Today in the chart

Seven Strategies to Try When You Butt Heads with Your Collaborating MD

A job in healthcare means navigating challenging relationships. For many APPs, working with a collaborating physician tops the list.

Healthcare settings are packed with complicated relationships, whether they’re between providers and patients or within the care team. One such dynamic that can be uniquely challenging is the collaboration between advanced practice providers and collaborating physicians. Why? Because their responsibilities and work are often shared.

“In some states, MDs need to co-sign your chart, and you need to talk to them about the treatment plan,” explains Andrea Lowe, MHA, PA-C, director of employer strategy at the American Academy of Physician Assistants. “You’re both deciding on meds, what course to take — together, you’re deciding what’s best for the patient.”

If you struggle to form a fast partnership, the nature of the work certainly raises the stakes, but many APPs face this. Here are some tips, based on Lowe’s 20 years of practicing medicine, that yield significant results.

Communicate Early and Often

This is most important, says Lowe, because “everyone has their own practice style. There are different ways to come to a diagnosis or treat a patient that has the same outcome.” (She adds that it’s crucial to communicate with everyone on your care team, not just physicians.)

Whether you’re working with someone for the first time or you’ve butted heads in the past, it’s okay to ask how that person prefers to work together. Perhaps you can offer to see patients with the MD as a duo or to do it alone and report back your findings. You can also go a more general route and simply say, “What’s your style?”

Be Willing To Pivot

Part of working on a healthcare team means dealing with many other people’s opinions, not just MDs’. As an APP, you might work a 12-hour shift, eight of which are with one physician, the rest with another, who may have a different workflow or approach to cases. When that switch happens, be ready to accommodate a new approach.

Ask Why Someone Wants To Do Something a Certain Way

At first, this might seem unnecessarily confrontational. Still, if you don’t understand why the physician has made a specific decision, you should say so while being mindful of how you pose the question.

For example, Lowe has asked, “Can you walk me through why you want to do it this way?” successfully. “I’ve found that I’ve been wrong, and something didn’t occur to me,” she says. “Focus on the why behind the difference of opinion and course of action.”

Drop Your Ego

When you don’t agree with the physician’s reasoning, it’s best to “agree to disagree,” Lowe says. “Arguing won’t get you anywhere.”

If you have a particularly challenging interaction, consider pulling the individual aside and saying something non-confrontational. A direct comment like, “Is there something you’d like to discuss?” can work wonders.

Remember, the Patient Comes First

When you have difficulty letting go of a situation, remind yourself of your responsibility to the patient. “In medicine, it’s not about being right all the time because that will lead to mistakes,” Lowe stresses. “You do what’s best for the patient.”

Focus on the Positives

“I’ve had some colleagues come to me and say, ‘Doctor So-And-So has a very strong personality,’” Lowe recalls. “But I’d point out to them that his patients love him. You must see beyond that and understand that he wants what’s best for the patient.”

Reframing the dynamic can help you refocus on patient care because, at the end of the day, as Lowe explains, “you’re both there to do a job.”

Stay Confident in Yourself — And Your Profession

You’ve likely heard criticisms of APPs’ increasing practice authority, whether they’re online or at your workplace. Lowe stresses that you shouldn’t concentrate on the negativity but use it to educate others about the role of APPs.

“You graduated from PA school and passed your boards because you’re smart — don’t let anybody take that from you,” she asserts, adding that conflict in healthcare happens across the board, not just between APPs and MDs.

“Recognize that you’re a part of a team,” she advises. “Be open to doing things differently and get yourself a seat at the table … [APPs] aren’t going anywhere.”

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