Should We Still Be Called 'Physician Assistants'? An AAPA Update

While at the 2019 AAPA conference in Denver, CO, I sat in a session titled “Title Change Investigation Update.” The hour-long presentation came from WPP, the research firm behind the exploration of whether the name of the PA profession should be changed. AAPA has released an article with an update as well, but I want to help you understand the information that was shared during the session and how it was received.

For a little background, the title change investigation comes from a resolution that was passed in the 2018 House of Delegates that resulted in a vote of starting a further investigation on whether the physician assistant title should be changed, whether it was feasible, and what were potential alternatives. Over the past year, this has been a topic of much discussion of PAs, but in the spring a 45-minute survey was sent out to begin this investigation. This survey received some backlash for length and lack of seemingly relevant questions, which was (somewhat) addressed in the presentation.

WPP had two key questions to address:

  • Is there a need to evolve the PA brand based on objective well-informed data and analysis driven view?
  • If so, how do we redefine how the PA profession is positioned in healthcare today and in the future?

The set up of the research process was discussed as a five-phase process, including discover and design, research and analytics, insights and strategy, title development, and validation. At this point, phase one and two have been completed, and we are in phase three with an estimated timeline of May to December 2019.

During Phase One, Discover and Design, WPP reviewed research to see how PAs operate today. They determined there was not enough data to indicate a name change, so they moved to Phase Two, Research and Analytics.

During this phase, they talked with PAs, PA students, NPs, physicians, patients, employers, “think tanks,” professional societies, medical boards, government agencies, and legislators across 20 states about how PAs are currently viewed. One of the main findings across all constituents in the qualitative portion is that overall, PAs are well regarded. According to patients, PAs are trusted with good communication skills, but sometimes they don’t know what the PA roles and responsibilities are. With other health care providers, PAs are “capable allies” who help manage patient care, are trusted, and sought for counsel. Employers appreciate the financial access and patient care benefits of PAs. All of this indicates a “clear value in today’s healthcare system with access and improved economics.”

Despite these benefits, it was found that there is a significant difference in the “perceived role” of PAs. Patients feel that PAs have more capabilities than NPs, stemming from the word “physician” in the title, which provides a “halo,” while NPs are viewed as “nurses with a lower order” from a patient perceived hierarchy. In contrast, other healthcare providers see PAs and NPs as the same in responsibilities and capabilities, with differences in how they are trained, while employers feel that PAs are more focused on procedures and surgical support, but NPs are more focused on preventative care and patient education.

From these results, it appears that perceptions are driven by the amount of direct contact PAs have with their constituencies. If a health care provider or employer has worked with PAs, they knew exactly what they did, but without that contact, they did not have a strong understanding of the capabilities. Patient understanding varies based on factors, such as exposure and age. Overall, PAs have a high degree of satisfaction and enjoy the role and its benefits, including direct patient contact, less debt, earlier start than medical school, flexibility, fewer “non-patient care” headaches, and are overall collaborative, not competitive, with physicians.

Moving on to the survey. For the quantitative portion, the survey was sent out to a list provided by the AAPA, and completed by 6,845 PAs and 1,357 PA students. This is a response rate of six percent, which sounds low, but AAPA states is in line with most research studies and provides a “good sample size and is robust for analysis.” The goal of the survey, like the discussions, was to figure out what are the perceptions of PAs and what drives value.

Though they didn’t share all their learnings from the survey, they did conclude “it is strongly suggested that an exploration of an alternative title should be pursued, and quantitative findings from physician assistants alone warrant this exploration.”

The next phases — Insights and Strategy, Title Development, and Variation and Implications — require more researching and surveying, though they plan to be ready in early 2020 with a new proposed title.

But PAs have some concerns: why didn’t the survey ask about what titles we recommend? While the survey was active, one of the main complaints among PAs was the 45 minutes it took to complete, as well as the lack of questions directly addressing a new title. At this point, WPP clarified that not only are they looking at the title issues, but the PA profession as a brand, and how these perceptions align with the ideal role of a PA to determine what it will take to move the profession in that direction. After those determinations, they will try to pick a potential title. If you were wondering during the survey why you had to rank various professions, the goal was to understand how PAs, physicians, and NPs are perceived along the same dimensions. Not to assert that one provider is more valuable than another, but to determine what makes PAs unique. This 360-degree perspective is meant to highlight PA strengths and the aspects of the role considered most important in providing care, pinpoint what differentiates PAs, and attempt to transcend the title for a “holistic brand strategy.”

So if it is determined to be a feasible option, what should the “physician assistant” title be changed to? I guess we’ll all wait on the edge of our seats until the next survey to see what our options are, but I would love to hear your suggestions in the comments.

Previously published on The PA Platform

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