Introduction
The history of the physician assistant (PA) profession is the story of volunteers who made great strides for the profession and for patients against sometimes long odds. These pioneers worked tirelessly to secure recognition for the profession, obtain reimbursement for PA services, secure prescribing rights, and each of the other elements that allow American PAs to practice effectively. Other PAs have made incredible contributions through service to and advocacy for impoverished patients, patients with disabilities, abused women and children, and refugees. It would be easy to think that all the hard work is done and that newly graduated PAs are not needed in service to the profession or the community. This belief is sadly untrue. PAs still need to serve the profession for it to thrive.
What is professional service?
Professional service is exactly what it sounds like: service by the PA to the profession itself or on behalf of the profession to others. Each PA can find a way to serve that matches her or his talents, availability, and interests. PAs have traditionally been involved in many types of service, including volunteering with physician assistant professional organizations, teaching and precepting students, participating in institutional or health system service, and providing community service.
Volunteering with physician assistant professional organizations
PA professional organizations at the national, state, and institutional levels rely extensively on volunteer support to carry out their missions. Although our national organizations, such as the American Academy of Physician Assistants (AAPA), the PA Foundation (PAF), the National Commission on Certification of Physician Assistants (NCCPA) Foundation, and the Physician Assistant Education Association (PAEA) each have a small number of full-time staff who work alongside volunteers, most other PA-related professional organizations rely almost exclusively on volunteers to complete the needed work. Without volunteers, the costs of providing services, lobbying legislators, organizing continuing medical education (CME) events, and so on would be prohibitive. In addition, having PAs direct these activities helps ensure that the profession is being effectively represented and that the services provided by the professional organizations are actually meeting the needs of PAs.
The minimum level at which each PA should serve the profession is by joining our national and state professional associations. Unfortunately, although the state and federal laws governing PA practice in most states are reasonably favorable, there are no guarantees that they will remain so. Many states have seen legislation proposed by other professions that would attempt to restrict PA practice in one way or another. Some of these legislative proposals have been so restrictive that they would have effectively made it impossible for PAs to practice at all in certain specialties. Other times, well-meaning politicians have proposed new legislation that inadvertently excludes PAs from performing an activity allowed for doctors and nurse practitioners. Sometimes regulatory bodies fail to include PAs as authorized providers in the regulations that govern medical practice nationally or at the state level. In 2013, for example, the author of the federal regulations on durable medical equipment (DME) excluded PAs from the list of providers who could authorize DME such as walkers and crutches for patients with TRICARE insurance, meaning PAs were unable to write prescriptions for these items for members of the armed services and their families! The only way to protect the legislative gains the profession has made is to continuously monitor proposed legislation and regulations in each state and on the federal level. Monitoring legislation and regulations in real time requires money to hire either staff or a lobbying organization. Most clinical PAs have neither the time nor the expertise to monitor legislation and regulations on their own. Supporting your national and state professional organizations with your annual dues allows these organizations to have a stable funding stream with which they can develop services that benefit all PAs and allow you to continue your practice.
Beyond simply supporting your professional organizations with your membership funds, there are many opportunities to get involved with PA organizations on the state and national levels. State organizations need PAs to plan CME conferences, serve on the organization‘s board, represent the state in the AAPA House of Delegates, develop public relations strategies, monitor the finances of the organization, liaise with medical and nursing associations, run membership drives, advise student members, lobby on behalf of the profession, develop legislative strategies in conjunction with lawmakers, represent PAs to large employers across the state, and develop community service projects. The subcommittees that perform these duties are often looking for more people to assist them and are frequently very interested in having newly graduated PAs serve alongside more experienced PAs. Newly graduated PAs often have energy and exciting new ideas to share ( Fig. 60.1 ).
After you have a bit of experience in your specialty or have served at the state level, you may wish to begin serving at the national level. The AAPA and the PAF have a host of volunteer opportunities to serve on behalf of all PAs. The AAPA and the PAF need people to sit on scholarship committees; work to develop stronger relationships with the federal government; develop the annual AAPA conference; liaise to medical, specialty, and other health professions organizations; and raise money for philanthropic work. You might also consider working with a constituent organization of the AAPA. Constituent organizations within the AAPA are groups of PAs with unifying interests, such as particular specialties (e.g., psychiatry, nephrology), common characteristics (e.g., ethnicity, religion, or sexual orientation), or specific interests (e.g., rural health, global health, administration, alternative medicine). Constituent organizations bring together PAs across the country to achieve common goals and to network. They may lobby for particular federal legislation or regulations. They often provide CME of specific interest to their members. They typically also provide support to their members facing particular challenges related to their specialty, cause, ethnicity, religion, or sexual orientation. Specialty constituent organizations often serve as the representatives of PAs to their medical specialty organizations. For example, the president of the Society for Physician Assistants in Pediatrics (SPAP) attends the annual American Academy of Pediatrics (AAP) meeting to speak on behalf of PAs and meet with AAP leadership regarding issues of mutual interest and concern to pediatricians and pediatric PAs. Volunteering on the national level provides exciting opportunities to meet new people and develop new leadership skills.
Teaching and precepting students
So many people invested in you to bring you into PA school and to get you through your PA training. Think of the people who patiently taught you to how to break bad news to a patient, how to suture, or how to deliver a baby. Although some of these people were paid to help you, many were volunteers. Most guest lecturers and clinical preceptors serve unpaid or are paid only a small stipend for their work. They teach students out of love of their profession, concern for patients, and passion for teaching medicine to others.
Most PA programs like potential lecturers, laboratory instructors, and preceptors to have at least 1 year of clinical experience before they begin to teach. After you are settled into your practice, however, consider participating in the training of PAs. PA programs have many types of opportunities for involvement ranging from occasional involvement to regular commitment. Programs may simply need PAs with surgical experience to come 1 day each year to teach students how to scrub, gown, and glove. They often use PAs to lecture or lead small groups in their own area of clinical expertise. Many programs provide you with some guidance about best teaching practices as you get started with teaching. Program faculty will always provide you with the instructional objectives for each session to guide you as you develop your material. As you gain experience and confidence in your teaching abilities, you will likely be asked to develop and present more sessions as the years go by.
Precepting students is a way to make a huge contribution to both PA students and to your patients. Training future PAs to deliver high-quality care ensures the best care for our patients even after we move on. Precepting PA students is a significant investment of your time and energy, but it yields great returns as well. As you remember from your own PA training, PA students typically work full time with their preceptors, performing nearly all the tasks the preceptor performs. Becoming a preceptor means being willing to take students for a defined period (typically 4–6 weeks), allowing them to see patients under your supervision, teaching the student through the lens of each patient visit, potentially assigning the student things to read and research, serving as a role model, and providing both daily and final feedback on their performance at your site. Some preceptors have students onsite nearly all year, but others choose to have students only at the times of the year when they believe they can provide the best educational experience for the students. Clinicians are often concerned that having a student present will slow them down as they see patients. Teaching does require taking time for the students, but savvy preceptors are often able to devise strategies to keep to the schedule while still allowing students to have time with patients. For example, sometimes students can perform time-consuming tasks such as patient education on behalf of the preceptor while the preceptor quickly sees several other patients. Working with students also encourages the preceptor to keep up with her or his specialty. Students often have questions to which preceptors do not know the answer, challenging the preceptors to do further research and expand their own knowledge base. Preceptors generally report that they love the personal interaction with the students. They enjoy getting to know them as people and seeing their skills and confidence develop over the course of the rotation. They also appreciate some of the perks that programs offer preceptors, such as academic appointments to the university, access to the medical library through the university, and CME credit for teaching ( Fig. 60.2 ).
