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Good-bye to all that
(with apologies to Robert Graves)
Charles DiMaggio, PhD, PA-C
The author is an Assistant Professor of Clinical Epidemiology, Columbia University Mailman School of Public Health, New York, NY, and a member of the editorial board of JAAPA. He has indicated no relationships to disclose relating to the content of this article.
 When I graduated from PA school, my mother threw a party to celebrate. In addition to cannoli, she bought some party favors from a little Italian bakery on Northern Boulevard in Queens. I’m looking at one now. It’s a small plastic figurine of a graduate in cap and gown standing atop a pedestal of books. The books are inscribed “Charles DiMaggio, PhD.” I had tried several times to explain to my parents exactly what a PA was, but between the language barrier (they spoke a kind of Italo-English indigenous to New York City in the 1970s) and the newness of the physician assistant profession, the inscription on the figurine ended up as “PhD.”
The end of an era
I was put in mind of my graduation from PA school, and what it means to be a PA, when I heard about the demise of my alma mater, the St. Vincent’s Catholic Medical Center Staten Island Physician Assistant Training Program (née Bayley Seton Hospital PA Program, née United States Public Health Service PA Program). Lawrence Durrell said, “We are the children of our landscape; it dictates behavior and even thought. . . .” Bayley Seton was my landscape, and it continues to dictate my behavior and thought. If for no other reason than it was among the very first PA programs and graduated more than a thousand PAs during its 35-year history, the passing of this program deserves note. It was housed on the site of the 18th-century Marine Hospital Service, the precursor of today’s Public Health Service, on a hill near the harbor on Staten Island with spectacular views of the Twin Towers and the Statue of Liberty. I remember walking
past the single, small room that once housed the old Public Health Service Hygienic Laboratory, which in some strange, unimaginable way morphed into today’s multibillion-dollar National Institutes of Health. Our learning lab seemed to have been borrowed from an episode of M*A*S*H, with army-surplus surgical lights, glass IV bottles and syringes, and olive-drab drapes. The institution’s quasi-military roots were also evident in the uniform of white pants and short white jackets we were required to wear daily. It was a marvelous juxtaposition of a very young profession rising amidst the remains of the very old.
The demise of this venerable program comes at a time when the PA profession
is redefining itself and reaching a new level of maturity. As we observe the death this past year of one of the profession’s great founding visionaries, Dr. Eugene Stead, the makeup and activities of the profession are changing. Physician assistants are younger, and they are more likely to be female than they were when the United States Public Health Service PA Program opened its doors on that hill overlooking New York Harbor. Our patients are more likely to know what a PA is, and those patients are also more likely to be encountered in places like emergency departments or surgical suites. We are also more likely to be found responding to national and international crises. When I received an e-mail inquiring about my willingness to assist in the aftermath of Hurricane Katrina, there was less interest in my epidemiologic credentials than in my background as a PA.
Once a PA, always a PA
All my professional efforts can be traced back to Staten Island. While there is a natural association between my current work in epidemiology and my PA training, I believe I would still somehow use that training if I chose to drive a cab for a living. If nothing else, I am more comfortable talking to folks and asking them questions than I was before I became a PA. I utilize and highlight my PA background almost daily in ways small and large. My PA degree appears on my papers and correspondence and even on my license plate. I maintain my affiliation with the AAPA and try to provide what service I can through my long tenure as a member of the JAAPA editorial board. My years working in an emergency department are a prominent part of the grant applications by which my academic career rises or falls.
Perhaps most important (at least for me), after a hiatus of 2 or 3 years, I’ve started teaching PA students at a local university on Long Island. I can think of no better way of keeping in touch with what drew me to be a PA in the first place than to interact with people who are close to those same motivations. I realize that, despite the unique aspects of where I learned to be a PA, how I learned to be a PA differs very little from what they are now experiencing. PA programs have honed to an art the act of imparting and receiving an almost impossible amount of information over a very short period of time. In the process, they also impart an identity. I am still very much like every other PA I’ve met, regardless of our areas of specialization. In one of those coincidences that constitute life, I eventually did get a PhD. (I sometimes wonder if I chased a plastic figurine for 10 years.) And I am no longer a PA in any traditional sense. I haven’t seen a patient in over 2 years. I’m not even sure where my stethoscope is. But, my training and identity as a PA inform my work on a daily basis. And most people would rather hear stories from my days in the ED than my current tales of logistic regression and academic politics. One doesn’t mature without leaving something behind. But, like a homunculus, we retain something of what we were at the very beginning. Although I haven’t been there in nearly a decade, I will miss Bayley Seton in the way we miss childhood friends we are likely never to meet again. Thanks to that place, I will always be a PA.
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