I will soon celebrate my 30th year as a certified physician assistant. I hope that by then, or not long thereafter, people will know what that means. I look forward to the time when someone asks what I do for a living; I say, “I'm a PA”; and the person doesn't look at me, somewhat slackjawed, with a quizzical expression, and reply, “What's a PA?”

I'm embarrassed to admit that, over the years, I've answered this question in less-than-accurate ways. In my early postgraduate years, I was often asked, “Is that somewhere between a nurse and a doctor?” The path of least resistance was to say “yes,” and then go on and make the distinctions, all the while hoping that a PA, a physician, or a nurse was not listening in on my lame explanation. Or I would ask, “Do you know what a nurse practitioner is?” Most people would say they did, and I would continue, “Well, PAs are very similar to NPs in terms of how and where they practice. They often function just the same.”

The AAPA provides the most centralized source of information about PAs, their education, scope of practice, and working relationship with physicians. But even the Academy cannot explain what a PA is in one or two simple sentences that the public can easily grasp. The more I have tried to condense my definition, the less accurate I become—and the more frustrated I get.

A variety of characteristics go into defining PAs, and these have changed a great deal since I graduated. The profession used to be dominated be men, for instance, but now more than 50% of PAs in practice are women.1 The percentage of PAs working in primary care fields has declined, and the number and proportion of PAs in specialties has grown rapidly.2 Educational opportunities for PAs have also evolved. Now, almost half of accredited PA programs offer a master's degree, and there are more than 40 postgraduate PA programs. The most recent expansion of PA education is into the world of clinical doctorates. Even the NCCPA has acknowledged the changes in PA practice. Beginning in March 2009, 60% of the exam for PAs recertifying will cover the same content as always, but the remaining 40% can be directed in one of three areas: adult medicine, surgery, or primary care.

The debate over what to call ourselves continues, and this discussion has been going on for years! Midlevel practitioner makes us sound as though we haven't yet quite become high-level practitioners. Physician extender reminds me of the mechanical hand used to retrieve items from the top of tall grocery store shelves. And I flinched just the other day when a physician author of a book of fiction referred to a PA as a physician's assistant—a punctuation gaffe that still rankles me.

PAs seem to be growing further apart, at least in terms of their education and practice setting. We are abandoning our common ground, taking a tug-of-war approach to defining who we are, what we do, and what we call ourselves. What happened to the level playing field where we all began? How can we expect the public to know what a PA is when the profession is having its own difficulties determining who we are and where we go from here?

As part of an effort to respond to these questions, the AAPA Board of Directors and senior staff, under the leadership of the Academy's new executive vice president/CEO, Bill Leinweber, have embarked on a planning process to identify strategic issues impacting the Academy and the profession. They are reviewing findings and recommendations from several working groups and will draft a 3-year strategic plan to address the crucial role that PAs will play in our nation's health care going forward. Part of this analysis will surely be to scrutinize how we define ourselves, as individuals and as a profession, as well as to explore how to increase our public visibility.

As of January 2009, Barack Obama, our country's newly elected president will have to grapple with a broken national health care system. A strong, coordinated effort will be needed to educate lawmakers, citizens, and other stakeholders about PAs and how we are an integral part of the solution to this country's health care crisis. Working together, we can help take our profession to the next level, so that in future, many more Americans—including ourselves—can answer the question, “What's a PA?” JAAPA

REFERENCES

1. Larson EH, Hart LG. Growth and change in the physician assistant workforce in the United States, 1967–2000. J Allied Health. 2007;36(3):121-130.

2. American Academy of Physician Assistants. 2008 AAPA Physician Assistant Census Report. http://www.aapa.org/research/Highlights08/2008AAPACensusNationalReport.pdf. Accessed November 6, 2008.