A new era—for JAAPA, the health care system, and the PA profession

Imagine yourself seated beside Dr. Eugene Stead in 1964 as he writes his famous letter about how ex-military corpsmen would be suitable candidates for what would later become the nation's first PA training program. Imagine you accompany Dr. Richard Smith to the Pacific Northwest to develop what later became the MEDEX PA program emphasizing service for the medically underserved. Then consider what it means to you to be a PA today. If you had the opportunity to go back and rewrite our early history, what would you do differently?


Imagine you are a patient in an exam room, perhaps preparing for an annual screening or suffering a health complaint. Maybe you are sitting on an unusually small chair with your child lying lethargically on your lap, warm from fever with damp hair fixed across his forehead. A nurse tells you that a PA will be in shortly to take care of you. This PA trained at one of the more than 150 accredited programs around the country. Consider what it feels like to be a patient or a caregiver for a sick child or parent. If you could design the ultimate training experience for the PA who will shortly walk through that door, what would you design? What accreditation standards would you create? 


Now imagine you are attending your community hospital's credentialing committee meeting. As the only PA there, you are the single voice for our profession. You have an opportunity to advocate for the use of PAs to expand access to care, improve quality, or decrease cost. During the committee meeting, a motion is made to exclude PAs from a patient care area in which we are well-trained. You make your counterargument, but your audience demands evidence to support your claims. How do you convince others of the value of PAs? What data do you offer to support your claims?


In our tireless pursuit to serve patients, has our profession failed to conduct enough research to validate our value and fully describe the impact of PAs on American health care? A small but meaningful body of evidence, largely created by a few dedicated scholars and AAPA, does exist; but there are simply not enough data to paint the full picture of the impact PAs have in the lives of patients and on access to care. My career is divided among teaching, administration, patient care, scholarship, and research. For me, teaching and patient care are much more satisfying than research. But I never forget that the research informs and guides what I most love to do. 


As our country faces the prospect of health reform, we observe much uncertainty, political turmoil, and fear of change. Clinics, hospitals, long-term care facilities, academic medical centers, and health systems around the country have taken different positions. Some are making thoughtful calculations and transforming the way they provide care. Others stand idle, awaiting a stronger signal about the direction of health reform or how funds will flow. Health professions, professional societies, and medical specialty groups are also taking varying degrees of proactive and reactive steps to leverage their futures. Training programs are refining curricula to prepare PAs for coming changes and trying to balance the latest accreditation standards against realworld demands and expectations from the employers of our graduates. If you could write the policy that would direct the future of the PA profession and shape the new health system in which we will practice, what would you create?


I have never been more proud to be a PA. Never have I felt such a strong sense that our profession can create transformational change in the way we engage, treat, and support patients and families. Never have PAs been so needed. Our profession is rich in talent and filled with the kinds of people patients really want involved in their lives. In an era of team-based care, no one knows better how to coordinate successful care than PAs. But we have to be fearless, so our country gets this health reform thing right. If PAs are at the forefront of this movement, then the needs of our patients will also be the first priority. 


I am both enthusiastic about and humbled by the opportunity to serve our profession as JAAPA's new editor in chief. The editorial board and I are committed to supporting you and the advancement of our profession, and we want the Journal to serve you through the publication of evidence-based clinical articles, innovative approaches to CME, timely messages about professional and policy issues, and more concise research that describes and guides practice. I have also invited thought leaders to offer insight and inspiration through editorials that seek to develop the leadership potential within each of us, and I hope they will suggest some interesting answers to the questions I posed earlier. I am aiming high, because I have not yet encountered a problem that a great PA cannot solve. The editorial board and I have been influenced by the power of the messages that have appeared in JAAPA over the years. Creating each issue is a journey for us, and one we invite you to join. I hope you will share with us your readership, scientific writing, stories, commentary, and innovative approaches to improving the lives of your patients and the health of your community. JAAPA