Is there Ageism in PA Academia?

    

     For all my colleagues who are considering transitioning into teaching, one word of advice: you must do it before you're older than 40 years of age. Otherwise, you could be considered past your teaching prime...regardless of how experienced or accomplished you have been in your PA career or professional journey. 

How do I know? What makes me an expert? Simple – I have lived it, so I am speaking from my very own firsthand experience. Sadly, implicit and explicit ageism exists even to this day in PA faculty hiring and retention practices.

And what I am about to say/share with you in this post, I suspect most likely will not be embraced by some if not by most of my peers. Moreover, I am very aware & very prepared for the barrage. Yet, I feel I must be truthful and transparent on a few PA taboo issues such as this one– the huge Elephant in the room, sort of speak and everyone tends to be oblivious to it. 

In all fairness to PA faculty recruitment practices, I will be the first one to admit that these faculty search committees oftentimes strive for hiring fairness. Fair, perhaps, but in many instances not even close; sadly to say even as holistic their candidate selection criteria are advertised on their job postings. Why? Because even with all the talk of practicing hiring inclusivity and aiming for diverse faculty retentive practices, etc., the reality is a very different one. Particularly in academia when it comes to PA faculty selection. Unfortunately, there remains an unexplained gap; a dissonant one seen in many instances. 

    For example, while earning & shortly after obtaining my master's degree and working full-time as an EMPA, I was able to be a PA adjunct faculty member in one program and a guest lecturer at another one in my state. All while receiving excellent evaluations from my PA and non-PA undergraduate students from another local university. Doesn't my decade-long teaching track record account for anything? 

To date, after applying for several local PA programs within the past 4 years, having published over 95 non-clinical articles & commentaries in various PA Journals, spoken at various state yearly conferences, & served as an advocate at the state level for my profession through the years, all I have received has been only 2 phone interviews, but no invitations for a face-to-face interview.  Hum...could it be my age? Most PA faculty bios that I have researched seem to showcase PAs under 40 years of age and have practiced for 3-10 years.

If we (they) are as serious as they say they are in hiring qualified diverse faculty members, then they may have to rethink their hiring policies or protocols when hiring younger & much less experienced peers over older/senior seasoned colleagues. Because ageism (the unspoken practice) is still alive and practiced in many subtle ways, it is detrimental to potentially experienced PAs by sidelining and disallowing them to be enriching contributing faculty members to the next generation of PAs. 

Furthermore, practice what you preach w/o exceptions if you're a social justice advocate and authenticity & credibility is a core values of your system. Better yet, actively combat this myopic hiring practice. In the end, who gets to be your faculty is just as important as who gets to be your PA student.  

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Is it January yet?

Is it January yet? This month were many of us wait to implement our New Year’s resolutions. Traditionally this is the month that we have decided to shed some pounds, stop smoking, or become better golfers, while others simply seek to have better work-life balanced lifestyles, etc. No one would argue these self-improvement strategies are meritless. But, how about a resolution outside yourself; not an individual one per se? 

Yet, as unhappy as many of us may find the environment we operate in, very few of us dive in to correct the crowded, confused, and at times unfriendly PA marketplace. Being able to provide a crystal clear brand image of our profession has not been our forte. We have remained brandless for far too long. Our internal culture has been one of apathy & passivity for the most part; this has been crystal clear through the years. We have allowed the anti-PA rhetoric to become louder & louder by the minute as seen by the American Medical Association (AMA) back in November 2020, entitled “ #stop scope creep... because patient safety isn’t a game”. Also, ACEP ( The American College of Emergency Physicians), and AFPPA ( The American Family Practice Physicians Association are the last physician communities to go public with this agenda. These Physician groups are morally bankrupt since their campaigns essentially seek to stall or halt the evolutionary progression of the scope of practice of Advanced Practice Providers ( APPs), mainly Nurse Practitioners, Physician Assistants, Nurse Midwives, and CRNAs. But they are not the only ones to blame. We must bear some equal responsibility after looking at both sides of the coin as this is difficult for some of us. 

We can still correct our course (professional destiny) if wanted & every member of our community decides to make a difference for the common good of the PA family. How? By taking personal responsibility, and professional accountability in becoming actively engaged advocates @ the state or national level. Everyone can make a difference for the better, even though they may not be able to be leaders on the national stage. Is time that we tell our truth, the one we have lived & know best. Namely, patient advocacy through uncompromised quality care deliverance. Increased patient access to healthcare through ongoing selfless interprofessional collaboration. 

And yes, you know what? We certainly can modify (reset) our internal culture, plus consequently optimize the marketplace we operate in by strengthening our brand. By executing a visionary strong servant leadership role, and staying above reproach this could be a collective resolution that we can implement without having to wait until January to see our promise come to fruition.

 

The Undying Phoenix in Me

    

        As a newly-minted PA 35 years ago, I faced & encountered numerous obstacles, early on in my career. Perhaps, more than I’ll ever publicly share. There were countless instances where my 1st 3 employers & peers doubted my ability to thrive in general in my newly chosen career. In retrospect, many years later after my slow start (from their perspective), I came to learn they had written me off for a host of reasons...none of which would have been fair to anyone at that point. But those were the demons I had to battle day in and day out. 

        Many assumed that I would become just another statistic, one who wouldn't be "able to cut the mustard" in the business of medicine. That's how wrongly & strongly they felt about my early beginnings and future as a Surgical PA. I carried some painful memories about those days, wondering if I would ever be accepted and belong 

        Honestly speaking and without a drop of animosity, I have to say, Thank You, to those who judged me, but forgetting that they too were novices and untested clinicians. How quickly they forgot that they were also student too in many respects early on in their careers.

        Because of those unsupportive working environments, I had to learn quickly, that no one was going to determine my career fate without me having the final say. Because of that negativity, I was able to make lemonade from lemons as the old cliche saying goes. Basically, those experiences provided fuel for my fire that didn’t allow me to succumb to the doubting Thomases surrounding me. No matter how hurtful people were, I chose the "higher ground", meaning I carried on with love in my heart and treated everyone with respect regardless of how dismissive, indifferent, or adversarial they were towards me. 

        It has been a roller coaster ride at times, yet, I feel proud of myself for enduring the trials and tribulations of these days. I am humbly proud to be here today, defying those expectations and remaining true to my value system. proving that with determination, resilience, and hard work, I was able to rise above every difficult circumstance encountered along the journey.

       I’ve experienced first-hand a journey thus far that has taught me the unshakable value of perseverance and the strength that comes from embracing challenges head-on and not giving up when everyone else scoffed assuming that I would. However, I would be remiss if I did not acknowledge those who believed in me and provided support, there were a few people who have been instrumental in my success, and I am truly grateful for their encouragement that reinforced my beliefs while traveling down this journey.

        Today, I share this personal sense of personal and professional accomplishment of being an empathetic provider of value through the years to my patients as well as to my students and colleagues. Throughout our careers, we will have "ups" and "downs", much like Paul the apostle wrote to his protege Timothy stating not only was he a warrior but more importantly he fought the good battle in being an exemplary to those who would come after him.

        I suppose, this personal milestone of mine of no different than many other successful folks. Fortunately, much like them, I can claim that also my success is a testament to the power of belief in oneself and the capacity to achieve dreams despite societal/other expectations. As my clinical retirement horizon approaches rapidly, I am still excited to embark on this new chapter of my life where I am confident, I will continue to grow personally in my senecent years.

Is Time to allow Physician Associates to practice w/o restrictions in Puerto Rico

        

        For the past 7 years, Puerto Rico has had a very critical shortage of practicing Physicians, yet their highly trained counterparts, Physician Associates/Assistants are severely restricted from practicing to the fullest scope of practice allowed by law in the island. Many studies have shown Physician Assistants can provide accessible life-saving care across all medical specialties and subspecialties, but arbitrary partisan laws prevent them from providing cost-efficient patient-centered care to those in most need: the 3.2 million disenfranchised Puerto Ricans from a broken politicized healthcare infrastructure system. 

        Today, nearly all Puerto Rican citizens lack the basic medical care services they need for the management of their chronic medical illnesses/conditions. Unfortunately, worsening a bad situation, the U.S. government declared a public healthcare emergency back in August 2016 due to an alarming rate of Zika infections followed shortly by the devastating effects of hurricanes Maria and Irma back to back in 2017. To this day, many other socioeconomic infrastructures have yet to recover fully from this.

        Those who have been following this Public Health crisis closely ( much like this author has), know that the root causes of The Puerto Rican healthcare crisis are complex, stemming from a myriad of many problems; ranging from economic shortfalls (budget constraints, etc.) to the duopoly of warring partisan factions when it comes to legislation as seen with the passage of “LEY #71”( law 71) in 2017. 

        Puerto Rican policymakers, along with other industry stakeholders as well as opposing nursing groups, and ultimately The Collegio the Medicos Cirujanos of Puerto Rico have all failed collectively to become aware of the benefits of the PA profession by failing to recognize the one method of alleviating PR’s strained healthcare system: the utilization of PAs to assist the depleted corps of physicians on the island. PAs have well over 50 years proven their ability as competent & empathetic providers not only in the US but around the globe. Especially in more recent times, including with the Veterans Administration Hospital in Puerto Rico. 

    

        Physician Assistants are highly trained in general medicine and are part of a patient-centered healthcare team. PAs improve access to care for underserved populations by diagnosing, treating, and preventing disease. PAs are trusted health care providers, licensed to practice and authorized to prescribe medication in all 50 states, the District of Columbia, and all U.S. territories with the exception of Puerto Rico. 

   

        Please urge your fellow colleagues to support us in changing this draconian practice setting/law so that the people of Puerto Rico can have increased access to medical services. Shouldn’t it be time PAs are allowed to make a difference during this time of extreme need in Puerto Rico? 

My Occupational PA Reality

 When someone asks what I do, it often feels like an oversimplification to say that I'm a PA. Perhaps, I'm a PA by trade, however, I feel that would be an inaccurate statement for a lot of reasons, granted not technically incorrect. And as true as that may be, that’s barely only the surface. Because in reality, and beyond a quick look, I feel I am at times more than just an advanced practice clinician. The other times I am a liaison, a “Psych attendant”, a colleague counselor, at many other times a student mentor, etc. I guess the list could go on, but I think you get the point. 

        The reality is this, saying simply that "I'm a PA" is not descriptive enough, it (personally) can feel as if I'm leaving out something really important–the parts that make the sum total that are just as important if not more so. In other words, yes, I am an Orthopedic PA who spends a great degree of my time not practicing solely as a PA, but also helping other people & other healthcare peers & professionals figure out how we can all be the best patient advocate at the end of the day. 

        While it can take some explaining to share in detail how I go about wearing these many hats simultaneously, I can say, after all these years, the blending of all these parts feels very integral to my workflow and/or workday. In 2 words, more like my professional identity. And while certainly, these might come at times a personal price, via work-related stress or at times some unexpected transactional frustrations, and operational patient-care related delays, etc., just to name a few. It is all part of trying to be the professional we were all called to be when we selected this professional path and career choice. 

        Personally, I know of many PA friends involved in other clinical subspecialties, various healthcare organizations, and work settings, who feel similarly about their professional lives and roles. Their inner compasses are in sync with mine even though we might see things differently at times based on the circumstances we are part of. Yet, the bottom line is the same: patient-centered care is number one…nothing less than that, even in the austere landscape of reimbursement. However, if you are a PA student you don't have to wait until you're a practicing PA to see if this is truly your calling in life. Or if it bodes well with your value system. Because even during your PA training, there will be times you will see and experience these demands placed on you. No one is immune. So, the question becomes: can you withstand these career expectations & or demands daily? Are you willing to go beyond what you envisioned & signed up for? 

        Remember, being a PA oftentimes is not just the easy part of medicine. It is about wearing the “many hats” you might be called to wear in your practice and workplace, but more importantly, can you wear them well, proudly, and diligently too? Therefore, if you one day or ever get asked what you do, you should be able to respond affirmatively that you’re PA…in the truest sense of the word. Think beyond the oversimplification tag or label others may feel inclined to label you with by (possibly) and indirectly diminishing your professional value or role. You know your reality because you live or have lived that PA reality yourself many times over while embracing it day in and out!