In his first major address on health care reform, President Obama recognized physicians and NPs as primary care providers but failed to mention PAs, sparking concern that PAs might be omitted from the administration's discussions of the issue.

"[W]e need to rethink the cost of a medical education, and do more to reward medical students who choose a career as primary care physicians and who choose to work in underserved areas instead of a more lucrative path," the president said in a June 15 speech to the American Medical Association. "That's why we are making a substantial investment in the National Health Service Corps that will make medical training more affordable for primary care doctors and nurse practitioners so they aren't drowning in debt when they enter the workforce."

The AAPA then issued a call for action to the profession, which the academy says prompted PAs to send nearly 7,000 messages to the White House expressing disappointment about the omission. A letter to Obama from AAPA president Stephen Hanson, MPA, PA-C, and executive vice president and CEO Bill Leinweber stated the academy's concern "that PAs will not be fully integrated into health care reform until the Administration begins to acknowledge the contribution of the physician assistant profession."

"With crisis comes opportunity," Hanson tells ADVANCE. "While we realize that President Obama has a much bigger perspective on matters of national concern, we're not going to give up," he says of the academy's PA advocacy efforts in the health reform dialogue. "You just can't talk about health care reform without talking about the people who deliver it--that is, PAs, NPs and physicians."

A week after the president's speech, the AAPA issued another call for action--this one preemptive--encouraging members to submit questions to ABC in an effort to give PAs a voice in the network's scheduled prime-time debate on health care reform. "Questions for the President: Prescription for America" aired June 24, and again physicians and NPs were mentioned, this time by an audience member, but PAs weren't. However, ABC broadcasters did mention PAs specifically as primary care providers twice during the show.

AAPA immediate past president Cynthia Booth Lord, MHS, PA-C, chalks up the Obama administration's "curious omission" of PAs to the fact that PAs always have been an understated group.

"Our work has always been that we are champions of patient-centered care," Lord says. "We haven't spent our careers caring about our name or our credentials; we're in the trenches. But now, we just want to make sure that we don't have to go back later and say 'write us into that bill.'"

In fact, PAs have been written into recent legislation, including the Affordable Health Choices Act introduced by the Senate, and the AAPA's constant presence on Capitol Hill and in the White House has assured that the profession remains visible.

"I don't think we're going to continue to be a 'curious omission,'" Lord says. "The health care reform process is just starting. Are we continuing to work with (the White House) to specifically identify PAs in a public domain? We are. But we have to keep our eye on the bigger picture."

Indeed, 15 or 20 years ago, PAs might not have been included in the legislation at all. It's important to remember how far the profession has come, Lord says.

"Though the President didn't mention us at the AMA or on the TV special, that does not in any way reflect where we are, where we are going or what we'll be doing when health care reform is all said and done," Lord says. "We will continue to hammer away."

Individual PAs can remind legislators and the public of their role in health care reform by talking to friends, family and even strangers about the profession, along with organized national advocacy efforts.

Students are contributing the PA advocacy movement, too. Elizabeth Murray, a PA student at Emory University in Atlanta, says she and her classmates are actively working to get the PA voice heard on health care reform matters.

"As students, we should make our voices heard in support of all practicing PAs and in support of a profession that we are about to enter," Murray says. "PAs are a part of the answer, and it's important for America to understand who we are, what we do and how we can help."

Lord salutes students' efforts. "Students are wonderful, because they're energetic and passionate even though they didn't have the struggles" that earlier PA generations faced, she says. Instead of entering the profession as a second or third career, many students today have grown up aspiring to be PAs. "They play a key role in advocating for the profession," Lord says.

While the profession has work ahead of it in matters of public perception and policy involvement, AAPA officials are optimistic. "We have to carry our own water and deliver our own message, because the only people representing PAs are PAs," Hanson says. "And we needed to revamp the way we represented PAs. A change in advocacy strategy was overdue."

"Though we clearly function on the physician-led team, identifying and articulating ourselves publicly is something new for us. We're working on that," Lord says. "I am confident that we are going to do it right this time."

For two Webcasts from editor Michael Gerchufsky about the "curious omissions," click here.