Episode 35 - Should You Be Concerned About Seeing a Physician Assistant for Spine Care?
Select tabs below to read the show notes or the full transcript of this episode.
Episode Summary
Just like the spine — the clinicians, doctors, and practitioners who practice spinal care comprise a complex system.
In this episode of Back Doc Talk, we are talking about the team it takes to manage your spinal health, and especially the role of Physician Assistants (PAs).
PAs like Mike Nido of Carolina Neurosurgery and Spine Associates are responsible for a range of treatments and assistance when it comes to fixing back and spine problems.
But is patient care compromised when you see a PA instead of a physician?
PAs are a backbone of the spine issue treatment. Pun fully intended!
Whether it is always seeking that second opinion, having multiple safety nets in place when it comes to films and imaging, or just having a friendly face,
“We make it very clear to [patients] that even though I'm here providing your care, the doctor that's standing behind me is very aware of what's going on and very involved in all of the decisions that are made,” Mike explains.
Listen to this episode of Back Talk Doc to understand the role of a PA and the type of care you can expect from one, how they work with physicians to address spine issues, and much more.
Featured Guests
Name: Michael Nido
What he does: Mike pulls double duty not only as a Physician Assistant, but also as the Director of Clinical Services at Carolina Neurosurgery and Spine Associates. He’s been with the clinic for 24 years.
Company: Carolina Neurosurgery and Spine Associates
Words of wisdom: “The important thing for our patient to understand is that you're not getting second class care. You're not going to the B team. This is your way of getting your foot in the door, getting your care initiated in such a way that by the time you see the physician, all the important stuff has been completed and ready for his review.”
Connect: LinkedIn
Anchor Points
Top takeaways from this Back Talk Doc episode
The team needed to keep a clinic running is larger than you think. Between doctors and receptionists, nurses, and PAs, there are more types of medical professionals at your local spinal clinic than you may realize. It truly takes a team to provide care and aid your back and spinal recovery.
PAs and physicians are in constant communication. One of the main concerns from patients when they go into a clinic and are assigned a Physician's Assistant rather than a doctor is that they may not believe the PA is up to the task. But the fact is that PAs work very closely with physicians and are making sure you are getting the highest quality care. PAs and physicians communicate a ton behind the scenes.
Seeing a PA is practical. When patients see a Physician’s Assistant rather than a physician, they’re not getting sub-quality care. In fact, it makes practical sense because a PA can help a doctor get all the tools needed to make a diagnosis. PAs help get tests done and identify the problem so that by the time the patient does see the doctor, everything will be in place for diagnosis and treatment.
Episode Insights
[00:00] Mobile-based solutions for clinical practice: Check out our sponsor, QxMD, which builds mobile solutions that drive evidence-based medicine in clinical practice.
[02:47] Introducing Physician Assistants: The lead Physician Assistant at Carolina Neurosurgery & Spine Associates, Mike Nido, describes his role.
[05:13] The role of Physician Assistants in clinics: Mike gets into the details of his day-to-day experience as a PA, including the education needed and what types of patients he cares for.
[07:33] PA vs. Certified Nurse Practitioner: Knowing all the different types of practitioners can be overwhelming. Dr. Lakhia asks Mike to explain the difference between these roles, especially in a clinic and hospital setting.
[9:55] But I don’t want to see the PA: Communication is important. Mike and Dr. Lakhia discuss why patients are often skeptical of Physician Assistants. They also talk about why this skepticism usually isn’t founded.
[12:09] Teamwork: Not all clinics have a collaborative model, but it is something Dr. Lakhia believes is beneficial for overall care.
[13:20] Getting an appointment is the hardest part: Everyone understands the pain of waiting to be seen. By choosing a PA instead of a physician, Dr. Lakhia explains that patients can get into the clinic a lot faster.
[14:13] Show and tell: Wrapping up. Mike Lido shares a bit more about himself and his family.
Subscribe & Contact
If you enjoyed this episode of Back Talk Doc, check out our recent episode How Back Pain Can Affect Your Relationship (and What to Do About It).
For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.
Subscribe in your favorite podcast app.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Just like the spine — the clinicians, doctors, and practitioners who practice spinal care comprise a complex system.
In this episode of Back Doc Talk, we are talking about the team it takes to manage your spinal health, and especially the role of Physician Assistants (PAs).
PAs like Mike Nido of Carolina Neurosurgery and Spine Associates are responsible for a range of treatments and assistance when it comes to fixing back and spine problems.
But is patient care compromised when you see a PA instead of a physician?
PAs are a backbone of the spine issue treatment. Pun fully intended!
Whether it is always seeking that second opinion, having multiple safety nets in place when it comes to films and imaging, or just having a friendly face,
“We make it very clear to [patients] that even though I'm here providing your care, the doctor that's standing behind me is very aware of what's going on and very involved in all of the decisions that are made,” Mike explains.
Listen to this episode of Back Talk Doc to understand the role of a PA and the type of care you can expect from one, how they work with physicians to address spine issues, and much more.
Featured Guests
Name: Michael Nido
What he does: Mike pulls double duty not only as a Physician Assistant, but also as the Director of Clinical Services at Carolina Neurosurgery and Spine Associates. He’s been with the clinic for 24 years.
Company: Carolina Neurosurgery and Spine Associates
Words of wisdom: “The important thing for our patient to understand is that you're not getting second class care. You're not going to the B team. This is your way of getting your foot in the door, getting your care initiated in such a way that by the time you see the physician, all the important stuff has been completed and ready for his review.”
Connect: LinkedIn
Anchor Points
Top takeaways from this Back Talk Doc episode
The team needed to keep a clinic running is larger than you think. Between doctors and receptionists, nurses, and PAs, there are more types of medical professionals at your local spinal clinic than you may realize. It truly takes a team to provide care and aid your back and spinal recovery.
PAs and physicians are in constant communication. One of the main concerns from patients when they go into a clinic and are assigned a Physician's Assistant rather than a doctor is that they may not believe the PA is up to the task. But the fact is that PAs work very closely with physicians and are making sure you are getting the highest quality care. PAs and physicians communicate a ton behind the scenes.
Seeing a PA is practical. When patients see a Physician’s Assistant rather than a physician, they’re not getting sub-quality care. In fact, it makes practical sense because a PA can help a doctor get all the tools needed to make a diagnosis. PAs help get tests done and identify the problem so that by the time the patient does see the doctor, everything will be in place for diagnosis and treatment.
Episode Insights
[00:00] Mobile-based solutions for clinical practice: Check out our sponsor, QxMD, which builds mobile solutions that drive evidence-based medicine in clinical practice.
[02:47] Introducing Physician Assistants: The lead Physician Assistant at Carolina Neurosurgery & Spine Associates, Mike Nido, describes his role.
[05:13] The role of Physician Assistants in clinics: Mike gets into the details of his day-to-day experience as a PA, including the education needed and what types of patients he cares for.
[07:33] PA vs. Certified Nurse Practitioner: Knowing all the different types of practitioners can be overwhelming. Dr. Lakhia asks Mike to explain the difference between these roles, especially in a clinic and hospital setting.
[9:55] But I don’t want to see the PA: Communication is important. Mike and Dr. Lakhia discuss why patients are often skeptical of Physician Assistants. They also talk about why this skepticism usually isn’t founded.
[12:09] Teamwork: Not all clinics have a collaborative model, but it is something Dr. Lakhia believes is beneficial for overall care.
[13:20] Getting an appointment is the hardest part: Everyone understands the pain of waiting to be seen. By choosing a PA instead of a physician, Dr. Lakhia explains that patients can get into the clinic a lot faster.
[14:13] Show and tell: Wrapping up. Mike Lido shares a bit more about himself and his family.
Subscribe & Contact
If you enjoyed this episode of Back Talk Doc, check out our recent episode How Back Pain Can Affect Your Relationship (and What to Do About It).
For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.
Subscribe in your favorite podcast app.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Ad: 00:00
This podcast is sponsored by our partner, QxMD. QxMD builds mobile solutions that drive evidence-based medicine in clinical practice. Check out, Read for easy access to research personalized for you. And Calculate for over 500 easy to use decision support tools. Try them today at qxmd.com/apps. Again, that is qxmd.com/apps.
Intro: 00:30
Welcome. You're listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health brought to you by Carolina Neurosurgery & Spine Associates. Where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 01:04
Thanks for tuning to another episode of Back Talk Doc. As you know, I am Sanjiv Lakhia and I'm a board certified podiatrist. And I work at Carolina Neurosurgery & Spine Associates with offices in Charlotte, and Rock Hill, and Ballantyne, just the greater Charlotte area. My office is in Rock Hill. I work five days a week. And we've been pumping out some episodes for you all. And my goal is really to provide you with the most comprehensive source of information on the topic of spine and back care, back pain. So you can make informed and educated decisions. Today, I welcome a guest to the show, Mike Nido, who is a physician assistant with Carolina Neurosurgery & Spine Associates. And he is kind of the lead PA for our entire group and has had extensive clinical history with the group. Mike, welcome to the show.
Michael Nido: 01:54
Thank you.
Sanjiv Lakhia: 01:55
And what I want to do today is I wanted to talk with our listeners really about the concept of how providing spine care, it really takes a team. And it's not just your doctor. We've had physical therapists on the show. I've talked to local chiropractors on the show. And when you hurt your back and you come to a clinic such as ours, there's going to be multiple touch points from a clinical side. And the mid-level provider or the advanced practice practitioners, physician assistants, they're an integral part of the team. And to be frank Mike, there's a lot of confusion about them. So I'm happy that you're able to come on the show today. But before we get into that topic, for those that don't know you and some of the work you've done over the last many years with the group, give us a little background about your training and your specialty interests and your career with the group.
Michael Nido: 02:47
Well, I graduated from PA school in 1981. Just for the sake of your listeners, just to give a little history of the PA profession. It began sometime around in the middle of 1960s, when there was projected to be a shortage of doctors. A physician at Duke University had the bright idea of training medical corpsman that were coming back from Vietnam. These guys were informally trained, but they were practically doing everything out in the field because there weren't doctors on the front lines. So these guys had extensive experience, but when they came back stateside, they didn't have the formal degree to put anything into practice. So he thought that maybe we could give these guys some formal training and put them to work doing some of the common routine things that doctors do to free up physicians, to do the more complicated things that they'd been trained to do.
Michael Nido: 03:36
The first group PA class from Duke University graduated sometime in the middle 60s. And they were four Navy corpsman. The profession kind of grew from there. A lot of the early PAs were informally trained. They took orderlies from the hospital and x-ray techs and people like that. And the doctor would take them under their wing and kind of train them informally. They would serve sort of like an apprenticeship. And the idea kind of caught on and several schools started opening up. And now there's, I don't even know how many schools. When I first came to North Carolina, there were only five programs in the state. And now there's, I believe, 11 or 12.
Sanjiv Lakhia: 04:14
Okay. And forgive us we're in the time of COVID. Breaking up a little bit with our audio. So thanks for hanging in there with us. Mike, how long have you been with Carolina Neurosurgery & Spine Associates?
Michael Nido: 04:26
24 years.
Sanjiv Lakhia: 04:27
Across that spectrum of time, what types of patient populations have you served?
Michael Nido: 04:34
I have the privilege of working with Dr. Michael Hefner, who was one of our pediatric neuro surgeons. So his practice was about 60% pediatrics. So I had the privilege of treating anywhere from neonates up to 90 year olds. We took care of the whole pediatric population. Plus we did some spine surgery and things like that in patients well into their 80s and 90s.
Sanjiv Lakhia: 04:54
So you've kind of seen it all. For those that are out there and they're just not familiar with PAs, can you give us kind of a, maybe a description of what a PA does on a day-to-day basis, just a broad overview of the clinicians that provide clinical support to physicians?
Michael Nido: 05:13
Well, we have a whole team of PAs. We have several PAs that like myself who provide office only outpatient care. We see the whole gamut from new patients coming in for screening with new problems, to all the way to followups, postoperative follow ups and things like that. We also have a large team of PAs that provide inpatient and outpatient care. They do everything from admitting patients to the hospital, doing daily rounds, ordering tests, following up on tests, assisting in surgery, providing all the post-operative care. They also see consults from the trauma surface from the emergency room. So they provide the whole gamut of care.
Sanjiv Lakhia: 05:54
What is currently the training to become a physician assistant?
Michael Nido: 05:59
Most of the programs are anywhere from two to three years. And the vast majority of them now are master's degree programs.
Sanjiv Lakhia: 06:06
So to clarify, that would mean undergraduate education and then post-graduate education.
Michael Nido: 06:12
Correct. And in addition to that, most programs now require at least 2,000 hours of hands-on patient care experience prior to entering a PA program.
Sanjiv Lakhia: 06:23
Folks, that's a lot. So when you come to the office and you see a physician assistant, they have extensive clinical training that Mike just outlined. Where do you see currently kind of the role of PA in our clinic?
Michael Nido: 06:37
I think the major function that we provide, I think we function a lot as a gatekeeper. Personally, I see a lot of new patients. Because of my level of experience, I can see most, any type of patient that we see here. If they're new to our practice and haven't been adequately worked up or what are their neurosurgical problem is, I can do an evaluation or the appropriate studies and refer them on to the appropriate physician in the group.
Sanjiv Lakhia: 07:02
Yeah. So I think that's a huge advantage working at a practice where we can offer the community a large number of excellently trained physician assistants, mid-level providers. It's a way to kind of get yourself evaluated in a quicker manner, get your foot in the door. And we have clinicians like Mike who do a tremendous job. That take a full history and physical exam and they can really get the ball rolling on your workup and your treatment. One question I get Mike, often from patients is kind of what's the difference between a PA and NP or a certified nurse practitioner?
Michael Nido: 07:37
Well, if you walked into our office, you probably would not be able to tell the difference. But basically PAs are trained in a medical model. Our training, pretty much mirrors, medical schools, just shorter. And nurse practitioners are trained by nurses. So they're trained in more of a nursing model.
Sanjiv Lakhia: 07:55
And are there scope of practice differences?
Michael Nido: 07:58
They are very similar. When nurse practitioners join our group and we have several, the training that we provide, they pretty much do the same thing. Like I said, if you walk into our practice, you'd have a hard time differentiating who was what, other than for the name tag.
Sanjiv Lakhia: 08:14
Talk about the role of the PA in the hospital setting.
Michael Nido: 08:18
Well, all of our PAs are paired up with a physician so that they follow that physician through his or her entire practice. That goes all the way from admitting the patients to the hospital, ordering the proper studies, assisting with surgery, and providing the outpatient care, providing the postoperative care in the hospital and also the postoperative care outside of the hospital.
Sanjiv Lakhia: 08:41
And so it's extremely comprehensive. And what's nice about that model is that's continuity of care. It's really amazing for someone to start in the hospital setting, let's say even emergently and end up seeing the same clinician when they do a followup eval, whether it's several weeks later, who understands everything that that patient has been through. Would you agree, Mike? That's pretty fascinating value add I think, to the clinical care that we can offer.
Michael Nido: 09:11
That's a huge part of what we offer. Because there's a lot of things that go on in the hospital that are not very apparent just by reading the chart. That PA knows intimately the hospitalization and everything that went on. And that really helps in providing the postoperative care. Plus it's comforting for patients to come to an office, especially if they're first stopped with us as in the hospital. It's kind of a friendly thing for them to come to our office and see a familiar face.
Sanjiv Lakhia: 09:37
Oh, that's great. And in fact, I know the PAs and nurse practitioners that are in my office in Rock Hill, a lot of times the patients, they just want to see them. They don't really need to see the physician. Sometimes they don't even want to just because such a high level of care that's being provided. They get very, very comfortable working with you and your team.
Michael Nido: 09:55
Well, most importantly, they know, and we make it very clear to them that even though I'm here providing your care, the doctor that's standing behind me is very aware of what's going on and very involved in all of the decisions that are made.
Sanjiv Lakhia: 10:09
So I'm glad you said that. That's a good point of clarification. Because I think one of the knocks, so to speak from the community and you've heard it is, I don't want to see the PA. I see the physician. And what you just kind of outlined here that people just may not be aware of, is how much communication goes on, somewhat behind the scenes. So give the listeners a few examples. Let's say someone comes in, they strain their back last weekend, they call the office, they get put on your schedule. A little nervous that you're not a physician. Explain to them the process that goes on behind the scenes to ensure that they're getting the care they deserve.
Michael Nido: 10:47
Well, for one thing, I've worked with these doctors or any of our PAs, if they work with a doctor, we make it clear that PA has been with that doctor for a long time. And they stand side by side all day, every day of the workweek. When I worked with Dr. Hefner, my wife used to call him my other wife. She thought I knew him better than I knew her. We just learn how they think and how they react to certain situations and what decisions they make in certain situations. And if there's anything out of the ordinary, we always go to our attending physician. And so even if I've made a decision, I will often, without talking to the physician, I will also back that up with going to the physician and saying, hey, I did this. Are you okay with this?
Sanjiv Lakhia: 11:28
Yeah. And one thing I think that you guys do that is extremely important is you co review films and images.
Michael Nido: 11:34
Yes, we do.
Sanjiv Lakhia: 11:35
Because I know patients really want to know what their MRI showed. And when they come in to see a physician assistant, sometimes they're a little bit unsure about did that get addressed or not? So you look at any film, first of all, you're already competently trained on interpreting films, just over the duration of your career, but any film I'm sure that you encounter that has any questionable findings, you're running that by your supervising physician. Correct?
Michael Nido: 11:59
Well, we run it by a supervising position and also just about every one of them is read by a board certified radiologist. So we sort of have a double safety net.
Sanjiv Lakhia: 12:09
Exactly. So I think that should hopefully put some people's mind at ease. When you work with physicians side-by-side in the office, talk about the team concept versus in some practices, the physician assistant has literally, they're kind of on their own. And they work almost as a solo practitioner. So talk about the benefits of the model that we have here.
Michael Nido: 12:32
We may be alone physically, but we're never, never really alone. Especially in this day and age, the technologies that we have available to us, we have phones. Our records are electronic. So I can always call my physician and have him look at film. If I've got a question about a CT scan or any kind of an imaging study, we can be looking at it simultaneously. Before we had this available to us 15 years ago, we had to rely on, if I was in the hospital and the physician was at home, he had to rely on me to be able to tell him exactly what I was seeing on a scan.
Sanjiv Lakhia: 13:09
You've covered a lot. My goal today was to bring you on the show and not so much as get into like clinical treatment protocols for back pain, but really educate listeners on the team-based approach. To me, they really add to the care. And oftentimes the biggest hurdle for cares is getting seen. And many times you can get in with a physicians mid-level within a week or two versus a month or two.
Michael Nido: 13:32
And that's exactly what we push. When a new patient calls in and wants to see Dr. Smith and told that, well, you can't see him for another six weeks, but you can see his PA in a week or two. The important thing for our patient understand is that you're not getting second class care. You're not going to the B team. This is your way of getting your foot in the door, getting your care initiated in such a way that by the time you see the physician, all the important stuff has been completed and ready for his review.
Sanjiv Lakhia: 14:02
Exactly. I couldn't summarize it better myself. All right, Mike, I know it's late and I kind of caught you on a last minute notice. Before I let you go, I'd love for you to share a little bit. What's kind of on your Kindle. What do you listen to? Help us understand something a little more personal that you enjoy maybe with personal growth or with health and fitness?
Michael Nido: 14:23
Well, I have three daughters and three grandkids and another grandchild on the way. So that occupies a lot of my off time. I listen to a lot of music. I try to read. I read a lot of different things. I listened to all kinds of music, other than country. Dabble in woodworking on the side. Fortunately, I've been able to keep all my fingers intact. And a little bit of photography.
Sanjiv Lakhia: 14:49
Between your family, and the hobbies, and the work, you got a well-rounded life. And I'm sure it keeps you busy. Once again, thank you for taking time today. I think this was very informative.
Michael Nido: 14:59
I might add, I always like to brag about this. One of my three daughters is a PA. And I didn't wish it, and she's very happy with her [crosstalk 00:15:06].
Sanjiv Lakhia: 15:05
Well, there you go. Well, you've done an amazing job for our group and for our patients. Certainly you're one of the go-to people in the group for a lot of reasons. And I appreciate taking the time today.
Michael Nido: 15:15
And I appreciate you having me.
Outro: 15:20
Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates. With offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia, and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
This podcast is sponsored by our partner, QxMD. QxMD builds mobile solutions that drive evidence-based medicine in clinical practice. Check out, Read for easy access to research personalized for you. And Calculate for over 500 easy to use decision support tools. Try them today at qxmd.com/apps. Again, that is qxmd.com/apps.
Intro: 00:30
Welcome. You're listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health brought to you by Carolina Neurosurgery & Spine Associates. Where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 01:04
Thanks for tuning to another episode of Back Talk Doc. As you know, I am Sanjiv Lakhia and I'm a board certified podiatrist. And I work at Carolina Neurosurgery & Spine Associates with offices in Charlotte, and Rock Hill, and Ballantyne, just the greater Charlotte area. My office is in Rock Hill. I work five days a week. And we've been pumping out some episodes for you all. And my goal is really to provide you with the most comprehensive source of information on the topic of spine and back care, back pain. So you can make informed and educated decisions. Today, I welcome a guest to the show, Mike Nido, who is a physician assistant with Carolina Neurosurgery & Spine Associates. And he is kind of the lead PA for our entire group and has had extensive clinical history with the group. Mike, welcome to the show.
Michael Nido: 01:54
Thank you.
Sanjiv Lakhia: 01:55
And what I want to do today is I wanted to talk with our listeners really about the concept of how providing spine care, it really takes a team. And it's not just your doctor. We've had physical therapists on the show. I've talked to local chiropractors on the show. And when you hurt your back and you come to a clinic such as ours, there's going to be multiple touch points from a clinical side. And the mid-level provider or the advanced practice practitioners, physician assistants, they're an integral part of the team. And to be frank Mike, there's a lot of confusion about them. So I'm happy that you're able to come on the show today. But before we get into that topic, for those that don't know you and some of the work you've done over the last many years with the group, give us a little background about your training and your specialty interests and your career with the group.
Michael Nido: 02:47
Well, I graduated from PA school in 1981. Just for the sake of your listeners, just to give a little history of the PA profession. It began sometime around in the middle of 1960s, when there was projected to be a shortage of doctors. A physician at Duke University had the bright idea of training medical corpsman that were coming back from Vietnam. These guys were informally trained, but they were practically doing everything out in the field because there weren't doctors on the front lines. So these guys had extensive experience, but when they came back stateside, they didn't have the formal degree to put anything into practice. So he thought that maybe we could give these guys some formal training and put them to work doing some of the common routine things that doctors do to free up physicians, to do the more complicated things that they'd been trained to do.
Michael Nido: 03:36
The first group PA class from Duke University graduated sometime in the middle 60s. And they were four Navy corpsman. The profession kind of grew from there. A lot of the early PAs were informally trained. They took orderlies from the hospital and x-ray techs and people like that. And the doctor would take them under their wing and kind of train them informally. They would serve sort of like an apprenticeship. And the idea kind of caught on and several schools started opening up. And now there's, I don't even know how many schools. When I first came to North Carolina, there were only five programs in the state. And now there's, I believe, 11 or 12.
Sanjiv Lakhia: 04:14
Okay. And forgive us we're in the time of COVID. Breaking up a little bit with our audio. So thanks for hanging in there with us. Mike, how long have you been with Carolina Neurosurgery & Spine Associates?
Michael Nido: 04:26
24 years.
Sanjiv Lakhia: 04:27
Across that spectrum of time, what types of patient populations have you served?
Michael Nido: 04:34
I have the privilege of working with Dr. Michael Hefner, who was one of our pediatric neuro surgeons. So his practice was about 60% pediatrics. So I had the privilege of treating anywhere from neonates up to 90 year olds. We took care of the whole pediatric population. Plus we did some spine surgery and things like that in patients well into their 80s and 90s.
Sanjiv Lakhia: 04:54
So you've kind of seen it all. For those that are out there and they're just not familiar with PAs, can you give us kind of a, maybe a description of what a PA does on a day-to-day basis, just a broad overview of the clinicians that provide clinical support to physicians?
Michael Nido: 05:13
Well, we have a whole team of PAs. We have several PAs that like myself who provide office only outpatient care. We see the whole gamut from new patients coming in for screening with new problems, to all the way to followups, postoperative follow ups and things like that. We also have a large team of PAs that provide inpatient and outpatient care. They do everything from admitting patients to the hospital, doing daily rounds, ordering tests, following up on tests, assisting in surgery, providing all the post-operative care. They also see consults from the trauma surface from the emergency room. So they provide the whole gamut of care.
Sanjiv Lakhia: 05:54
What is currently the training to become a physician assistant?
Michael Nido: 05:59
Most of the programs are anywhere from two to three years. And the vast majority of them now are master's degree programs.
Sanjiv Lakhia: 06:06
So to clarify, that would mean undergraduate education and then post-graduate education.
Michael Nido: 06:12
Correct. And in addition to that, most programs now require at least 2,000 hours of hands-on patient care experience prior to entering a PA program.
Sanjiv Lakhia: 06:23
Folks, that's a lot. So when you come to the office and you see a physician assistant, they have extensive clinical training that Mike just outlined. Where do you see currently kind of the role of PA in our clinic?
Michael Nido: 06:37
I think the major function that we provide, I think we function a lot as a gatekeeper. Personally, I see a lot of new patients. Because of my level of experience, I can see most, any type of patient that we see here. If they're new to our practice and haven't been adequately worked up or what are their neurosurgical problem is, I can do an evaluation or the appropriate studies and refer them on to the appropriate physician in the group.
Sanjiv Lakhia: 07:02
Yeah. So I think that's a huge advantage working at a practice where we can offer the community a large number of excellently trained physician assistants, mid-level providers. It's a way to kind of get yourself evaluated in a quicker manner, get your foot in the door. And we have clinicians like Mike who do a tremendous job. That take a full history and physical exam and they can really get the ball rolling on your workup and your treatment. One question I get Mike, often from patients is kind of what's the difference between a PA and NP or a certified nurse practitioner?
Michael Nido: 07:37
Well, if you walked into our office, you probably would not be able to tell the difference. But basically PAs are trained in a medical model. Our training, pretty much mirrors, medical schools, just shorter. And nurse practitioners are trained by nurses. So they're trained in more of a nursing model.
Sanjiv Lakhia: 07:55
And are there scope of practice differences?
Michael Nido: 07:58
They are very similar. When nurse practitioners join our group and we have several, the training that we provide, they pretty much do the same thing. Like I said, if you walk into our practice, you'd have a hard time differentiating who was what, other than for the name tag.
Sanjiv Lakhia: 08:14
Talk about the role of the PA in the hospital setting.
Michael Nido: 08:18
Well, all of our PAs are paired up with a physician so that they follow that physician through his or her entire practice. That goes all the way from admitting the patients to the hospital, ordering the proper studies, assisting with surgery, and providing the outpatient care, providing the postoperative care in the hospital and also the postoperative care outside of the hospital.
Sanjiv Lakhia: 08:41
And so it's extremely comprehensive. And what's nice about that model is that's continuity of care. It's really amazing for someone to start in the hospital setting, let's say even emergently and end up seeing the same clinician when they do a followup eval, whether it's several weeks later, who understands everything that that patient has been through. Would you agree, Mike? That's pretty fascinating value add I think, to the clinical care that we can offer.
Michael Nido: 09:11
That's a huge part of what we offer. Because there's a lot of things that go on in the hospital that are not very apparent just by reading the chart. That PA knows intimately the hospitalization and everything that went on. And that really helps in providing the postoperative care. Plus it's comforting for patients to come to an office, especially if they're first stopped with us as in the hospital. It's kind of a friendly thing for them to come to our office and see a familiar face.
Sanjiv Lakhia: 09:37
Oh, that's great. And in fact, I know the PAs and nurse practitioners that are in my office in Rock Hill, a lot of times the patients, they just want to see them. They don't really need to see the physician. Sometimes they don't even want to just because such a high level of care that's being provided. They get very, very comfortable working with you and your team.
Michael Nido: 09:55
Well, most importantly, they know, and we make it very clear to them that even though I'm here providing your care, the doctor that's standing behind me is very aware of what's going on and very involved in all of the decisions that are made.
Sanjiv Lakhia: 10:09
So I'm glad you said that. That's a good point of clarification. Because I think one of the knocks, so to speak from the community and you've heard it is, I don't want to see the PA. I see the physician. And what you just kind of outlined here that people just may not be aware of, is how much communication goes on, somewhat behind the scenes. So give the listeners a few examples. Let's say someone comes in, they strain their back last weekend, they call the office, they get put on your schedule. A little nervous that you're not a physician. Explain to them the process that goes on behind the scenes to ensure that they're getting the care they deserve.
Michael Nido: 10:47
Well, for one thing, I've worked with these doctors or any of our PAs, if they work with a doctor, we make it clear that PA has been with that doctor for a long time. And they stand side by side all day, every day of the workweek. When I worked with Dr. Hefner, my wife used to call him my other wife. She thought I knew him better than I knew her. We just learn how they think and how they react to certain situations and what decisions they make in certain situations. And if there's anything out of the ordinary, we always go to our attending physician. And so even if I've made a decision, I will often, without talking to the physician, I will also back that up with going to the physician and saying, hey, I did this. Are you okay with this?
Sanjiv Lakhia: 11:28
Yeah. And one thing I think that you guys do that is extremely important is you co review films and images.
Michael Nido: 11:34
Yes, we do.
Sanjiv Lakhia: 11:35
Because I know patients really want to know what their MRI showed. And when they come in to see a physician assistant, sometimes they're a little bit unsure about did that get addressed or not? So you look at any film, first of all, you're already competently trained on interpreting films, just over the duration of your career, but any film I'm sure that you encounter that has any questionable findings, you're running that by your supervising physician. Correct?
Michael Nido: 11:59
Well, we run it by a supervising position and also just about every one of them is read by a board certified radiologist. So we sort of have a double safety net.
Sanjiv Lakhia: 12:09
Exactly. So I think that should hopefully put some people's mind at ease. When you work with physicians side-by-side in the office, talk about the team concept versus in some practices, the physician assistant has literally, they're kind of on their own. And they work almost as a solo practitioner. So talk about the benefits of the model that we have here.
Michael Nido: 12:32
We may be alone physically, but we're never, never really alone. Especially in this day and age, the technologies that we have available to us, we have phones. Our records are electronic. So I can always call my physician and have him look at film. If I've got a question about a CT scan or any kind of an imaging study, we can be looking at it simultaneously. Before we had this available to us 15 years ago, we had to rely on, if I was in the hospital and the physician was at home, he had to rely on me to be able to tell him exactly what I was seeing on a scan.
Sanjiv Lakhia: 13:09
You've covered a lot. My goal today was to bring you on the show and not so much as get into like clinical treatment protocols for back pain, but really educate listeners on the team-based approach. To me, they really add to the care. And oftentimes the biggest hurdle for cares is getting seen. And many times you can get in with a physicians mid-level within a week or two versus a month or two.
Michael Nido: 13:32
And that's exactly what we push. When a new patient calls in and wants to see Dr. Smith and told that, well, you can't see him for another six weeks, but you can see his PA in a week or two. The important thing for our patient understand is that you're not getting second class care. You're not going to the B team. This is your way of getting your foot in the door, getting your care initiated in such a way that by the time you see the physician, all the important stuff has been completed and ready for his review.
Sanjiv Lakhia: 14:02
Exactly. I couldn't summarize it better myself. All right, Mike, I know it's late and I kind of caught you on a last minute notice. Before I let you go, I'd love for you to share a little bit. What's kind of on your Kindle. What do you listen to? Help us understand something a little more personal that you enjoy maybe with personal growth or with health and fitness?
Michael Nido: 14:23
Well, I have three daughters and three grandkids and another grandchild on the way. So that occupies a lot of my off time. I listen to a lot of music. I try to read. I read a lot of different things. I listened to all kinds of music, other than country. Dabble in woodworking on the side. Fortunately, I've been able to keep all my fingers intact. And a little bit of photography.
Sanjiv Lakhia: 14:49
Between your family, and the hobbies, and the work, you got a well-rounded life. And I'm sure it keeps you busy. Once again, thank you for taking time today. I think this was very informative.
Michael Nido: 14:59
I might add, I always like to brag about this. One of my three daughters is a PA. And I didn't wish it, and she's very happy with her [crosstalk 00:15:06].
Sanjiv Lakhia: 15:05
Well, there you go. Well, you've done an amazing job for our group and for our patients. Certainly you're one of the go-to people in the group for a lot of reasons. And I appreciate taking the time today.
Michael Nido: 15:15
And I appreciate you having me.
Outro: 15:20
Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates. With offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia, and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
Top quotes from the episode:
Michael Nido:
[06:37] “I think we function a lot as a gatekeeper. Personally, I see a lot of new patients. Because of my level of experience, I can see any type of patient that we see here.”
Dr. Lakhia:
[07:02] “I think that's a huge advantage working at a practice where we can offer the community a large number of excellently trained physician assistants, mid-level providers. It's a way to kind of get yourself evaluated in a quicker manner, get your foot in the door.”
Dr. Lakhia:
[09:37] “I know the PAs and nurse practitioners that are in my office in Rock Hill, a lot of times the patients, they just want to see them. They don't really need to see the physician. Sometimes they don't even want to, just because [of] such a high level of care that's being provided. They get very, very comfortable working with you and your team.”
Michael Nido:
[10:50] “[I]f they work with a doctor, we make it clear that PA has been with that doctor for a long time. And they stand side by side all day, every day of the workweek … we just learn how they think and how they react to certain situations and what decisions they make in certain situations. And if there's anything out of the ordinary, we always go to our attending physician. And so even if I've made a decision ... I will also back that up with going to the physician and saying, hey, I did this. Are you okay with this?”
Michael Nido:
[06:37] “I think we function a lot as a gatekeeper. Personally, I see a lot of new patients. Because of my level of experience, I can see any type of patient that we see here.”
Dr. Lakhia:
[07:02] “I think that's a huge advantage working at a practice where we can offer the community a large number of excellently trained physician assistants, mid-level providers. It's a way to kind of get yourself evaluated in a quicker manner, get your foot in the door.”
Dr. Lakhia:
[09:37] “I know the PAs and nurse practitioners that are in my office in Rock Hill, a lot of times the patients, they just want to see them. They don't really need to see the physician. Sometimes they don't even want to, just because [of] such a high level of care that's being provided. They get very, very comfortable working with you and your team.”
Michael Nido:
[10:50] “[I]f they work with a doctor, we make it clear that PA has been with that doctor for a long time. And they stand side by side all day, every day of the workweek … we just learn how they think and how they react to certain situations and what decisions they make in certain situations. And if there's anything out of the ordinary, we always go to our attending physician. And so even if I've made a decision ... I will also back that up with going to the physician and saying, hey, I did this. Are you okay with this?”
