PAs have made it past the first few decades of the profession’s history and evolution. As America prepares to re-think much of how our system of healthcare delivery, the PA profession must start to make the changes needed for us to impact healthcare delivery at the highest level possible. I thought I would write down a few (of many) wishes for the profession this coming year.

Name Change 
There are many things we have waited too long to accomplish and on the top of that “to-do” list is our name change. Many PAs hope that 2012 bring us closer to the adoption of our original name, physician associate. Other words and definitions also need to changed to reflect what we do but none is more important than the words we use to tell the world who we are. What do those words say to the people that hear them? Do they instill confidence? Are they generic? We are real clinicians, we are not assistants. I pray that all PA leaders realize that so many PAs want this change and we can all begin to effectively deal with the problem of having a profession with what all of us agree is a name that does not represent what we do. If our leaders choose to ignore the grassroots PAs feeling on this, it will only divide and hurt the profession. If we do not act because we are worried about what organized medicine would say or do, we have a huge problem that must be addressed. This is not a scope of practice issue, just one central to our future and identity.

Research 
Second on the list of what we have waited way too long to do is meaningful research. Just what level of medicine do PAs practice at? If we are to have a seat at the table of clinicians who deliver care, we must answer some basic questions. Do we really need chart review? What do our outcome studies look like? How much does a PA save the system, especially in primary care?  Does mandatory supervision really make the quality of care better? If it does and we can show that, why don’t all professions need some degree of oversight? Why just us? Are some new requirement needed that might work better in ensuring we grow as excellent clinicians delivering excellent care? So many questions, not many well researched answers.

Reimbursement 
We need to start working together with the NP profession to look at how, when, and by whom we are reimbursed. If we can make that better, easier and remove some barriers let’s work together to remove them. Home care, Federal Workmen’s Comp or where ever those barriers lie, let’s start taking them apart-together.

Ability To Practice To The Full Scope of Our Education 
Let’s face it, PAs are good. Really good. We should be able to do all that we can learn to do. Pronounce people dead, why not? Order home care or order blood, why not? Prescribe controlled substances in Florida, let’s see what the national research shows? Cystoscopy ? Absolutely. Either we are a part of medicine or we are not. If we are, let’s work to stop the arbitrary way our legislators and organized medicine looks at us and what we do on a daily basis. Especially now that there are 90,000 of us doing so much medicine in all states and our skills are needed more than ever. I expect that along with this will come a fair way to insure our competency, especially in regard to procedures.

A Clinical Ladder Linked To Autonomy 
As I previously stated, either we are a part of medicine or we are not. If we are, let’s look at more autonomy for years practiced and residency training. I will not try to say what that would look like but it seems foolish that we would need a “supervising” physician if we wanted to do physicals part time on weekends for the US Army or give flu shots at Walgreens after 10 years in practice. All that does is allow us to provide care to people that need it. How do we make people understand this is a “no brainer”? Possibly by proving that we are qualified by our experience and training to do some things on our own. This makes sense. We have earned it.

Let’s Look At The MBBS Degree and See How Far We Are From That? 
Here is where some good research is needed. I would love to see a study done that looks at the MBBS degree and compares it to PA training. Exactly because this degree is recognized as one that confers a physician level education. The MBBS degree is a Bachelor of Medicine and Surgery degree that many physicians outside the USA graduate with. The degree is currently awarded in various forms in institutions in Australia, Bahrain, Bangladesh, Barbados,China, Egypt, Fiji, Ghana, Guyana, Hong Kong, India, Indonesia, Iran, Iraq, Ireland, Jamaica, Jordan, Kenya, Kuwait, Libya, Malawi, Philippines, Malaysia, Mauritius, Mexico, Myanmar, Nepal, New Zealand, Nigeria, Pakistan, Papua New Guinea, Samoa, Saudi Arabia, Sierra Leone, Singapore, South Africa, Sri Lanka, Sudan,Tanzania, Trinidad and Tobago, Uganda, the United Arab Emirates, the United Kingdom, Zambia and Zimbabwe. I would like to see how the Master’s PA degree (and NP degree) differs and measures up to this degree in hours and especially in content? My bet is that PAs and NPs come out looking pretty good. I know the PAs one year internship can’t be less than these schools and I bet it is at a higher level than many of these programs. Why is this degree recognized as physician level training while we PAs and NPs are talked about as “ill prepared” to practice? Let’s look at our training and see if ours is even better? I am not asking for this so that we can become physicians. I am asking because I feel that organized medicine uses the excuse that we are not educated enough to provide good care without really looking at how educated we are. Let’s see if that is true and how we measure up to many of the worlds medical schools. 

If we can get some of this done, it will be an interesting year. 

I hope I have made you think. As importantly, I hope these suggestions have made our leaders think. 
Have a wonderful New Year. May it be a happy and healthy one for us all.

Dave

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”.

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