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| A PA Week Realization: PAs Were Born To Change Medicine |
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by David Mittman, PA, DFAAPA - October 3, 2011
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 Provided by Clinician 1
The PA profession was founded by people who clearly did not respect the status quo. It is not folly to think of them as revolutionaries. Up until 1965, no medical school established any program to train non-physicans to do what physicians did… none. Just the idea of a non-physician writing a prescription was thought of as insanity. All agreed there was absolutely no way you could gain the clinical expertise you needed to understand prescribing unless you went to medical school. There were no NPs to use as a frame of reference, as they too were just getting started at the University of Colorado. The waters Duke and others were treading in, were at best uncharted. Even the use of military corpsmen was truly non traditional but there were few other people available with the medical training they had. Our profession was lucky they were there. If not, it might not have developed. Imagine what most physicians thought of this new idea? Many saw it as another academic experiment that would not work in the real world. The Duke nurses and physicians training PAs were as revolutionary as any medical thinkers of their time.
The staff at Duke also named us physician associates. They stayed away from “assistant” as they knew assistant was an inappropriate title that would be misunderstood. They knew in our society an assistant is generally thought of as a “helper”, not an actual clinician. They were training clinicians, not helpers and were clear in that message. They wanted us to be more.
Over the years Dr. Stead also felt PAs deserved advanced placement into medical school and had a few other ideas that would have seen PAs advance and grow in diffwerent ways. He never stopped thinking and never stopped wanting the PA to keep advancing as a profession, doing new things and entering areas never previously considered.
Today, we can wonder what counsel he would have given the profession with healthcare being turned upside down, with the power of insurance companies, with the PA profession having proven itself and with physicians admitting they can not provide primary care to millions of patients, especially the poor and uninsured. Currently, with 83,000 PAs in practice, each one providing medical care in more different areas and at a higher level than the founders of the profession could have dreamed, what different visions would they have thought of? Would they have advocated that we look to a way to get us into the areas and specialties that need PAs? Surely. Would they have looked for us to be more autonomous? Perhaps. Would they have heard the cries about the PA name not representing the profession anymore. I truly believe, yes.
As we honor the graduation of the first PAs from Duke this PA Week, we can only imagine what thoughts so many of the first people who founded the profession would have had today and more interestingly how they would have handled the problems our profession now faces?
My bet is Dr. Stead and his cohorts would find the status quo to be unacceptable and urge us to move forward. After all, revolutionaries seldom stop dreaming.
Dave has been a PA, and later NP, leader for thirty years. He strongly believes that NPs and PAs must work together to insure a better future for both professions. Most recently Dave has been busy launching another dream; Clinician 1, the first internet community for PAs and NPs. In October 2008, Dave was honored by the New Jersey State society of PAs with its “Lifetime Achievement Award”.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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| Dave Mittman (Livingston, NJ) |
on 04 Oct 2011 at 4:30 pm |
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Bill:
Thank you for the kind words and the lesson on where "Associate" came from. Duly noted.
I have to believe that the re-imagining of today's healthcare system would suggest that all of our early leaders would hold some traditional views and many others that would be thought of as heresy by todays PA leaders. The rise of both the NP and PA professions and the PAs inability to compete on a level playing field would be noted. The realization that physicians will hire the clinician who would be easiest to collaborate with was something not considered 40 years ago. The distinct point about how our name hold us back was not imagined 30 years ago. The fact that a PA was Chief Investigator for the NY City Medical Examiner's office in charge of 9/11 would have been amazing to them as would PA Admirals and General officers.
Our profession is growing and we hold it back more than any other group. Time to realize that and get on the road to fixing it.
Thank you for your support of not just me but the 6,000 PAs that have sent in letters of support to the AAPA and have been to date ignored.
Dave
BTW, I have a video of you speaking at NYSSPA in 1975? One with a quote on it that set me upon the path of PA leadership. I will have to share it.
Hope to speak soon. |
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| Bill Stanhope (Atlanta GA) |
on 04 Oct 2011 at 11:57 am |
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Hi Dave,
I certainly applaud your thoughtful editorial completely agree with your premise that
many of the professions pioneers and leaders including doctors Stead, Meyers, and Silver, Estes, Smith, Todd and Hamburg would find some elements of the contemporary status quo to be unacceptable. The question of course is which are those elements would be unacceptable, which would be lauded and what advice would those early physician advocates offer.
I have no doubt that if we could have them all around the dinner table a most lively discussion would ensue. I imagine that that discussion would reveal a divergence of opinion around nomenclature, roles and appropriate entry levels of education and would take us no closer to us universal agreement that it did 40 years ago.
Dave, I don't mean to quibble however from a historical fact point of view the University of Oklahoma PA program was the first to break ranks and rebrand itself as a physician associate program. Having been at the epicenter of that decision I can assure you that created a mini firestorm amongst the other similar programs.
I completely agree with the position that you are taking around the compelling need to explore the concept of supervision and thus find an alternative way to understand the complex relationships which exist within the community which provides hands-on definitive health and medical care services. I believe that from that undertaking appropriate nomenclature would become clear to all involved. I am deeply distressed that the contemporary spokespeople (AAPA elected officials) have not made this a first order of priority. Like other elements of our society our profession is crippled by an overabundance of politicians and a distressing paucity of statesmen.
Bill Stanhope, PA
Founding President AAPA |
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