The past year or so has seen a virtual explosion of new or renewed interest in the perennial PA name-change discussion. Last year, 100 PA leaders signed a document calling for the profession to change its name to physician associate. This year, more than 5,000 PAs signed an online petition to the American Academy of Physician Assistants (AAPA) calling for the change. Some advocates have taken up the issue on blogs and online discussion forums; even YouTube has videos about this issue!
This is not a new debate, so one must ask why it suddenly became important again. Many have referred to the lines in Shakespeare’s Romeo and Juliet in which Juliet says, “’Tis but thy name that is my enemy…. What’s in a name? That which we call a rose by any other name would smell as sweet.” In other words, a name is an artificial and meaningless convention.
Is this, in fact, analogous to the PA name-change debate? Is it less important what we are called and more important what we do? Or is it both? This certainly lies at the core of our debate. One must ask, as in this case, how a name influences a person’s character and/or profession. Is it just sound and alphabetical symbols? Or is it the intellectual embodiment of who we are? One would think the answer is obvious.
Nevertheless, for the past three or four years, I have remained on the fence regarding this debate. I have been apolitical, except for the occasional comment to close friends that I thought the debate was a colossal waste of time. As with a lot of ideas, however, timing is everything, and I have now come to the realization that the time has come. I have changed my mind. With apologies to my NP colleagues for being so PA-centric in this editorial (although I welcome your comments) and at the risk of alienating some of my close professional friends, I have decided to speak openly and share my thoughts in support of change.
Having been in the profession almost four decades, I have witnessed significant changes in the PA scope of practice, including subtle transitions in the relationship between PAs and their supervising physicians (all positive, I might add). The word assistant may have worked well in the 1970s and ’80s, as we were defining the profession and not wanting to step on the toes of organized medicine. But as PAs became integral members of the health care team, this nomenclature paled.
In fact, the debate is not really for a wholesale name change but for a name modification to provide clarity to our physician colleagues, our patients, regulators, third-party payers, and our current and future students. While many suggest the name-change debate is very egocentric, I actually think we owe it to everyone else to settle this question.
Let me review the issues as I see them, albeit editorial in nature, and share my comments. I do this while sharing what I call the four “Laws of Nature” that I have used in decision-making.
The Law of Perception: People tend to think that in the marketplace of ideas, services, or products, the best will win. However, as Ries and Trout say in their book The 22 Immutable Laws of Marketing, “Marketing is not a battle of products; it’s a battle of perceptions.”1 It has been said that perception is reality—everything else is illusion. While this concept seems unfair, it is fundamental, and we might as well get used to it.
If indeed, as many have suggested, the term assistant does not describe what PAs do, and the public (ie, patients) has trouble understanding the distinction between physician assistant and medical assistant, then we have a perception problem. And thus, we also have a reality problem. I’m not sure that the old solution—throwing more money at public education to redefine or further explain the term assistant—will yield much reward. In fact, it may only further confound the situation if we wind up convincing the public that their medical assistant can do what PAs do.
The Law of Focus: Again, according to Ries and Trout, the most powerful concept in marketing is owning a word or a phrase.1 Once a word or phrase is ingrained in the mind of the public and is associated with a product (or in this case, a profession), it becomes an incredible success. Nurse practitioners have accomplished this with their name. There are few people I have met who do not understand what an NP is or does. The same is true for RNs and physicians and attorneys.
A successful marketer has to “burn” their way into the mind of the public by narrowing the focus to a single word or concept. The most effective words are simple and benefits oriented, and have a clear meaning. I am not sure that assistant in this case has a clear meaning—at least, not the one we want. Moving to associate has the potential for us to “brand” our name. It will no longer be generic, and it is clearly more descriptive of where PAs are as a profession today.
The Law of Exclusivity: Two professions cannot own the same word (or name) in the public’s mind. This is where the term assistant causes the biggest problem, since many health professions—particularly medical assistants, nursing assistants, anesthesiology assistants, and surgical assistants—share that title as well.
On the other hand, the term associate isn’t exactly unique either: There are associate deans, associate partners, and associate professors. I would argue, though, that (a) the term associate isn’t widely used in health care as a job title and (b) associate is usually used as a descriptor rather than as the name of an actual profession. Marrying physician to associate certainly clarifies the phrase and creates a new name that could be leveraged to send a powerful message about our role and our relationship to the physicians with whom we work. When thinking of that name, I refer you back to the laws of perception and focus.
The Law of Unintended Consequences: You are probably familiar with this one, the idea that actions have effects that are unanticipated or unintended. Economists, social scientists, and strategists have heeded this law for centuries. It is also true that politicians and popular opinion have largely ignored it.
This is a law that we cannot afford to ignore. One could say (and many have) that we have worked long and hard to ingrain the physician assistant name in state and federal statutes, hospital bylaws, public service announcements, the public consciousness, etc, and many wonder if changing the name now would have negative consequences for the profession.
Some have postulated that changing the name would be a huge task that would eat up millions of dollars and years of time. I think this a bit of an overstatement. (Easy for me to say, right?) Others say that changing assistant to associate may just be a “cosmetic” or “technical” fix with state legislators, hospital administrators, and third-party payers.
As a PA who has been involved in state legislative efforts for more than three decades, I tend to favor the latter viewpoint. With the right support (and the right timing), the change could be fairly barrier-free. It is often done in legislatures when names of organizations, certification bodies, and others are changed. Getting rid of the apostrophe-s years ago is a case in point. When this happened, we changed our name in state legislatures throughout the country; it did not cost millions of dollars, and there were no significant attacks on our scope of practice.
The biggest perceived barrier, of course, is the support of physicians, particularly the American Medical Association, the American Osteopathic Association, the American Academy of Family Physicians, the American College of Surgeons, and the rest of “organized medicine” (see law of perception). However, if we convince these groups that a name change would not alter the scope of practice nor signal a move for independent practice, then we may be able to engender their political support.
If the perception is otherwise, it could be problematic. However, PAs have become strong members of the health care team, and I think physicians and federal agencies recognize our importance in being part of the solution to caring for the 34 million new patients who will soon enter the system.
I must also mention that without the active support of the AAPA, the Physician Assistant Education Association, and the National Commission on Certification of Physician Assistants, the name change issue will likely die on the vine. The old saying that “we should hang together or certainly we will hang separately” makes an important and serious political statement. I call on state and national PA leaders to listen to their constituents on this issue.
Many prominent PAs have spoken eloquently on the name change issue. Robert Blumm suggested, “The word assistant no longer reflects what we do or who we are as a profession.”2 Vic Germino, one of the first three PAs in the country, has said: “PAs are associated with physicians in ways that enhance their ability to practice with their particular population of patients, whether that enhancement involves assisting in surgery, managing chronic illness, doing preventive and educational care, practicing in underserved areas to extend the physician’s ability to reach more patients, or doing research. We use our variety of skills and our knowledge and education to function as associates and colleagues in these and other ways. Clearly, the level of independence (with supervision) of most PAs today is far beyond the generic term assistant that has been applied to health care workers with as little as six to 12 weeks of training.”3
Even some of those who are opposed to a name-change effort have acknowledged the merits of the idea. Professor James Cawley says, “While intellectually I wholeheartedly agree with change proponents that physician assistant is an undesirable name for the profession, and agree that physician associate would be a far better and more accurate name for the profession, practically speaking, it’s just not going to happen.”4
If indeed we are “Here for the Long Haul” as new AAPA President Robert Wooten said in his first President’s Letter,5 then it is time to do what is right for our profession. If we want to continue to attract some of the best and brightest to our programs, then it is time to do what is right for our students. If indeed we are tired of sacrificing time with new patients and others to explain that our name doesn’t mean what it sounds like it means and that we are in fact qualified to provide their care, then it is time to do what is right. But as Colin Powell once said, “A dream doesn’t become reality through magic; it takes sweat, determination, and hard work.”
Are we, as a profession, ready to invest in this yet? I hope so. As always, I welcome your comments at PAEditor@qhc.com.
1. Ries A, Trout J. The 22 Immutable Laws of Marketing: Violate Them at Your Own Risk! Harper-Collins Publishers; 1993.
2. Blumm RM. Physician associate: a name that reflects our heritage and future. PA Professional. 2011;3(5):26.
3. Germino VH. Personal communication.
4. Cawley JF. Get used to it: why the name change is impractical. PA Professional. 2011;3(5):27.
5. Wooten RL. President’s letter: here for the long haul. PA Professional. 2011;3(5):5.