When I heard the news that JAAPA is now considering manuscripts on surgical topics and will include these articles in the Journal on a regular basis, it gave me pause. I thought, why is this such big news? Has being a PA in surgery for the past 31 years relegated me to the outskirts of the PA profession? Am I some kind of maverick? Those who know me must laugh at either possibility. I have been active in multiple PA professional organizations over my career, which has certainly ensured that I remain committed to the profession and all its missions, visions, and strategic directions. As for being a “maverick”—well, let's just say that I am no James Garner. But still, this announcement about JAAPA did cause me to revisit why I ended up in surgery.
A surgeon mentor
The PA program at Alderson-Broaddus College started shortly after the one at Duke and was the first 4-year degree program for PAs. The first class graduated in 1972. This program, like Duke's and others to follow, offered a curriculum intended to train PAs to help physicians in order to improve the ability of patients to access primary health care. The difference, for me, was that the program at Alderson-Broaddus took shape through the efforts of Dr. Hu Myers, who envisioned the PA program, promoted it, and acted as its first medical director. He was a surgeon.
He and his physician brothers had a long history of bringing health care to rural West Virginia. He even had a residency training program at the Broaddus Hospital located on the rural college campus. My respect for Dr. Hu (there were too many physicians in the Myers family to use their surname) grew from the knowledge and skill he was willing to share—and from the gentlemanly manner in which he conducted himself among students, faculty, staff, and patients. I became adept at positioning myself so that I could make rounds with him. I grew skilled at finding avenues into his operating suite.
Despite my interest in surgery, the job interviews I was offered as I approached graduation were similar to those offered to most PAs in my class. There was a well-paying and interesting job on the Alaska pipeline construction project. There was a job at a rural clinic in Beckley, WV. I was not seriously looking for positions in surgery, and few were being offered. One day, though, while I was walking down the hall of the administration building, Mrs. Myers, Dr. Hu's wife and the program director at that time, called me into her office. All I remember is that she said to me, “Hu thinks you should stay in surgery.” This was all the encouragement I needed to pursue a job as a PA practicing in surgery. Standing across from Dr. Hu in the operating room was where I had first felt comfortable. His guidance proved most valuable, as I have had no regrets.
Why, however, has it taken the PA profession this long to recognize the valuable contributions to patient care made by PAs in surgical specialties? Why has it taken this long for the Journal of the AAPA to actively promote surgical topics? Those questions still beg to be answered.
Catching up to reality
Although surgery-related subjects have appeared in JAAPA from time to time, this issue, with the appearance of the article on endoscopic vessel harvesting, announces the regular appearance of articles focused on topics of surgical consequence. Since JAAPA is the official clinical journal of the AAPA, it is only fitting that it embrace the Academy's goal to represent all PAs and recognize the diversity of specialty interests in the PA profession. The AAPA has endeavored to represent PAs without consideration of their area of practice. Its recognition of specialty organizations, special interest groups, and caucuses; representation of surgical and medical congresses in the AAPA House of Delegates; multispecialty CME sessions at the annual conference; and ongoing dialogue with specialty PA and physician organizations are appropriate given the diverse nature of the PA profession.
Recent AAPA census data indicate that PAs in surgical specialties—including general surgery—now make up 25% of all practicing PAs. According to Kevin Marvelle, Vice President, Data Systems and Analysis, at the AAPA, the percentage of PAs in surgical subspecialties rose from 16.2% in 1994 to 23.2% in 2004, making surgery one of the fastest-growing areas of PA practice. There are multiple reasons for this change, including the limits placed on the hours residents can work; decreases in the placement of foreign-trained physicians; lowered reimbursements for surgical services, which has led surgical practices to limit the number of physician partners but maintain case loads by utilizing PAs; hospitals enhancing support services for reimbursable surgical patient care; and historically higher salaries for PAs in surgical specialties. All these factors have contributed to the increased number of PAs practicing in surgery.
