment part, but on the day-to- day highs and lows we all encounter. It’s invaluable.
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