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The Myth of More Time
By Justine Strand, MPH, PA-C
APAP Director at Large
“I want to be a PA because I’ll be able to
spend more time with patients.” How often have you heard an applicant
say this in an essay or interview? I informally queried several PA
faculty from programs across the country, and their responses were
“constantly,” “frequently,” “all the time.”
Do PAs really spend more time with patients than physicians? PAs in
clinical practice find the idea amusing — especially if they
are in primary care, where a perfect storm of reimbursement mechanisms,
guidelines, and productivity demands create an ever more harried existence.
Are applicants to the profession naïve, misguided, or just repeating
platitudes they believe will help them get into a PA program? Or is
there some real difference in PA practice behavior that contributes
to this urban legend?
Roter et al1 found
that female physicians spent more time with patients than their male
counterparts and also used more positive verbal and nonverbal communication
styles — with no sacrifice in the quantity or quality of biomedical
information exchanged. Bylund and Makoul2
found that female physicians had more empathic interactions with patients
than male physicians. The authors found that patient encounters with
at least one empathic opportunity, a statement by the patient that
could trigger an empathic physician response, were 35 percent longer
than encounters without such opportunities. Epstein3
noted that time is fundamentally subjective, and “patients judge
the time spent with their physicians not only according to elapsed
time but also by the physician’s interest, presence, attention
and responsiveness.” Positive, empathic patient interactions
on the part of the clinician, according to Epstein, lead to the perception
of more time and greater patient satisfaction.
If some unique quality of PA interaction with patients
accounts for the perception — or reality — of more time,
what is it, and why does it occur? Are those who choose the PA profession
different psychologically from those attracted to other health care
roles? Is it a result of PA programs’ applicant selection processes,
what we teach, how we teach it? Is it due to indoctrination, socialization,
regulation? What about PA demographics and levels of occupational
prestige? If there is a more time effect in PA practice, the possible
reasons for it are many and varied — exciting questions for both
qualitative and quantitative research.
This question of more time is just one of many intriguing
research questions that could be examined as the profession further
defines itself. APAP encourages educational research and builds faculty
research capacity through training and mentoring of those new to research
(I include myself in this category). Funding is available for PAs
who wish to delve into aspects of physician assistant education and
training through the APAP Small Grant Programs and two additional
research partnerships between the Association, the National Commission
on Certification of Physician Assistants (NCCPA), and AAPA. Workshops
for faculty who wish to add to or perfect their research skills have
preceded APAP’s annual Education Forums for the last couple of
years. And research methods are increasingly being taught in PA programs.
Intuitively, it seems, PAs are unique. As our research
capacity increases in sophistication and breadth, we move beyond process
and description — and myth — to document the fundamental
questions about what, if anything, makes PAs different. APAP is more
than just the engine for research and inquiry about PA education and
practice. Where scholarship and research are concerned, APAP provides
the financial resources that allow us as faculty to validate the assumptions
that will affirm our unique role as faculty and inform our activities
involving recruitment, selection, and the education of tomorrow’s
PAs.
Notes
1. D.L. Roter, J.A. Hall, Y. Aoki, “Physician Gender
Effects in Medical Communication: A Meta-analytic Review,” JAMA
288 (2002): 756–840.
2. C.L. Bylund, G. Makou, “Empathic Communication
and Gender in the Physician-Patient Encounter,” Patient Educ
Couns 48 (2002): 207–216.
3. R. Epstein, “Time, Autonomy and Satisfaction.”
JGIM 15 (2000): 517–518.
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