How can you smooth the way when you are considering accepting or have accepted a position in a practice or institution that has not previously used PA's? Conversely, how can you repair the damage to the PA Concept caused by another PA in your institution? What follows are suggestions for actions, keeping in mind that you may well think of other things to do because of what you know about the situation.

1. Define your duties and their expectations in writing. This could be in the written contract for the position, or in a separate job description. You should review this information before you accept the position. This includes ancillary personal assigned to you (nurse, medical assistant), when to refer, when to contact the supervising physician, and who has control for arranging your appointments. This may also include Institution bylaws, if credentialed for a Hospital or other institution.

2. Know your practice laws. Call or write the state agency that licenses, registers, or certifies you as a PA. Ask them for a copy of the laws that govern your practice. Read what they send you, and call them if you have questions. Then, when questions arise as you work you will have an answer for the physicians, managers, and coworkers to their questions.

3. Educate your patients. Introduce yourself as a PA the first time you provide care for each patient. (Many states require this anyway, along with a name tag that says you are a Physician Assistant.) Be prepared to answer their questions. Consider a press release to the local newspapers, radio, and television stations. Have written material on PA s from state and national chapters in waiting and patient rooms. Consider a permanent announcement on the exam room wall for patients to read in the short time they have to wait to see you. (Many patients will actually read it!)

4. Break in the new doctor. Consider how you can expose your new supervising physician to observing PA/physician interaction. Are there PA s working elsewhere in the institution or the community that the physician may have ties with and speak with a physician there? Also, each of you should have a clear understanding of your responsibilities, including diagnostic and prescribing limitations. You may have to initiate this discussion, and meet weekly or monthly until a level of comfort is reached by both of you. Another consideration is an initial period of increased hands on supervision by the new physician, to include chart review, case discussions, test result reviews, etc. A new physician has a right to be nervous: we act in their behalf and they are frequently held responsible for our mistakes.

5. Educate the other staff. Consider a luncheon meeting or a presentation at a staff meeting on PA s, the laws, working relationships, etc. The earlier this is done the better. Others may see working with you as going against their professional codes or laws. An example is a nurse refusing to accept the order of a PA because he/she believes it is against state law or nursing code of ethics. (This recently happened in Michigan to a PA who was applying for hospital privileges and was told by the Director of Nursing that the American Nurses Association has a policy that a nurse may not accept the order of a PA. A phone call to the ANA reveled that they have no policy whatsoever regarding physician assistants.)