KODAK has been a part of many of our lives as much as any company I can think of. If you are of a certain age group, you grew up with KODAK. So much so, that for many of us, our first camera almost always was a KODAK. Paul Simon wrote a song in praise of KODACHROME film. Years ago we all excitedly bought a few rolls of KODAK film before every vacation and as we took our pictures we kept our small finished film containers in a safe place. Then we took them to the drug store for processing on KODAK paper with KODAK processing machines. If KODAK was so important to the lives of so many, how is it that today KODAK is now close to bankruptcy? KODAK stock that sold for about nine dollars a year ago is worth fifty cents today and it may be bankrupt as you read this. Why? And what can it teach PAs more than any other health profession?

If you ask KODAK what it did as a business, I am sure they would say they made film and later cameras and they made them better than anyone else in the world. What KODAK never realized was it was never in the film or camera or photo processing business. Never was, not even for a day. They did not know their strength was that KODAK was in the business of creating memories, the business of self expression and the business of catching people’s dreams on film. Our prom, our babies, our cars, our vacations all were captured by KODAK. 
They never got that message and the inability to understand what their market really was, where it was going and that it needed to drastically shift its corporate identity from a film company took down one of the best businesses America ever produced.

So, let’s look at the PA profession. Forty, thirty and twenty years ago the fact that we stressed that we were “dependent” worked for us. We work “under the supervision of a physician” was our mantra. It helped us gain the trust of our patients and the healthcare community. The fact that we did not need advanced degrees was also a plus as many of us entered the profession loaded with life experience and began to practice and show just how good we could be. The fact that we needed chart review or ratios or countersignatures on our orders worked to satisfy those that questioned our ability and training. So did designing a recertification system that treated us as if we were all in the same specialty, that believed that twenty years out we would still all need to know the same information. We took great people with medical experience and trained them in exceptional programs and created a very, very successful profession.

Today the PA profession must recognize that things have changed. We must fully embrace the fact we are in a new medical world. We have to realize that what worked to promote us in the past, won’t work into the future. We have to realize that we are in a country where physicians are not entering primary care. Hard to work as part of a “medical care team” when the other team mate is not even on the playing field, nor will they ever be. Or when the other team mate leaves after being with you for 30 years because the hospital bought their practice.Teamwork only goes so far you know. I believe we are all part of a team; NPs, PAs and physicians but we have to realize that most physicians don’t want to be saddled with anyone who will slow them down with restrictions. This has been felt by many PAs as most of us will agree employers will hire the profession with the least requirements they have to deal with, not the most. It is time to admit that few of us ever acted as “assistants” to physicians and for the most part have been competent healthcare providers, no different from most other providers who work in a group practice. Time to realize that when we tell people we “assist” or need “supervision” that these words no longer promote us, but make us seem unable to do the job our country needs. Time to realize that almost every other professional group that is even near our professional level is autonomous and producing students at the doctorate level. Time to realize that America needs primary care providers with a proven track record of caring for people that can be backed up by research. Time to set up federally funded post graduate residencies in primary care that could (with further work) provide a doctorate and much more autonomous practice. Time to say we are excellent clinicians who can take their earned place as providers (read that as much more autonomous) and not worry about a town losing their medical care because there is no one to sign the PAs charts or because the doc retired. Time to think far out of the box. Time to plan for our place in the future as medical care providers/associates and not anything less. 

If we don’t, we risk the chance of waking up one morning and finding out we were too busy making ourselves dependent partners who were good clinicians while the need was clearly for autonomous clinicians who could also be good partners. 

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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