Reflecting on the PA profession's 50th anniversary

FigureFigureThe golden anniversary of the PA profession is here! JAAPA launched its special anniversary content series a year ago, and now it comes to an end. The PA profession, once a nontraditional career, is fully established. Thousands of students apply to and enter PA programs annually, and more than 115,500 certified PAs practice in the United States in every specialty and clinical setting. The future looks bright. However, Everett and Quella reminded us in “Diffusion of PA innovation: Risk-taking vs. safe bet” (June 2017) that PAs face important new challenges and opportunities in the years ahead. Let us highlight a few themes from the anniversary collection as we look to the future. FLEXIBILITY REMAINS CRITICAL From the beginning of the PA profession to today, flexibility remains a critically important and powerful phenomenon within the PA movement. A generalist education with clinical and interpersonal skills that translate across myriad practice settings has powered PA adaptability. This flexibility, novel to US healthcare, enables PAs to evolve in concert with patient needs, advances in biomedical knowledge, and disruptive changes in the healthcare system. Adaptability and flexibility were powerfully illustrated in “A history of PAs in the US Public Health Service” (December 2016), “Presidents as patients: A White House PA recalls his service” (January 2017), and two pieces about the fight to establish practice regulations for PAs in New Jersey and Mississippi (April and May 2017, respectively). PIONEERING NEW TRAILS Reflections from four physicians, each in collaborative practice with PAs across different generations, offered an interesting vantage into this unique professional relationship and its progression over time. “PAs: Public awareness and the popular media” (July 2017) examined the socialization of PAs in the United States in an unconventional way. This story revealed an important, largely underused opportunity to strengthen public perception of PAs in the future. And, Pederson and Wendel shared an inspiring and heartbreaking story about a PA who single-handedly took the profession to new heights (April 2017). These stories and others are evidence that PAs continue to pioneer new paths to increase access to high-quality healthcare and improve the health of our communities. A CALL FOR LEADERSHIP Stories from the anniversary collection point out important gaps, challenging us to face new paradigms and emerging cultural norms that can strengthen the PA profession. Leadership was a dominant theme. One piece (June 2017) that took a personal look into two successful clinical leaders made the call for PAs to assume a “seat at the table.” Most of us became PAs to care for patients and families. However, as our profession grows, we must embrace leadership and not abdicate the responsibility to shape healthcare policy and the models of care in which PAs practice. Collaboration has been a defining quality and strength of PA practice for 50 years. We must reconcile a path that embraces interprofessional collaboration but increasingly empowers the profession to drive its own journey ahead. The potential risks of being silent on matters such as national healthcare policy was evident to us in “The GMENAC report and the PA profession” (October 2016). As this editorial is being written, partisan politics and tension permeate the discussion of US healthcare policy on Capitol Hill mitigating any meaningful improvements or reform. Although the PA profession has spent recent years building and improving the regulatory foundation for PAs state by state, PAs have been relatively silent on the national healthcare policy debate. The future of recent expansions in healthcare insurance coverage for Americans appears uncertain. Is this public silence from the PA profession a strategic move or evidence of inadequate capacities for leadership and risk-taking? New PA programs are developing rapidly with local feasibility studies occurring in the absence of any meaningful national scans. Recent frictions among internal stakeholders within the profession may have distracted attention away from these national health policy and workforce issues. A case to prioritize these discussions was made by Hooker in “When will physician assistant supply exceed demand?” (November 2016) as well as by Salsberg and Quigley in “Are we facing a physician assistant surplus?” (November 2016). WHAT LIES AHEAD? In “Predicting the past” (July 2017), Reed shrewdly reminds us that trying to predict the profession's future is a fool's errand. Although we will not dust off any crystal balls here, we speculate that 25 years from now the full effect of the profession's decision to move to advanced degrees will manifest. Will this dramatically change who we are as a profession? How diverse and inclusive will the PA profession be? Will requiring advanced degrees for entry into the PA career be associated with improved care for patients or greater success in negotiating professional autonomy or self-regulation? One hope we share is that the benevolence and altruistic character that have defined PAs for 50 years will continue to mature. Although the tendency to volunteer and serve our communities remains common among PAs, a culture of philanthropy is lacking despite today's highly competitive salaries. Maybe we should make October's PA Week a time of giving for PAs, highly publicize this priority, and acknowledge contributions and successful projects. As the PA career is now well established, we must prepare ourselves for the emergence of new careers and thoughtfully consider potential relationships and interdependencies. In the same way that PAs were welcomed by some established professions and disregarded by others, will we elect to advocate for and support the development of careers that fill gaps in our healthcare system? Similarly, should PA organizations increase their support for the global development of PAs and similar workforce derivatives? What are the potential advantages and disadvantages of global mobility for PAs? Our anniversary collection included pieces about the evolution and challenges of the PA movement in Canada and the United Kingdom (January and April 2017, respectively) but this only scratches the surface of the global adoption and adaptation of PAs. We hope you have enjoyed the 50th anniversary content as much as we have enjoyed developing it. The editors want to acknowledge the tremendous contributions of those who brought the collection to life, including contributing authors, historians, and numerous collaborators from the American Academy of PAs, Physician Assistant Education Association, and the PA History Society. “In this volatile business of ours, we can ill afford to rest on our laurels, even to pause in retrospect. Times and conditions change so rapidly that we must keep our aim constantly focused on the future.” These remarks from Walt Disney resonate with us and feel inexplicably relevant to the PA profession. At our golden anniversary, let us commit to 50 more years of risk-taking, ingenuity, and collaboration. And let us ensure that the well-being and interests of the patients and communities we serve are at the heart of every decision.

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