American Academy of Physician Assistants (AAPA) President Robert L. Wooten, PA-C, admits he wasn’t always actively involved in professional affairs. In fact, he describes himself as “one of those people who was on the sidelines—I could make a lot of criticisms but didn’t step forward to help with the work.” But once he took that first step, he found himself on an incredible journey that has led to the top elected position within the PA profession.
Wooten credits his initial involvement with the North Carolina Academy of Physician Assistants (NCAPA) to a colleague, Gail S. Marion, PA-C. It all started with attendance at one meeting. “It’s one of those things where you go to a meeting, you say a few things, and the next thing you know, you’re put on a committee,” Wooten says with a laugh. From there, his participation grew to include a tenure on the NCAPA Board of Directors, eventually as president. When the AAPA contacted him, he repeated the cycle at the national level.
“It’s a major achievement and a tremendous amount of responsibility, when you think that you are representing thousands and thousands of PAs,” Wooten says of his term as AAPA President, which began on June 10. “It has been a bumpy road, but I’ve learned so much and have been able to connect with so many people that it has been a joy for me.”
Wooten graciously spoke with Clinician Reviews about PAs’ role on the health care team, navigating a contentious political climate, and his goals for his year in office.
CR: How has your tenure as President-Elect prepared you for taking the reins as President of AAPA? What experiences or advice have impacted your approach to your new role?
WOOTEN: As President-Elect, I spent the past year learning from and being mentored by our Immediate Past President, Patrick Killeen, and the AAPA Board. So I certainly have to thank them for their help and encouragement.
Last year was a fairly busy year. We had a lot of work to do with the implementation of the new health care legislation. And then we started to undertake a search for our next AAPA CEO, and we’re still involved in that. We also initiated a rigorous research agenda—the first time we’ve done something like that. Through getting all of that set up, I’ve really learned the importance of being able to multitask and do a number of things pretty much at the same time!
So it was a dynamic period, which confirmed for me a couple of things. One is the need to identify and get out in front of issues and problems that could present barriers to PAs’ ability to care for patients. Also, the need to motivate PAs to go the extra mile and think beyond the “treatment” and to question what it really means to care for a patient. So many times, we see patients and it’s not just that particular illness that they have; there are many other problems people are facing today, whether it is social, economic, etc. I truly believe PAs have to become what I would call “prevention ambassadors.” We need to work with our patients in the area of identifying and preventing illness and disease, rather than just treating them.
So I think my years of experience on the state level, and serving as the liaison to the Commission to End Health Care Disparities and some other organizations with specific health care perspectives, have certainly helped me to understand that we don’t have all the answers to the health care challenges and that working together with others and as a team will certainly be very important if we’re going to take care of our patients to our fullest abilities.
CR: As nurse practitioners seek more independence from the medical community, there are mixed opinions among PAs as to whether their profession should follow suit (and to what extent). What are your thoughts on the proper balance between recognition of PAs’ capabilities and respect for the doctor-PA relationship?
WOOTEN: PA history and education have been rooted in a team-based philosophy. The physician-PA team concept has been the backbone of our profession, and I don’t see that changing. While working as part of a team, in many cases, PAs are called upon to practice autonomously. So the higher visibility and increased recognition of PAs, I think, are keys to addressing many of the challenges that our health care system, and our patients, face. PAs do act autonomously.
To me, it all goes back to the team concept. We all have to be—whoever is on the team has to be—in it to take care of the patients. That’s how you provide the high-quality care, whether you are in a big tertiary medical center or a remote area or underserved location. And that is what PAs do.
Whether we have a doctor who is immediately available or the doctor who we are consulting with is available through phone, email, text, whatever it is, it’s still part of that team concept. As a PA, knowing what your abilities and capabilities are, and having your physician out there as the person that you are consulting with, is how you keep it all together. It’s about communication, it’s about teamwork—and ultimately it’s about the patient.
CR: Attention is already focused on next year’s federal elections; what challenges does the PA profession face in achieving its goals in this political climate? What legislative or regulatory issues for PAs need the most attention?
WOOTEN: The AAPA usually develops a federal legislative agenda at the beginning of every new Congress. Currently, AAPA is in the process of developing its new agenda for the 113th Congress.
What is important is that we make sure our issues are not partisan issues, that they are pretty much focused on providing greater patient access to the quality medical care that is provided by PAs. Those patient-centered issues are bipartisan. So the Academy works hard to identify Senators and Representatives on both sides of the aisle to sponsor our bills, so that we do build bipartisan support. We also try to talk about cost-savings. That really resonates in today’s climate of fiscal restraint.
We have constantly focused on issues that affect the profession, such as reimbursement. Right now, what is going to happen with Medicaid and Medicare—I don’t think any of us are sure how that is going to shake out, especially with the debate on the debt ceiling and whether we’re going to cut back Medicare and Medicaid programs. There are a lot of things going on, but still we have to focus on making sure that we’re giving high-quality care to our patients.
We’ve been talking with members of the House and Senate about PAs being able to write for hospice care. We have not been able to do that, which is frustrating. You take care of a patient through all of their illness, and then when it comes time for them to need hospice care, the PA can’t write for that and they have to have the physician do it. If your physician is many, many miles away because you are practicing in a remote area, it can make things difficult.
Our staff continuously monitors those issues and develops agendas accordingly. We have a Day on the Hill each year. But what we’re doing more these days is, as PAs come to the national office or to Washington, DC, for meetings, we try to find a time when we can go to the Hill and talk to the legislators, just to let them know that our concerns are about our patients and that we want to make sure we are able to provide the best possible health care.
And to take that another step, as we talk about 2020 and the projected 90,000-physician shortage, it is going to be critically important for PAs to be able to step up and help to fill that void. We know there is a tremendous void now in primary care, and in certain areas of the country, such as urban/inner city areas, there is a bigger dearth of primary care providers.
CR: Personally, what do you hope to achieve during your presidency? What initiatives are at the top of your own agenda?
WOOTEN: Well, the presidency of course is that one year. We all have lots of hopes and dreams. But there are a few things I want to focus on, and I think even if we get them started, they will continue.
I think we have a great opportunity as a profession to address and to help end health care disparities, and certainly improve the relationship to diversity in the medical workforce. So one of my initiatives is that each PA, no matter what practice he or she is in—whether it’s clinical or in the education arena—address the health care disparities issue. That is one of the pillars. If we eliminate that, we can certainly get people the high-quality care that they deserve. I think that’s very important in improving the health of this country.
I also think it’s important that PAs volunteer—in their communities or nationally, however they want to do it. It doesn’t have to be in the medical arena. There is a lot going on in the educational arena; there are many students who are behind in reading, math, or science. These students start out behind and don’t progress. So as we’re looking for more and more people to come into the workforce, particularly in the medical community, they have to have the education.
So in our communities, we need to look at what’s going on and where can we get involved. The school systems are very important. I think there are programs in our houses of worship that we can be involved in. There are so many different areas—with senior citizens, doing educational programs on nutrition. But PAs have to be involved, impact their communities, to make a difference.
And of course, advocacy and personal activism for the profession is another important area. We certainly have to be advocates for our patients—once again, going the extra mile to make sure that we can get our patients what they need.
Working in an emergency department, I see patients who are certainly not going to be able to get their medications filled because they don’t have income or insurance coverage. Sometimes, you just have to go the extra step to see if you can’t work out a way for them to get a medication or a particular appliance—wheelchair, crutches—that they need. So you get involved in many aspects. You get the social worker or case manager or sometimes clergy involved.
And in our communities, we should know what the big issues are and then help folks take steps to solve them—particularly when it comes to health care. If we have a large portion of people who are not getting immunizations, people who are having trouble with asthma, diabetes, or hypertension, how can we tie into the efforts in our community to help break some of the cycles that allow these things to continue? And maybe address some of the environmental issues that are causing the asthma and other things.
So, those are three areas that are certainly, I think, important and that I would like to continue to promote during my presidency.
CR: How would you describe the overall relationship between PAs and their nurse practitioner colleagues? In which areas might it benefit both professions to work more closely together to achieve goals?
WOOTEN: Once again, it’s all about the patient. Once you put all the other stuff aside, it’s about working as a team to take care of the patient. There are more than enough patients for everybody to take care of. As I mentioned, as we go further down the road and we start to see this shortage of physicians, it is going to require that PAs and NPs are working to take care of the patient.
On our local levels, you see PAs and NPs working together in the same office, on the same team, seeing patients and getting the job done. I would think that overall the relationship, particularly among those of us who are working in the trenches day to day, is very good.
At the upper levels, as you have two organizations, sometimes we need to get together and talk about what is going on and focus on what’s out there that is affecting our professions and keeps us from providing care to patients. So whether it’s legislative issues, whatever it is, those are the kind of things we need to focus on, because ultimately it comes back to patient care.
CR: Finally, what other message do you have for your colleagues?
WOOTEN: The PA profession has certainly come a long way since the first PA students graduated from Duke University in 1967. But I think we still have a long way to go. We all have both personal and professional interest in ensuring the success of our profession, and we all have to invest in the profession’s future, through advocacy, mentoring, and community service efforts. In order for the profession to grow and properly serve all of our patients appropriately, I think PAs as a group must become culturally competent and ensure that the profession through its diversity efforts actually reflects the patient population that we serve.
And again, I reiterate that advocacy is not only the job of the “professionals,” or the profession; it is also our individual responsibility to participate in advocacy efforts at both the local and national level. And this is particularly true in these times when health care legislation that can affect our ability to serve our patients is either written or reviewed almost daily.
So I think the PA profession has certainly come a long way, and we need to continue to work as hard as we have been to make sure that we are meeting the needs of the patients we serve and working to improve the health of America.