Why I Decided To Go With “PA”

Jan. 26, 2016

David E. Mittman, PA, DFAAPA, is an AAPA Director-at-Large.

I just saw an article that struck me as odd. Here is the first paragraph:

“Did you know “Physician Assistant” (PA) was ranked the best job in America? Did you know their average base salary is higher than that of software engineers, business developers, and even your run-of-the-mill data scientist? Yet, most people still liken PAs to any ordinary assistant-level employee.”

I know, it just keeps coming around, and up and in our faces. After 50 years, articles have to explain we are not really “assistants.” So what shall we do with a title that we all agree does not represent who we are and how we practice? I have decided to go with the compromise of using “PA” that was recently developed by the AAPA and let me tell you my reasons why.

As many of you know, I am a staunch believer that the word assistant hurts us every time we write or say it. My belief is it has held the profession back immensely. After 50 years we are still telling people we are not “that kind” of assistant. Sadly, every time we say we assist for a living, we lie to ourselves and our patients. When that happens, three things occur to us physician assistants. You get numb to saying it, somewhere inside of you a toxin builds up and eats away at your professional self-esteem and you start to think it won’t matter. Sadly it does. If we really do assist then we help someone do a job, we don’t do the job. That means we should always have the person who does the job do the REAL work, the diagnosis and treatment. We don’t. Never have. We do the REAL work. We are the medical provider. We diagnose, we treat, we prescribe, the patient goes home. No assisting needed. We just keep blocking that.

So, where do we go with all this?

We could go to associate. It is our profession’s birth name. It is my professional birth name. My PA program certificate says Physicians Associate. I like it, and it fits. Honestly, we do associate with physicians. Legally, we are their associates and we collaborate with them. I certainly could live with the title but only for today. It may not work for tomorrow. Someday, we may not be tied as closely in the legal sense to the physician. Do we still want to call ourselves something that even they might find no use for? What if the profession sees itself as healthcare providers and team members but not required associates? In the same light, if we are not tied legally to physicians, are we not also associates of NPs, nurses, and other professionals? Maybe healthcare associate would be better? Or medical care associates? For those who argue we are “sort of” physicians, associate physician (like associate professor or associate dean) would be much more accurate. And for those that say we practice medicine, maybe medical associate or medical practitioner works. See where I am headed? As I grow, I realize I may not know yet what my heart feels is the best title and then again, we might just have it today.

I am a “PA.” It is in my genes. I bleed PA blue. To me, it could mean physician associate or assistant but really it now only means “PA.” If someone asked me what “PA” meant, I’d answer by saying that “It used to mean physician associate or assistant but we grew out of those titles, so we felt we would go by our well-known initials; “PA.” “A PA is a medical professional educated to practice medicine.”

Simple as that. If we can all and yes, I mean all of us: programs, individuals, students, teachers and most importantly clinicians, say that, this change could work. Maybe even call ourselves, “PA Jones” and PA Smith?” It sounds better than Mr. Smith and Ms. Jones, I think. If we can get behind “PA,” we can and will make assistant a thing of the past. I believe the golden age of PA evolution is just upon us. It’s just starting. There is so much to do and if “PA” becomes our accepted title, we will be better off for it. If in ten years we decide PA is not working for us, then we, in a better position legislatively and knowing where we want to go, can choose a title that will significantly more clearly describe us. I am asking you today to re-do everything you legally can to say “PA.” Work with the AAPA on this. If not, I promise our title will chip away at our collective psyches and continue to be a problem that raises its head every few years.

It will continue to divide and disrupt our profession. Many of us cannot live with a descriptor that includes assistant. More importantly, it will continue to confuse our patients, the general public, legislators and others who will believe we “assist,” and that, my colleagues, is something we can no longer afford to do. It is misleading, confusing to all and no profession deserves to have that yoke around its neck.

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