Do dogs like bones? A time for physician assistant action

Bill Leinweber is executive vice president/CEO of the American Academy of Physician Assistants, Alexandria, Virginia.

Health care futurist Joe Flower posed this question about our canine friends' affinity for bones at the AAPA's Leadership Summit this past summer. As nearly everyone in the audience nodded Yes in response to the question, Flower abruptly reminded us that in fact, dogs like steak but are willing to settle for the bones.

But, when it comes to health care—our own and that of our patients—are we willing to settle for the bones?

And what about our profession? Do we want to settle for the equivalent of “the bones” in regard to the presence and voice of physician assistants in shaping a new health care paradigm for the nation?

As a nation, we spend more than $2 trillion on health care—more than any other industrialized nation in the world. Health care spending accounts for an estimated 16% of our nation's economy and is projected to grow to 20% in the next decade. The return on this enormous investment is underwhelming at best. The United States now ranks last out of 19 countries on measures of mortality amendable to medical care, falling from 15th as other countries raise the bar on performance.

In the coming weeks, we have the privilege of participating in the election of a new president of the United States and a new Congress. The topic of health care reform is receiving a level of interest not seen in over a decade. As professionals dedicated to the practice of medicine, PAs must filter out the cynicism that can too often taint discussion, debate, and decisions surrounding the selection of our elected leaders. All it takes for a sick health care system to get worse is for well-intentioned professionals to do nothing. That means sitting on the sidelines, doing our day-to-day jobs (important as they are), and waiting for others to take up the battle—settling for what we have.

The choices we make in the voting booth are driven by a host of complicated personal and professional criteria. Whatever your criteria and your choices, it is important that you are informed of candidates' positions on the future of our nation's health care and take action based on that information.

Those elected to office in 2008 will inherit a health care system that grows ever more perilous. This past summer, the 2008 National Scorecard on US Health System Performance was released. It is prepared for the Commonwealth Fund Commission on High Performance Health Systems. Across 37 core indicators and five dimensions of performance (healthy lives, quality, access, efficiency, and equity), the United States achieved an overall score of 65 out of a possible 100 when comparing national averages with US and international performance benchmarks. The Scorecard notes that access to health care in this country has significantly declined and that health system efficiency remains low. Last year, more than 75 million adults—43% of all adults aged 19 to 64 years—were either uninsured during the year or underinsured, up from 35% in 2003. Quality metrics, the focus of national campaigns and/or public reporting efforts, did show some improvement gains.

Is this really the best that we can do? The commitment to improved health for all by PAs that I observe as I travel the nation tells me that the answer to these questions is a resounding NO!

When it comes to shaping a new health care paradigm for the nation, my dialogue with PAs across the country tells me that we have grown tired of wishing and hoping and quietly asking for “a seat at the table.” I see exceptionally competent professionals prepared, if need be, to take that seat. PAs are eager to offer significant contributions to dialogue and decision making about the future of health care.

At AAPA's annual conference in San Antonio in May 2008, the Academy launched an advocacy initiative: PAs for a Healthy America: Vote 2008. Since then, we have undertaken a variety of activities to make certain that the campaigns of the presidential candidates are informed of the AAPA's health care reform principles. It is important that candidates for the presidency and for Congress be informed of the positions of the organization that represents some 70,000 PAs who provided care via an estimated 245 million patient visits last year. Additionally, PAs for a Healthy America offers tips and tools to support your personal outreach to presidential and congressional candidates. More information about this initiative is detailed in From the AAPA in this issue of JAAPA (page 8). I strongly urge you to take a look. For more information, visit www.aapa.org and click on PAs for a Healthy America: Vote 2008.

There was a time in the evolution of the profession when it seemed advisable for PAs to hold back in deference to others in the health care workforce relative to advocacy for patient health, health care overall, and the advancement of the profession. Aren't you glad those days are over?

It's time to step up, meet the challenge of reviving a sick system, and actively play our role as valued members of the health care team. JAAPA