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Physician assistants: Quality and innovation made in America

Bushardt, Reamer L. Pharmd, PA-C

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Journal of the American Academy of PAs: December 2012 - Volume 25 - Issue 12 - p 10
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During a recent business trip to California, thunderstorms precipitated an unpleasant chain of events: a diverted flight, several missed connections, and lost luggage. I arrived a day late dressed in what business attire I could piece together from airport shops. It took 2 days for a seam to unravel from my new dress shoes and about 4 hours before I lost a button from a new shirt. The shoes and shirt were American brands, but both were made in developing countries—undoubtedly a strategy the manufacturer used to reduce costs. Two poorly made products aren't an adequate sample by which to evaluate all foreign goods, nor am I trying to dismiss the importance of a globalized economy. Still, I did find it interesting that none of my new purchases was made in America, and most were bought “on sale.” I got a “good deal,” but I didn't get good-quality products.

Small businesses, creativity, and innovation have helped make America great. The personal computer, the airplane, the artificial heart, the lightbulb, the Internet, the polio vaccine, jazz, and rock and roll are all American inventions. The people behind these innovations helped reinvent an era through their creativity. Contemplating their contributions led me to think about the early “inventors” of the PA profession. Visionaries such as Dr. Eugene Stead, Dr. Richard Smith, and Dr. Henry Silver at some of our country's leading academic medical centers reinvented a model of care by connecting local need, existing talent, and innovative curricula. The collective commitment of these early pioneers to highquality training, their expertise within medical education, and their deep appreciation for regional workforce needs were integral to the early success of our profession.

Has it ever struck you that PAs are health care professionals made in America? (Not to mention an increasingly popular export). PA programs that stay focused on quality, require the highest standards of student performance, and design their programs collaboratively with regional workforce leaders will advance our profession and honor the legacy of our early pioneers. In contrast, new programs that seek tuition dollars while ignoring regional workforce needs and quality standards for medical education risk diminishing our profession and losing the respect of the educational community.

As we end a milestone year for health reform, we continue to face enormous challenges to increase quality and lower the cost of health care as well as to extend access to preventive services and health promotion. What opportunities do we have to meet these challenges? What are the potential threats? What if our profession was designed to solve the complex issues our health system is facing today? What if we choose to become the next wave of American innovators?

Our training uniquely prepares us to enter diverse clinical environments, forge close relationships with supervising physicians, and operate flexibly to enhance access to care, improve continuity and coordination of care, continuously evolve through active supervision to meet changing needs, and facilitate highly effective team-based care. Consider how adding a skillful PA with strong leadership skills can transform a model of care. I meet with PAs and physicians all the time who together are reinventing the way patients receive health care for the better. These inventors thrive when the health systems around them support entrepreneurism, creativity, and innovation. Just recently, they've told me about a PA-managed transitional care unit for older adults, a mobile screening unit for common cancers that serves rural communities, and a preoperative assessment unit staffed by PAs and advanced practice nurses focused on maintaining better control of chronic disease processes before surgery. The best models are frequently informed by the communities they serve, characterized by mutual respect and a high level of collaboration, and easily adaptable.

The PA profession is one of the most nimble health professions in the world—if not the most nimble. Our generalist model, a compressed curriculum, and affinity for continued professional development through on-the-job training give training programs major latitude to adapt to their regional workforce's needs. If our country can embrace our historical affection for invention by aligning payment with value, if health systems possess the institutional courage to support creative redesign of the models of care they employ, and if PAs speak up and offer solutions, couldn't we reinvent the way we care for Americans for the better? We were designed to increase access to care and facilitate effective team-based delivery of care. Look around you. If you were asked to suggest ways to improve the quality of care, make it easier for patients to navigate our services, or improve coordination of care between members of your team, what would you offer? I bet you have some very practical solutions.

To successfully reinvent the way we care for patients, we need to be able to share our successes and failures with each other. We need regular social and professional engagement with other members of our profession. We need to learn from each other. How will you contribute to the reinvention of health care and advance highly effective models of care involving PAs? How will you live up to the reputation for quality and innovation that comes with being Made in America?

© 2012 American Academy of Physician Assistants.