
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.
In conclusion
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
Preach! All of the above ring true. I’m 15 yrs in (EM), practicing in the midwest. Typically, even in my white coat (and usually despite my introduction of myself as a PA upon entering the room), my patients assume I’m a nurse, until I give “the talk” for the 9,628th time. I can understand how a patient would be concerned if they thought someone without the extent of our training was ordering and interpreting their tests, prescribing their treatment, etc.
In addition to hospital administration awareness and branding/exposure, I think we also need to work more with medical schools to help future attendings understand what we do and how we’re trained. I don’t think there’s any excuse for a new attending physician in 2023 to not be knowledgeable about what we do and how our practice aligns with theirs.
Ha Ha same here. Been practicing in the ER for 26 years. Distant friends and relatives continue to ask me if I’m still a paramedic. We have made some progress though, I no longer call the general surgeon for a consult and have them insist on talking to my attending. LOL. We should be good to go in another generation.
Great essay with many valid points. I agree that AAPA dropped the ball with the name change – my recommendation was change to medical practitioner which more adequately reflects what we do and would be easier for patients to understand in relation to the NPs. I also just can’t do the PA honorific – I use my first name which think is an important distinction and benefit of being a PA in terms of breaking down barriers with patients.
After 24 years of explaining my job I think I finally found the response that seems to work and minimizes the delay. I have been using this for the last several years: “I practice medicine alongside a physician. I went to school for 3 years after college to do this work. I am board certified and state licensed and been seeing patients for more than 20 years. If you have ever had a provider that used their first name, you have probably been seen by a PA. So what brings you in today?”
It answers the question and moves the visit along while building confidence in the profession. PA education is accelerated and has more than three years of academic work at 115+ semester units, and I think it is important that patients understand the rigor of our training.
That is an amazing response! Do you mind if I quote you and add this to the blog post? I might have to create a “cue card” with this response in my notes app. 🙂
Stephen
I like and relate to all of this so much. I feel “seen” 🙂 All of that “renaming” money should have been thoughtfully spent on EDUCATION of our field.
Thanks Jessica! And thanks for taking the time to leave a comment. It’s comforting to know that I am not alone in my feelings around this issue and I am so glad we can talk about this honestly and openly. It has been great to see how others in our field are dealing with this, and I am learning a lot from our discussion here in the comments. Hopefully the AAPA will hear our concerns and earmark some funds on the education component (as you have suggested).
Thanks!
Stephen
I agree with many of your points after 23 years as a PA. I was just in Iceland where PAs don’t exist and trying to explain what I do was the same challenge. My most common successful tactic in the US is, “Are you familiar with nurse practitioners?” The answer is somehow almost always yes. “We are similar to them (and then I throw in a little more).” People come close to getting it at that point. Why are NPs so well known and we aren’t? Same branding problem?
NPs: Founded 1965
PAs: Founded 1967
As of 2022, there are over 355,000 nurse practitioners licensed in the United States. This is according to the AANP.
As of 2022, there are over 154,000 certified physician assistants in the United States. This is according to the NCCPA.
So to put it simply, there are over twice as many nurse practitioners as there are physician assistants currently practicing in the US. While both professions were founded at similar times.
So yes, maybe a branding problem. Thanks for your thoughtful comment!
Stephen
Great article and thanks for calling out the AAPA. Why do we want to confuse people even further by changing our name to “Associates”? I tell people that I’m a PA and people tell me that they either love their PA or ask me what that is. I use the NP story as well.
I am on a crusade to eliminate the 10 year test. It seems that groups that should be advocating for us are concentrating on 1) Changing our name to “make us more professional 2) Massaging the 10 year retest instead of eliminating it all together and relying on CME 3) and if you’re ARC PA, shutting down PA programs like everyone elae.
I am currently taking the PANRE-LA and I have to say this has been a huge step in the right direction. The in-person exam every 6 years was a nightmare so I am so glad to see baby steps in the right direction and the adoption of a 10 year cycle. I tend to agree with you though, it would be great to see the recertification exam sunset in favor of a learning tool that wouldn’t result in the loss of ones license on a pass fail basis and still allow for self assessment and continued learning.
Hey Stephen,
Great article to read. I feel your pain. I spent 14 years at 1 facility (23 years as a P.A.) and every new administrator I get (almost every 6 months) asks “So what is it that you do here?”
So I would add to everything you expounded that we need ADMINISTRATION EDUCATION AND AWARENESS. I think that is what ultimately will get us more recognition and APPRECIATION for what it is we do.
Hi Stephen, I enjoyed reading your recent posting about being a PA for 18 years (has it really been that long?) and nobody knowing what you do. For me, being from NJ, which was the 49th state to allow PA practice, I think it was even harder. I agree with much of your essay, especially asking the AAPA for more help in promoting the profession. While I retired 4 years ago and moved to Salt Lake City, UT, I still do some Zoom EKG teaching for 3 different PA Programs and support our cause.
Hi Carol! Wow, it is so wonderful to hear from you. I often think back fondly of my days at Rutgers, and of course, you always come to mind and were such an integral part of my development as a PA. Every time I read an EKG, honestly, I have you to thank!
We are going to Salt Lake this year to do some skiing with our shiny new Icon passes. Our family has grown since my PA school days, so we will bring our two teenagers (hard to believe I have two teenagers 😀). Maybe we will see you on the Mountain?
I may have been overly dramatic in this blog post, but even after all these years, I do think we PAs have a bit of a marketing problem. Regardless, I am so grateful every day to wake up and call myself a PA!
I am still a ways away from “retirement,” but as you know, that is probably one of the best aspects of our profession. There are so many options for work that are fulfilling, and as a PA, the landscape is vast. After graduating from Rutgers, I spent 10 years at my NHSC site and have now transitioned to what I consider my dream job – providing free healthcare to my community’s many unhoused and uninsured residents in Santa Cruz, CA. It’s fulfilling and challenging and fills so many of my cups. And, of course, I continue to work here on the website.
Again, thank you so much for all you have done (and continue to do). You are a true “gem” of a human being, and your counsel during my years at Rutgers got me through those three years and has been instrumental in my career as a PA.
I hope you and your family are happy and healthy. I hope you enjoy your retirement, and if you are ever interested in bringing your expertise in EKGs to an online course, let me know! We are partnering with a new MedEd company on Smarty PANCE. We would love you to come to the recording studio and record an EKG lecture for the masses.
Stephen