Growing up, my dream list of future occupations was varied: Supreme Court justice, Shirley Temple stand-in, crime-fighting assassin/journalist, astronaut, and finally, Nobel Prize-winning brain researcher. Alas, Sandra Day O’Connor took my seat, Shirley Temple grew up, being Catholic put the nix on the whole killing people gig (even if you only kill the bad ones, the Church frowns upon that–see Commandment #6), my 5 foot even height makes me too short to be an astronaut, and no matter how much I loved studying the brain, I found I really dislike research. However, I was blessed to work with stroke patients in my research work, and it turns out, I love people. So in 2003, I became a physician assistant (PA).
If you know any PAs, this is a logical conclusion. As a whole, PAs love people–helping them, taking care of them, and making a difference in their lives. I had never heard of the PA profession until shortly before I applied to PA school, when I met one while working with a surgeon who did not particularly like people (but that’s a story for another blog post). That PA was, and is, a paragon of compassion and competence. She said and did all the things I had always associated with physicians, and her patients loved her and asked for her by name. Not by doctor but by Jennifer, because as she said, “If I cared about titles, I wouldn’t have become a PA.” Inspired by her quiet example, I researched the profession (all that time in research wasn’t wasted), and was astonished by what I learned.
1. PAs have been taking care of Americans since around the time of the Vietnam War. The first PA class graduated October 6, 1967 from Duke University. In fact, PA training was based on the fast-track model of training doctors in World War II because of the health care shortage at that time, and the fantastic Navy corpsmen and their wealth of knowledge from the Vietnam War–necessity being the mother of invention and all. And in a time of civil unrest, one of the examples Dr. Eugene Stead used for the PA-physician team model was a white physician and his African American assistant, Henry Lee “Buddy” Treadwell, who capably managed the clinic while the physician was out of town, and whom “the richest man in town would rather have. . . sew him up than [the physician] because he can do it better. . .” as quoted by said physician. As a female Asian American PA, I can’t think of any better testament to the founder of our profession than that he was progressive enough to recognize quality health care and not care who was delivering it, in a time when Jim Crow laws still existed.
2. PAs work collaboratively with physicians and other members of the medical team to provide quality health care in all fields of medicine. Yes, all.
3. PAs can write prescriptions for what ails you. And when there is no prescription, you can count on us to listen and be present, and fight like hell for you. I mean, advocate strongly for you.
4. PAs not only work in all branches of medicine, they can be found in a variety of settings. We don’t just deliver health care in hospitals, operating rooms, and private practices, we also teach at universities, work in prisons, practice in schools (not the same thing, no matter what you might recall about middle school), perform research (I suppose someone has to), lecture around the world, serve our country in the military and in the White House, own our own practices (in some states), publish in medical journals, care for nursing home residents, and work in industry. The sky is the limit in terms of opportunities available for PAs–literally. I’m still trying to figure out how to work the astronaut angle–first astronaut PA anyone?
5. PAs have to bring similar prerequisites for medical school to the table when applying to PA school, and to be competitive they usually need 2-3 years of healthcare experience to even be considered. My dual degrees in biology and neuropsychology from the University of Michigan were not sufficient. I had to go back and take more classes than I needed for a medical school application, just to be able to apply to PA school. Suffice it to say, I would have taken those classes in medical school if I had gone, but PA school expects you to come loaded for bear so you can be out practicing medicine upon graduation. The time I spent in the healthcare field before PA school was helpful in navigating through the intensive onslaught of information during PA school, and has made me a better PA now that I’m practicing because I had already worked as part of a healthcare delivery team prior to becoming a PA. The PA who has helped clean patients in nursing homes before PA school knows to be on the lookout for decubitus ulcers from first-hand experience, just like the PA who was a paramedic before PA school is acutely aware of the possibility of tension pneumothorax in a patient with blunt chest trauma from an MVA.
6. PAs can be found practicing medicine internationally. Besides those serving in the military for the United States, the PA concept has spread to Canada, the United Kingdom, the Netherlands, Ghana and South Africa. The Russian feldsher was a forerunner to the physician assistant profession dating back to the 17th and 18th century and introduced by Peter the Great to the Russian military in the setting of a physician shortage–not a new problem as you can see. PAs also work in disaster relief and with medical mission groups across the entire world, and many PA schools offer international rotations. One of the best experiences I had in PA school was going on a medical mission to Honduras. Nothing makes you more grateful or humble than knowing that patients have walked miles carrying their shoes just to see a medical provider in order to show up wearing their best clothes. Seeing ingenious providers treat patients in a clinic without reliable electricity inspired me to be more aware of how I allocate our health care dollars, and to hone my physical exam/diagnostic skills.
7. PAs are required to have both national certification and state licensure, and must recertify every 10 years by passing a national exam covering the following areas of medicine: surgery, pediatrics, cardiology, pulmonology, orthopedics, dermatology, psychiatry, neurology, infectious disease, hematology, genitourinary, gastroenterology, endocrinology, and otolaryngology (see #2 above). In addition, we must remain up to date by earning 100 continuing medical education credit hours every 2 years. So even though patients ask us frequently when we are going to finish our schooling and become physicians, the answer is never, because we will never stop learning and we love being PAs.
National PA Week starts today. Even though I never did win a Nobel Prize, travel to outer space, or learn to dance like Shirley Temple, I am blessed to do what I love. Being a PA has been a more rewarding career than I ever dreamed possible. I am thankful for all the patients who have allowed me the privilege of caring for them, listening to their life stories, and sharing their journeys. I am humbled by the incredible trust they place in my hands, and strive like all in the medical field, to be worthy of it.