Members of the ADVANCE for Physician Assistants editorial advisory board have always provided us with insight into the PA profession and unparalleled advice in subjects that matter to you. That is why we decided to periodically check in with our editorial advisory board members and ask them to share with readers of ADVANCE certain aspects of their personal and professional experience.

Every month we will ask a handful of our trusty advisors to respond to a different question, so keep your eyes peeled for more Q&A articles like this one in the future.

This month, we asked three editorial advisory board members--Dale M. Janson, RPA-C; Ann M. Griwatz, PA-C; and Daniel Wood, MPAS, PA-C--to tell us what changes they predict the PA profession will see in the next 10 years. Read on to see what they each had to say.

Official Recognition for Specialties

In the 28 years that I have been a practicing PA, a great deal has changed. For example, during my first several years of practice, I had to answer the question "What is a PA?" almost every day. Though I no longer hear that question, there are a few important areas in which little progress has been made in the last three decades.

One such area is the lack of PA specialty certification. As a PA who has always practiced in the sub-specialties of hematology and oncology, I believe that it is both inevitable and imperative that we, as a profession, develop methods to train and certify our colleagues who wish to specialize. Every other major health care profession provides the opportunity for members in specialties to show colleagues and patients that they possess a level of expertise and knowledge gained through training and experience and demonstrated by testing and peer review. Why shouldn't PAs do the same?

Within my department, five senior PAs have a total of 100 years of combined experience in hematology and oncology. Unfortunately, there is no mechanism for official recognition of this extraordinary level of qualification. Instead, each of us has been required to prove ourselves every six years by taking a test for generalist certification. This is outdated and no longer relevant to a growing body of PAs who practice in a specialized field. 

In March, 2007 the American Society of Clinical Oncology published a comprehensive analysis of the projected increase in demand for oncology services through 2020. Increased use of PAs and NPs was cited as one of the few solutions that stood a reasonable chance of positively impacting projected shortages in our nation's ability to deliver these cancer services.

I believe that, by 2020, physician assistants should be given the opportunity to pursue and maintain certification in specialties such as hematology and oncology.   

Dale M. Janson, RPA-C, is past president of the Association of Physician Assistants in oncology. He is currently supervising physician assistant and research director in the division of hemotology and oncology at the Long Island Jewish Medical Center in New Hyde Park, N.Y., and clinical assistant professor at SUNY Stony Brook School of Health Technology & Management.

Growth vs. Obstruction

Over the next 10 years, I foresee positive changes in the PA profession, including increased clinical utilization of PAs with subsequent gains in public awareness. This growth will largely be fueled by the prospective changes in health care intended to better meet our national community's needs. The relative affordability of PAs will have tremendous impact on our profession's growth. Our proven record of success in patient care enables PAs to court expanding clinical opportunities. As partners in medicine with our physician counterparts, we help facilitate the unique benefits of team practice.

Specialty certification may enhance both physician and public perception of PAs as more clearly qualified to provide effective care in the varied disciplines of medicine. However, I question whether this certification will have measurable or favorable clinical impact.

The surgical testing component of PA certification was suspended "indefinitely after the final 2004 administration, because the cost of developing and administering the exam exceeded the revenue generated" (NCCPA News Quarterly, Spring 2004). This statement fuels my own query: How effective can a test be in forecasting our clinical efficacy in any specialty? 

Clearly, a large bulk of our knowledge base as PAs comes from clinical experience. This parallels the strong practical benefits derived from physicians' rotations, residencies and fellowships in their areas of expertise, complemented by taking a test in that same medical specialty.

I suspect the specialty certification test may represent both a barrier to practice and a worthwhile goal to achieve for those PAs looking to appropriately strengthen their knowledge base in their self-declared area of interest. For physician assistants who have spent many years in a specialty, where they have gained a broad and deep bounty of medical knowledge, the test will affirm their strong clinical knowledge.

Ann M. Griwatz, PA-C, is past president of the Association of Family Practice Physician Assistants. She works for Emergency Services of New England in the ED at Springfield Hospital, Springfield, Vt.

Doing What We Do Best

I have practiced as a PA for nine years, and I am happy to say that the public perception of PAs continues to become more and more favorable. That's partially because of the growth of the profession and increased exposure, but it's also because PAs do and will continue to provide what patients want: quality health care services and great bedside manner. PAs also have become an integral part of the health care system, and no matter what kind of healthcare reform occurs--if any--I believe PAs will continue to maintain a valued role with strong organizational leadership.

A controversial topic is whether PAs should be able to pursue a doctorate as a terminal degree. I think that the doctorate is fine for academic purposes; however, I am not sure how having a doctorate would change my daily practice. If earning a doctorate becomes an option for PAs, I hope that it would lead to more research and knowledge about the PA profession that is still lacking.

Specialty certification is already in the works. Will this training model lead to better-trained PAs? I don't know. I do think that specialty certification puts at risk one of the profession's most under-recognized attributes: generalist training. After nine years of general pediatrics and family practice in an underserved area, I have sought new challenges in the PICU at a local level 1 trauma center. I've been lucky enough to receive on-the-job training, which likely would not have been possible with specialty certification. In Texas, a specialty-trained PNP who wants to work in the PICU needs additional certification. As a PA, I did not need any certification--at least not yet.

Daniel Wood, MPAS, PA-C, is past president of the Society for Physician Assistants in Pediatrics. He is currently a faculty associate at the University of Texas Health Science Center San Antonio School of Medicine and a member of the LAPD council for AAPA.


Ask the Editorial Board (8/13/09) - ADVANCE editorial board members reveal what drew them to the PA profession and whether they'd do it all over again.