Picture this: it's summertime, the sun is shining, the bathing suits are coming out of storage, and it is time to take our annual family vacation.
This year, with COVID restrictions waning and my never fading hunger for adventure, I decided to take the family on a ten-day surf trip along the west coast of Costa Rica.
We purchased plane tickets, packed our bags, and set out on the open road. It was an epic adventure.
Along the way, we met interesting people from all over the world. This is one of my favorite parts of traveling. It levels the playing field. Everyone is in the same position, open to new experiences, primed, and ready to explore beyond their safety bubble.
The "What Do You Do" Question
Now, more often than not, when meeting a new person, the question arises, "What do you do for a living."
Now, if you are a PA, you are probably already nodding your head because you know what's coming next.
More often than not, when I tell people what I do, they kindly nod in agreement, but their expression is one of total confusion.
Sometimes, I am met with a follow-up question, but that often causes even more confusion. The conversation then moves on. Occasionally, I push on, or, to make life easy, I give up and ask more about what they do for a living.
Contrast this to my wife, an RN of 23 years. When she tells people that she is a nurse, people get excited; she gets to talk about her specialty (oncology), and people thank her kindly for her service.
Please understand that I am not complaining. I love what I do, and I love sharing it with others. But it's frustrating and, at times, disheartening.
How to Tell People That You are a PA
If you came to this post looking for a one-size-fits-all answer to this question, sadly, I still don't have the answer. But I will give examples of how I try to answer this question. If you know the secret sauce, please share it in the comments below.
With 18 years of practice, I have tried every way possible of attempting to explain what I do for a living. Below is a sampling.
Here are the three main variations I use, along with some typical responses:
- "I am a PA." Response: "A what?"
- "I am a physician assistant." Response: "Oh, like a medical assistant."
- "I am a physician associate." Response: a complete look of confusion
In response to this, and in an attempt to further clarify what I do, I have tried several approaches:
- "We are kind of like nurse practitioners. Do you know what a nurse practitioner is?" Response: a confused nod.
- "We are kind of like doctors. We prescribe, diagnose and treat patients, and can do much of what doctors do. We work in collaboration with doctors." Response: oh, so you are a doctor!
- Note: Doctors probably hate the "We are kind of like doctors" comment, but in primary care practice, we can all agree our duties are often indistinguishable. It's important to note that I do not pretend to be a doctor, nor do I play one in real life.
- "We are like eternal medical residents." (I honestly hate that I have given this response, but you know, these are desperate times... Response: yep, you guessed it, total confusion!
Questions people ask me.
- So you are kind of like a nurse?
- So you assist doctors!
- Do you need to go to college for this?
And it's not just people from other countries.
Honestly, I can completely understand why anybody outside the US would be 100% confused by what we PAs do. We are, after all, a reasonably new medical profession that has, until recently, been relatively confined to the United States.
But my main frustration comes from the fact that most people in the United States still have no idea what PAs do, what we are called, or are familiar with our level of medical training.
Who's to Blame? How about the AAPA?
I know many people will hate me for saying this (yes, I am looking at you, AAPA), but I partially blame our professional body for the lack of understanding of the PA profession.
This is, after all, the result of poor (OK, nonexistent) marketing and inadequate branding - and the confusion is likely to worsen with our recent name change to physician associate.
How to Solve The Problem
PAs need a branding department!
It's going to take lots of money and boots on the ground to explain to people what we do.
Let's start by finalizing the name change - I know this is an unpopular opinion, but I have mixed feelings about our name change to "physician associate." Just when patients were beginning to understand the role of the PA, we are now associates. Although I understand all the reasoning behind it (some of which is undoubtedly ego-driven), it will cost a lot of money ($21.6 million, according to AAPA estimates) and cause much confusion. That being said, it's a clean slate. So, let's finalize this already, put a stake in the ground, and embrace a name - Here's looking at you, American Medical Association (AMA)!
We need more PAs on TV - Yes, you read that correctly. How many episodes of Grey's Anatomy, ER (to their credit, they tried), Chicago Hope, and House (or whatever new medical drama is hot today) do we need to start seeing PAs on TV? Yes, Americans watch TV, and even though these dramas rarely reflect the actual day-to-day lives of medical practitioners (I'm looking at you, Grey's Anatomy), it's time we start to see PAs in ALL of these medical dramas. Yes, we need to see a PA running into the mop closet to engage in casual sex before scrubbing into surgery or seeing a patient for follow-up. Americans get that! So, we need to pay real money to TV show executives to cast leading actors as PAs in their shows. I know it seems ridiculous to task the AAPA with engaging with ABC executive producers, but come on, I think we can all get behind a PA McDreamy!
We need to educate hospital and clinic staff - We need medical teams who understand what we do and explain this to patients at the time of their booking. Like the docs, I only have 15 minutes for an appointment, and I shouldn't have to spend 1/4 of this explaining to patients why they are seeing a PA or educating them about my profession. Let's all be on the same page. Patients shouldn't have to feel like they are receiving second-rate care, and it is only through a thorough understanding at all levels that we can ensure they don't.
We need literature explaining what PAs do in every exam and waiting room. And by literature, I mean really cool videos with PA staff featured in the videos. 😀
Doctors need to get off their high horse! OK, I get it. You spent four years in medical school and completed a residency. To borrow a line from Avitar, "I see you." I love doctors. I am 100% on your side. But we all have the same goal - to keep our patients safe and healthy. There is no I in TEAM, and PAs serve a valuable role in ensuring access to care. Get on the bandwagon already. If you don't like it, you certainly don't have your patient's best interest in mind.
Embrace Optimal Team Practice - Optimal team practice (OTP) is a healthcare delivery model in which PAs, physicians, and other healthcare professionals work together to provide quality care without burdensome administrative constraints. Under OTP, PAs can practice to the full extent of their education, training, and experience without requiring a specific relationship with a physician. This allows PAs to provide care more efficiently and effectively and improves access to care for patients.
The journey of understanding and recognition for PAs is a long, windy road filled with much-needed conversations and clarifications.
Whether through a revamped branding strategy or through the subtle yet impactful narrative of a TV drama (NBC, if you are reading this, I am available for the ER remake), the essence of what we do must resonate throughout society.
The rebranding, the dialogues, the representation in media, and the education of our peers and patients are all steps toward painting a clearer picture of who we are and the invaluable service we provide.
After all, amid all the confusion, our core remains faithful to its mission: to deliver care with empathy, expertise, and excellence.
So, the next time someone asks, “What do you do for a living?” take a deep breath, wear a smile, and embrace the "life-affirming" journey of explanation. Every curious mind is a step towards a future where our profession is understood and celebrated. Through each interaction, we are defining our work and reshaping the landscape of healthcare, one understanding at a time.
Here’s to the many more discussions, explanations, and representations awaiting us on the horizon. The voyage of discovery continues, and we are all a part of it.
Thanks for reading!
Stephen Pasquini PA-C