In its 46th year, ADVANCE for NPs & PAs joins all physician assistants, patients and healthcare associates in honoring the anniversary of the PA profession. This, and every year, we celebrate the growing group of professionals who tirelessly provide expert care to patients across the nation and abroad.
October 6 marks the official start of the week's festivities, in honor of the birthday of Eugene A. Stead Jr., MD, the father of the profession. That day also celebrates the graduation of the three former navy hospital corpsmen -- Ken Ferrell, Vic Germino and Richard Scheele -- who completed the nation's first PA program at Duke University.
This and every year, we honor them and the thousands of men and women who have come after to change the face of medicine for the better.
According to the Bureau of Labor Statistics, the number of PAs practicing in the United States is expected to grow 20% by 2020 -- a much faster pace than other professions. The sheer number of PAs working today is a testament to the leaps and bounds the profession has come since its first days in 1967.
Each day, members of your profession are striving to improve practice laws and working conditions for PAs across the nation. Here are a few legislative highlights from this year so far:
- - Texas Senate Bill 406, taking effect in November, will increase from 4 to 7 the number of NPs and PAs a physician can delegate the authority to write prescriptions. For practice sites in underserved populations, no limit on delegation will apply. The law also reduces the frequency of required face-to-face meetings between a supervising physician and NPs or PAs. In the first 3 years of the relationship, a monthly meeting is required. Afterward, it decreases to a quarterly face-to-face meeting with teleconference meetings in between. SB 406 will also mandate a prescriptive authority plan that includes chart review; the number of charts to be reviewed will be determined by the physician, NP or PA. Physicians will be allowed to delegate ordering of schedule II controlled substances to NPs and PAs who practice in hospitals or hospice care. Finally, the legislation prohibits the Texas Medical Board from adding requirements to the prescriptive authority agreement between physicians and NPs and PAs that are not listed in the bill's statute.
- - Missouri House Bill 315 removes the previous requirement that supervising physicians be on site two-thirds of the time. The new law mandates that physicians need only be physically present 4 hours out of every 14 days a PA practices. The physician must be available by phone at all other times. The bill also requires that PAs practice in the same specialty as a supervising physician and only in facilities where the physician frequently provides care. The exception is existing patients who must be examined in their homes or a correctional facility.
PAs and PA groups across the nation are making gains for the profession in other ways, too. Here are a few of those highlights:
- - David Paulk, EdD, PA-C, DFAAPA, will write the introduction on upcoming guidelines for the treatment of mild traumatic brain injury in children, from the Centers for Disease Control and Prevention, released in 2014.
- - The National Commission on Certification of Physician Assistants (NCCPA) recently received a formal endorsement from the Association of PAs in Psychiatry (APAP) for its certificate of added qualification in Psychiatry.
- - The American Academy of Physician Assistants (AAPA) 2013 conference saw more than 7,400 PAs and PA students gather in Washington, D.C. The conference featured more than 300 hours of available CME credit, advocacy training and Capitol Hill visits, and several special events focused on the particular health needs of veterans and their families.
- - PAs for Tomorrow, a grassroots physician assistant organization, came into their second year. In June, members elected a new board and looked forward to heated discussion on PAs' futures.
As you continue throughout the week, celebrating you and your colleagues' accomplishments, consider your roots as an early PA. We invite you to join in telling us your earliest memories of the first patient you encountered as a certified PA. How did that impact you as you continued through your career? Send your stories to assistant editor Kelly Wolfgang at firstname.lastname@example.org and we'll feature them here.
Whether you are treating your first patient or your thousandth this week, remember that the work you do creates a better world for us to live in. For all of your work in hospitals, clinics, offices, homes and facilities across the nation, we commend you. For your work in geriatrics, women's health, surgery, pediatrics and specialties across the face of medicine, we commend you. For dedicating your lives to improving the health of patients across the United States, we commend you.
Thank you for your service and commitment to healthcare and for allowing ADVANCE for NPs & PAs to remain a part of your ever-broadening and exciting profession.
Kelly Wolfgang is the assistant editor. Reach her at email@example.com.
Below, share in the memories of physician assistants who recall their first patient.
"I've been a PA for over 30 years, so I really had to push aside some cobwebs in the cerebral sulci.I had just started my first job, and of course, being the new kid on the block, I was assigned to the 11 p.m. - 7 a.m. shift that nobody else wanted. The hospital was in a kind of mixed neighborhood, or should I say, split: It had a stronghold of ultra-orthodox Jews pretty much surrounded by blacks and Puerto Ricans.
I showed up for work in street clothes. The PA on-call room was down the hall from the ER, so I changed into scrubs and put on my white jacket, pockets stuffed with all kinds of junk-cheat sheets for CPR, a couple of pens and some paper, my reflex hammer, whatever. I was about to go up to the floors to see if there was anything I needed to do, but I was derailed by a page (remember beepers?) from the ER. I threw my stethoscope around my neck and ran down the hall, and when I got to the ER, a nurse thrust a chart at me.
The patient's name-which I will never forget-was Troy. So there I was, thinking, what Jewish family names their kid Troy? I was looking for a white Jewish kid, but didn't see anyone that fit the bill. I must have looked confused, because the nurse raised her eyebrows and pointed me to a curtained-off cubicle; when I slipped behind the curtain, I was face-to-face with a young black man of about my age, 23 or so.
He was propped up on the gurney and didn't look too bad at first glance. I was kind of scanning the chart and asking him, "What's the problem?" when I saw "stab wound to the abdomen" as the chief complaint. I was like, whoa! This is over my head. He wasn't much in the mood to talk, and I soon found out why: When I asked him if I could have a look, he pulled aside the sheet, and I guess my eyes bugged out a bit, because it looked to me as if things that should not be seeing daylight-that is, small intestine-were out there.
So I was like, "OK, ummm.let me call my resident." As I waited for the resident to arrive, I tried asking him some basic questions, like, "When did this happen?" "Do you know who stabbed you?" and so on. He wasn't very forthcoming with the details, so I didn't push it. In a while, we took him to the OR and tried to figure out what was injured, what needed fixing.
Troy spent several months with us in the hospital after that, having multiple complications and eventually having more operations, second look, third look, but apparently a pancreatic injury had been missed at the time of the first surgery, and unfortunately the pancreatic enzymes were essentially dissolving his internal organs. This was 1982, so medicine, surgery, radiology.we didn't have the same capabilities.
He was in the ICU, NPO on TPN, developed a fistula.it was so sad. He basically was fading away in front of us. I used to go in to talk to him if he had some energy; I don't think he had too many visitors. The exchanges were not very deep, mostly just about how he was doing, but as time went on, you could see he was giving up-WE were giving up-and eventually, as he became more and more anemic, one day he finally sort of evaporated.and died. It was painless and quick, and soft as a breath he was gone. I will never forget him." - Sherry
"I still get a chuckle along with a tug on my heart strings reflecting on my first patient. I was 16 years old and was a JANGO (Junior Army-Navy Guild Organization). This was a pre-nursing/medicine program where interested military dependents could become nurses' aides at a very young age.
I trained at Henderson Hall in Arlington, Virginia and had my first shift at Fairfax Hospital (now known as INNOVIA) in Northern Virginia. We were far more than candy stripers and could actually perform basic nursing tasks. I always knew I wanted to be a nurse for as long as I can remember.
It was the first time holding and rocking a newborn baby. What a thrill!
Well, imagine a naïve, shy, gawky teen meeting her first patient and being instructed to help him with his sponge bath! He was the spitting image of Jesus Christ Himself! At least the version we American kids grow up thinking of on the standard Sunday school portraits. Before my eyes was a rumpled, though very handsome, street person with long locks and a body with nothing but skivvies!
Blushing, I helped him sit up as he wore off his bender. His body odor was so intense I almost lost my cookies. His tennis shoes had maggots in the soles and were adhered to his feet until I pulled, revealing frostbite and dead-smelling flesh.
I recall being so humbled over my youth and this Christ-like man who had suffered the tougher tracks in life. It taught me to never feel superior and to meet people where they are in life. It brought back the Biblical passage of washing of the feet and humility and love for your fellow man.
He asked me to clean his private area with a drooly grin. I was scared but gave him the soapy cloth and excused myself, reminding him of his independence! I never knew his name but will never forget him." - Anonymous
"I am a PA who graduated in 1983! I'm currently working at RMA of CT in reproductive medicine and infertility. I remember one of my first patient encounters was when I was doing a rotation in urology. I had to do a hernia examination on an elderly gentleman. He turned to me and said, 'Does your mother know you are doing this?' Thinking about it over the years has made me laugh." - Diana