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 PA 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 has 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 on 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 have continuous monitoring of 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.
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 AAPA. Constituent organizations within 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. However, after you are settled into your practice, 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, perhaps for the first time. 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 themselves 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 present 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 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.
If you are unable to precept students full time, you may still be able to do some precepting. Some PA programs send first-year students out to preceptors for a few afternoons a month to begin to learn to see patients, perform physical examinations, develop differential diagnoses, interpret laboratory studies and radiographs, and initiate treatment with an experienced PA or doctor. Other programs even send students out only a few times per year just to practice patient interview or physical examination skills. Contact your local PA program to find out if they have a need for intermittent precepting that you might be able to fill.
Institutional or health system service: Most hospitals and health systems have leadership by doctors and nurses in all areas of hospital management, including safety, operations, finance, human resources, and patient relations. Unfortunately, it is still relatively rare for PAs to be routinely included on these committees or in these leadership roles. These committees often wield tremendous power within a hospital or health system. PAs sometimes discover that policies have been made that substantially impact their ability to practice without any PA input whatsoever. PAs who wish to make an enormous and immediate impact on their own clinical environment should consider serving on committees within their medical center or health system. You should not wait to be invited to join these committees; instead, you should ask to be appointed to a committee in an area of your interest. Many PAs have had the experience of requesting to serve on a committee and receiving a response such as, “Well, we’ve never had a PA on that committee before, but now that you mention it, that’s a good idea!” Consider working with a trusted physician or nursing colleague to advocate for you if the initial answer is no. Serving on a hospital or health system committee will give you enormous insights into your institution and the health system at large and will allow you to advocate for PAs and PA practice.
Community service: Another important means by which you can serve the profession is to serve your community. The PA profession was started, in part, to meet the needs of people who were not being properly served by the medical system at the time. Groups of PAs, individual PAs, and PA programs have always served their communities as part of their professional commitment to provide holistic care for patients. Knowing that our patients’ health is affected as much by whether they have a safe place to live and food to eat as it is by medical care, many PAs are regularly involved in community service. The AAPA annually recognizes a PA for service with the PAragon Humanitarian Service award for outstanding achievement in serving marginalized people. PAs are working with victims of natural disasters, sexual assault and domestic violence survivors, linguistic and cultural minorities, homeless people, people with low levels of literacy, people with intellectual disabilities, and many others. They provide medical care, counseling, tutoring, food, mentoring, preventive screening, and friendship. PAs partner with schools; hospitals; health systems; homeless shelters; and organizations such as Habitat for Humanity, the American Red Cross, and Boys and Girls Clubs of America. This service is the source of enormous satisfaction to the individual PAs, but their service also reflects well on the profession. PAs serving their communities demonstrate that our profession is committed to our patients beyond the reach of our clinical settings. Their service builds trust and confidence in PAs and the PA profession.
Physician assistants who decide to provide medical care on a volunteer basis need to be aware of some specific concerns. First, you must meet your state’s requirements for physician supervision even if you are not being paid for your work. You will generally need to obtain a new delegation agreement or practice agreement with a supervising physician who also works at your volunteer site to cover your work there. It is essential for you to clearly understand and conform to the regulations your state has for supervision in PA practice. Failing to do so risks sanction by the state medical board. Second, you need to obtain malpractice coverage for your volunteer work if you are providing medical assessment and treatment services. Sometimes the organization has blanket coverage for all health professional volunteers, but it is not safe to assume this, and you should confirm any coverage before beginning to see patients. You may need to purchase a policy yourself to cover your work at the volunteer site. Third, your employment contract may have an exclusion clause preventing you from doing substantially the same work you do in your day job for another clinic in the same area. These exclusion clauses typically are meant to prevent you from moonlighting with a competitor, but you would not want to jeopardize your primary employment by inadvertently violating your contract. Most employers are happy to write an exception for a clinician who wishes to volunteer to care for medically underserved patients, but it is essential to clarify this issue with your primary employer before starting your volunteer work.