Monday, March 24, 2014

PAs by Any Other Name...

One of the markets I serve, physician assistants, is currently going through some rough times as a profession. There have been discussions for many years about "Assistant" in the title Physician Assistant. The professional association for PAs, the American Academy of Physician Assistants, has held numerous discussions, debates, and votes about changing the title, but consensus has so far been impossible to achieve.

The last few years have been particularly rancorous, it seems to me, with debates raging on the Physician Assistant Forum, Facebook, and even Clinical Advisor, most recently with a wonderful article by Jim Anderson, MPAS, PA-C, DFAAPA, ATC, called, "A new vision for the AAPA."

Jim asked for feedback on the topic from PAs for Tomorrow and received a number of sensible suggestions, including this one:
"Market us as PAs, not as Physician Assistants. Anything we can do to diminish 'assistant,' even if we don't end up at associate, is a positive change."
I thought I might be able to shed a bit of light on this subject from the point of view of an author, editor, publisher, and nurse. A linguistic bit of light, if you will.

Let's take the title one word at a time.

Physician

In traditional medicine there are two preeminent models, the medical model and the nursing model. Nursing has been highly consistent in their, let's call them, naming conventions.

For instance, when the NP arrived on scene in 1965, through the University of Colorado's groundbreaking program, Nursing "decided" to call them Nurse Practitioners. That is, whoever coined the term nurse practitioner, whether it was Loretta Ford, RN, or her partner at UC Henry K. Silver, MD, the profession adopted the term and made it real. It likewise made real advanced practice nurse, nurse midwife, and nurse anesthetist, consistently using "nurse" in the title.

Eugene Stead
When Eugene Stead, MD, formed the first PA program in 1965 at Duke University, he too, like Ford and Silver, was reacting to a shortage in physicians. Unlike the NP movement, though, there were at the time three iterations, by my count, of the PA:
  1. Physician Assistant
  2. Physician Associate
  3. Medex
It took some time for the profession to make PA real, and the effects are still being felt. The title Physician Assistant does, though, indicate consistency in medical model, just as Nurse Practitioner does with the nursing model.

Assistant

Unfortunately the PA profession didn't have the benefit, from a purely linguistic view, of using practitioner to distinguish them from physicians. To call a PA a "physician practitioner" would have been redundant and unclear.

Associate, I think, was better but still not quite right.

What other descriptors might work? Well, there aren't many.
  • Colleague? Rather vague.
  • Collaborator? Sounds like a co-conspirator.
  • Ally? Oh, please.
  • Representative? Adjunct? Adjuntant? No, no, and definitely no.
There just aren't words out there that meet all the needs of the profession.

Now what?

As I see it, PAs have three basic options:
  1. Stay with the status quo. [Hate it.]
  2. Use a  different term that more accurately identifies what PAs actually do, whether it's physician associate, advanced medical provider, Medex, or some other term as yet unknown. [We haven't found an acceptable term yet, and I doubt we will.]
  3. Do what the reader from PAs for a Future suggested. Stick it out with PA, meaning Physician Assistant, but make it much harder for people five years from now, people who have never heard the term physician assistant, to find out what PA means. The thinking here is that if you use the abbreviation consistently but almost never use the full term, people will eventually forget the full term and recognize the profession purely by the abbreviation.
It's that latter course I recommend. Here's how I might implement it:
  • Revise association names and logos to delete "Physician Assistant" and instead use "PA."
  • Change web copy and copy in other documents to  PA instead of spelling it out, but leave it spelled out in selected documents and web pages. Make the user look for the spelled out name.
  • Replace PA in all instances within the profession's own lexicon, and then "push" that lexicon out to the public at all pertinent points.
It might take time, and it will certainly take money and effort, but I'm not sure, at this point in the growth of the profession, whether there are other viable options.

From my purely linguistic view, of course.