When I was an undergraduate student during those final years of the Vietnam conflict, the draft was still on; and young men were called to military service. I elected to enlist in the U.S. Coast Guard to fulfill my military obligation. Although I wasn't aware of it at the time, compared to the ranks of the Army, Navy, Air Force and Marine Corps, the Coast Guard was a relatively small group—only 35,000 servicemen, seemingly a mere drop in the DOD bucket.
One thing that drew me to the Coast Guard was the commitment to humanitarian service. Its primary mission was search and rescue (SAR) at sea. When the weather turned foul and other vessels made for home port, the boats of the Guard were deployed. On more than one occasion the cutter to which I was attached made its way through heavy seas to tow a disabled fishing boat to safety, while myriad other SAR vessels did likewise.
In addition to search and rescue, the Guard was also charged with offshore fisheries patrols, ocean station patrols, drug trafficking surveillance, and the staffing of long-range aid to navigation (LORAN) stations around the globe. For such a small group it provided a lot of muscle on the front lines.
After my enlistment ended I applied and was accepted to PA school. Although I had served four years as a hospital corpsman on active duty, I still found the academics and PA training rigorous and demanding. After graduation I took a position at a health center working with the urban poor in Lancaster, Pennsylvania. My supervising physician and I provided the gamut of primary care services to the local community, everything from office gynecology, prenatal care, pediatrics, adolescent medicine, internal medicine, and minor surgery. We even offered psychiatric services, monitoring a large group of patients that had no where else to go after the local guidance clinic lost its psychiatrist.
Back then, primary care medicine was the bellwether of PA training. Over the decades the role of practicing PAs has expanded dramatically. These days you find PAs working in practically every medical specialty and subspecialty available. But I still consider generically trained PAs to be generalists at heart.
When I graduated from PA school, there were less than 8,000 PAs in clinical practice. Today there are over 75,000—still a relatively small number in comparison to the myriad nurse practitioners and physicians, but nonetheless a significant group of clinicians. Surveys show that 36% of PAs continue to work in primary care settings.
I sigh when I read the occasional article in the press about the problems entailed in attempting to provide services for the uninsured 50 million Americans when they enter the healthcare system. Who's going to care for them? We are faced with a shortage of primary care physicians, and fewer medical school graduates elect a career in primary care. Precious few of these articles mention generically-trained physician assistants. Have the members of any Washington think tank seriously considered the role of PAs in this equation? If they have, it certainly hasn't made headline news.
As healthcare professionals whose roots go deep in the commitment to provide primary care to rank-and-file Americans, like those select rank-and-file Coast Guardsmen, here we stand—semper paratus, always ready.
Is anyone in the higher echelons of political influence aware of what we have to offer, of what we can do?
Brian Maurer practices pediatrics at Enfield Pediatric Associates, Enfield, Connecticut. He is the author of Patients Are a Virtue and blogs at http://briantmaurer.wordpress.com/. This blog post expresses his personal views and does not express or represent the views or policies of AAPA.