|Author: Daniel Sean Kaye|
|Physician, PA Team Up for Quality Healthcare|
|Robert M. Blumm, RPA-C, is the senior physician assistant at Gold Coast Cosmetic Surgery, a plastic and reconstructive practice specializing in cosmetic surgery. It is the solo practice of Gerald A. Acker, M.D., past Chief and Director of plastic surgery departments at Deepdale General Hospital, Lydia Hall Hospital and Long Beach Memorial Medical Center. The New York practice is internationally known, with patients coming from as far as Hong Kong and Europe, as well as both coasts of the United States.
Blumm found his way to the physician assistant profession as a result of his military training and speedy introduction into trauma medicine while serving as a combat medic in the 5th Special Forces Group in Vietnam from 1966-67. He served in the 3rd Mobile Army Surgical Hospital (MASH) in Dong Tam, Vietnam, under Sydney Levitsky, M.D., presently Chair of Cardio-Thoracic Surgery at Deaconess Hospital in Boston, MA, an affiliate of the Harvard Medical School.
Like many medics in Vietnam, Blumm quickly became over-trained in his military occupational specialty. Under Levitsky, he helped perform emergency surgery on more than 500 wounded American soldiers, and was involved in the early usage of surgical glue for gun shot wounds three decades before today's current use of the product. "The physician assistant profession was a natural progression for the early medics and corpsmen who returned to the United States with far more experience than could have been provided in a residency program, and who needed to supplement their experience with core didactic medical education," says Blumm.
Dr. Acker opened his practice in July 1971. A graduate of Johns Hopkins Medical School who did his plastic surgery residency at the University of Pennsylvania, Acker also trained at the Mayo Clinic and in Beverly Hills, California. Blumm met Acker at Deepdale Hospital where the two became close colleagues after working together on many cases. "I observed that Dr. Acker was a technical genius and managed to get myself assigned to his cases," says Blumm. "[There] I would have the opportunity to display both my enthusiasm for plastic surgery, as well as impress upon him the fact that mid-level practitioners could study these cases prior to surgery and be more than just another set of hands. A good surgeon needs someone with whom he can discuss the contemplated procedure and its various approaches and be a sounding board. I knew that I could provide this for Dr. Acker, and this began a journey that has lasted 29 years."
Blumm joined the practice in 1972 and has been an integral part of it ever since. In addition to his current day-to-day responsibilities as office manager and administrator, he also does consultations, pre- and postoperative care, first assisting in surgery, lecturing, and overseeing the education of residents, other PAs and nurses.
In addition to his work with Acker, Blumm owns a surgical assistant business and assists on "head and neck" and trauma cases, as well as general, laproscopic and orthopedic surgeries. He is also a senior physician assistant in Emergency Medicine at Good Samaritan Medical Center in West Islip, New York, where he practices every other weekend for two twelve-hour shifts and every other Monday for an eight-hour shift.
Blumm's involvement with medicine doesn't end there. He is the American Academy of Physician Assistants (AAPA) Liaison to the American College of Surgeons, as well as Chairman of the Surgical Congress of the AAPA. He is clinical instructor for the Touro PA Program in Bay Shore, a clinical preceptor in Emergency Medicine for PA students at Touro, SUNY Stonybrook and New York Institute of Technology, and is a frequent speaker at state and national PA and nurse practitioner conferences. He and Acker are also on the medical staff of the North Shore/Long Island Jewish System, with most of their cosmetic surgery conducted at Bay Shore's Southside Hospital, a cutting edge state-of-the-art facility.
Last May, Acker and Blumm were the recipients of the first ever AAPA "Physician-Physician Assistant Partnership Award." The honor, presented at the AAPA's 29th Annual Physician Assistant Conference in Anaheim, California, recognizes "a physician/PA team that exemplifies the unique relationship of trust and mutual respect that is essential to the PA profession. The team displays evidence of collaboration that allows both the PA and the physician to provide greater medical service to their patients and their community than either would be able to do working alone," according to the AAPA's release.
What sets these two men above and apart from other similar teams, is the way that they approach the "physician/PA model" in their practice. Instead of seeing the practice as simply the doctor's business with the PA as an employee, at Gold Coast Cosmetic Surgery the PA is accepted as an associate, a "priest to the physician's bishop," explains Acker. It is a partnership were the two men work together to improve the care given to their patients. They believe that a successful practice must be seen through the eyes of the physician, the PA and the patient.
At the conference, Blumm explained that the PA expects certain things from his supervising physician: recognition, responsibility, respect, professional knowledge, trust and to serve as a model for the PA. "Like in a marriage, it's easy to take advantage of each other and to take each other for granted," said Blumm. "There needs to be a time when the physician says to the PA, 'Thank you, that was an astute diagnosis,' or 'Thank you for coming into the hospital at 2 a.m. because of some intuitiveness you may have had and seeing that patient.'" Blumm remarks that the team has to "decide who has what responsibility. It must be clearly delineated so that each knows what is expected of them." This leads to respect, where the physician recognizes that the PA is his associate and colleague, and is willing to listen to his questions and consider his suggestions.
PAs need their physician to be a mentor, and for him to share his professional wisdom and insight. But he also needs to be up-to-date with advancements. Blumm suggests that the physician attend AAPA, state society and specialty meetings with the PA to get that extra knowledge. That way, both are up-to-date with advancements. In addition, the physician must support the PA's "decisions and entertain his judgment." By building this trust, the PA will continue to willingly contribute to the practice. If the PA "feels good inside, [he] will continue to give and give." Lastly, the physician needs to show the PA what to do to best serve his patients and himself for the rest of his career. This will make him a more integrated member of the practice.
Dr. Acker then offered what the physician expects of the PA. "Education, education, education," said Acker. This is the cornerstone of the career, it is what "affords [the PA] the opportunity to respectfully disagree. It is how medicine evolves and changes." Acker advises PAs to have strong core knowledge, more than just knowing basic material. "Nurses do not have the same clinical background that PAs do, and the technologists don't have the core medical background that PAs have." This helps the PA evolve as "a thinking individual." The surgical PA should know pre-op assessment, post-op care, ICU care, current drug therapy, and cardiac resuscitation skills, and the non-surgical PA should be familiar with a large universe of patients. "Many relate more to the PA than to the doctor. Under the HMO-modeling system we now have, the PA is effectively a general practitioner," said Acker. "[PAs are] replacing the GPs of the United States as the first core of the first line of defense in medical care."
"PAs have to be able to diagnose and treat everyday diseases," Acker said. "But most importantly, they must be able to distinguish the critically ill, to be able to define a patient with multiple diseases, and to have a modicum of courage to be able to confront the doctor they're working with and say, 'Here's an individual with multiple diseases, with something that's a bit different and I'd like your opinion. PAs must learn the boundaries of professionalism."
Acker stresses self-education. "By pursuing this, PAs will be able to grow as individuals and become better healthcare providers. They will be increasingly comfortable approaching complex cases and they will earn their supervising physician's respect. Continuing education helps a PA become a learning, thoughtful person," Acker stated. Going to local, state, national and international meetings, college of surgeons meetings, etc., expands their awareness. PAs must know that core medical knowledge is insufficient for surgical specialty. [PAs] need to be current in techniques and evolving philosophies. "In my practice" said Acker, "Bob (Blumm) has maintained basically a level of knowledge and a level of competence equal to a physician and he has earned the respect of our patients accordingly."
PAs must have aptitude ˘ "inherent human skill." Acker said, "This demands a unique personality that has the capacity to subordinate ultimate decision-making. The medical practice is to be treated [by the PA] as if it belongs to the PA exclusively. Think of the practice as if it was yours." This includes first impressions or how you dress, speak and relate, as well as the PA's ability to be compassionate and their lead physician's "second set of eyes." They need to be thorough. "In our practice," noted Acker, "that entails pre-operative evaluation, looking at patients, instrumentation, follow-up care, and availability." PAs also need to embrace specialized training. "PAs are not the dependent individuals they think they are," Acker said. "The physician and PA are a team and the PA's knowledge and expertise and skill will be regarded as equal to a physician. Therefore, you need the same corpus of knowledge as physicians."
Lastly, Acker spoke to what the patients want from the physician/PA team, revealing thoughts given to them by their own patients as the result of a query the practice gave out. "They expect that the M.D. has complete faith in the PA's ability to treat patients, they expect the M.D. and the PA to have an excellent relationship and evident mutual respect for each other, and they expect the M.D./PA team to be knowledgeable and to be qualified, that they put the patient at ease, they take the time to listen, and they are a truly compassionate and caring team."
Blumm has said that people need the courage and insight to say, "Yes, this concept can work." The Acker/Blumm physician/PA model, just one of a profession over 40,000 strong, believes that the team approach to healthcare has more to offer than solo practices. They know that their patients reap the benefits when they work together and that two have more to give than one. This builds better physicians, practices, healthcare services and PAs.
That is why Blumm likes to challenge PAs to become involved in self-study programs, to give back to their profession by teaching others, and to join their representative groups. "Regardless of how busy you may be in your professional/clinical life, there is still time to give back to the PA profession by serving as a mentor, educator or in an administrative capacity on the state and national level," says Blumm. "Every PA should feel compelled to join their national organization, their state chapter and their specialty group. When we work together, we all win."
Robert M. Blumm, RPA-C, attended the nursing program of Queensboro Community College in 1968, Northwest College A/G in Kirkland Washington from 1969-70, and received his BS from Northwestern in 1973. He is past president of the American Association of Surgical Physician Assistants and the New York State Society of Physician Assistants.
Daniel Sean Kaye is a freelance writer from the Philadelphia area. He is on the editorial staff of NEWS-Line for Physician Assistants.