In our ongoing profile series, we honor nurse practitioners (NPs) and PAs who are making a difference in the field. Today, we highlight Desmond Watt, MMS, PA-C, who is medical director of Virtual Care Delivery at Eden Health. He is also director-at-large for the American Academy of Physician Associates (AAPA) Board of Directors and co-founder of the AAPA specialty interest group PAs in Virtual Medicine and Telemedicine (PAVMT).
Q: Who was your mentor in the PA field?
PA Watt: I have been fortunate to have many mentors in the PA field — some in the clinical space and others from a professional advocacy perspective. On the clinical side, my growth as a PA has been informed by too many clinicians to count: PAs, NPs, physicians, nurses, and others on the health care team.
If I were to call out 1 experience in particular, it would be my time working with Sameer Panjwani, MD. I was already a few years out of PA school when Sam joined our practice at One Medical in Chicago. Our dedicated examination rooms happened to be side-by-side. I learned so much in my time collaborating with him, particularly his approach to patient care, bedside manner, and diagnosis and treatment. He always brings a data-driven and analytical approach to his patient assessment and is an expert in distilling this active thought process into patient-friendly terms that ensures patients feel heard and cared for. I have taken those experiences with me into my patient encounters on a daily basis.
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On the advocacy side, I’m fortunate to have had many mentors who have helped me grow and build my competence in driving and supporting change in the PA profession. To name a few, Jennifer M. Orozco, MMS, PA-C, DFAAPA, current AAPA President, gave me my first nudge into real PA advocacy and has continued to foster that relationship to this day. She is one of those people who seems to get 36 hours out of every day and has taught me a tremendous amount about persistence, perseverance, and planning.
David E. Mittman, PA, a recent Past President of AAPA, has had an enormous impact on how I think about advocacy including the importance of building relationships, listening to others, and thinking big. Dave has so often been at the leading edge of PA advocacy, championing key issues years before they became mainstream. He is a true agent of change and his impact reverberates throughout the profession.
Lastly, Mordechai (Mike) Sacks, DMSc, PA-C, of Sacred Heart University is a colleague and friend but he may not realize that I also consider him a mentor. His vision for his career path and tireless advocacy for our profession are incredible. I’ve learned so much from our conversations and collaborations over the last few years and continue to be inspired by who he is and what he does every day.
Q: What made you choose medicine as a career?
PA Watt: I credit my path to a career in medicine to my grandmother Suzanne Watt, who we called Nana. My nana had originally planned to attend medical school in the 1940s and had the grades and credentials to accomplish it. She ultimately started a family and built a rewarding career in laboratory services, retiring as the assistant director of Laboratory Services at Rush University Medical Center. She always encouraged my pursuit of scientific studies and was a guiding hand in my decision to become a PA. She grew up on a farm in Kansas during the Great Depression and always reminded me, “To whom much is given, much is expected.” Her words resonate to this day, and I regularly return to them in times of stress or challenge.
Q: What aspects of your profession are most challenging?
PA Watt: Over the last half century, PAs have become uniquely skilled providers who deliver high-quality patient-centered care, expand access, and meet patient needs wherever they may be required. We have demonstrated this both prior to and throughout the COVID-19 pandemic. Yet the laws that govern our practice at a state and federal level simply have not kept up. As a profession, we come from a historic background of a very explicitly defined 1-to-1 physician to PA relationship. While these relationships still exist in the health care system, they are more frequently the exception rather than the rule.
Among the central components of our training is the importance of team-based care. This is an acknowledgment that each individual on the care team brings unique skills and abilities to patient care, and we should work together dynamically to ensure those skills are fully utilized in service of our patients.
Frequently, our existing laws and regulations ignore this reality and miss the opportunity to fully utilize and take advantage of our unique training and skillset by obligating specific practice arrangements that are inflexible and administratively burdensome. I’ve spoken with far too many colleagues over the last 18 months who have shared with me the various ways in which the laws and regulations governing PA practice have limited their ability to serve patients and that is completely disconnected from their education and skills.
This experience became heightened in the resource-constrained environment created by the ongoing COVID-19 pandemic. State-level scope of practice laws often constrain a PA to provide only the services their collaborating physician can perform. For example, this means a PA with years of experience in pediatrics may not be able to provide care for children if their collaborating physician does not. Similar examples abound across the health care system for PAs. As lifelong learners who are required to complete at least 100 hours of continuing medical education every 2 years to maintain their certification, PAs are committed to expanding their medical expertise through their years in practice. No law should ever impose constraints that undermine a health care team’s flexibility and withhold timely care from patients in need. Those laws exacerbate existing health care resource shortages nationwide.
Q: Have you found a way to overcome these challenges?
PA Watt: To an extent, yes, though the pathway is through legislative change. In 2017, AAPA announced a new practice recommendation for PAs called Optimal Team Practice (OTP). The basis of OTP is to examine the current state of PA practice within the health care space and maximize an individual PA’s impact within their care team and organization while reducing or eliminating administrative burdens associated with our practice. Optimal Team Practice reiterates our firm commitment to team-based care but makes several recommendations to achieve this goal.
To support OTP, states should:
- Eliminate the legal requirement for a specific relationship between a PA, physician, or any other health care provider in order for a PA to practice to the full extent of their medical education, training, and experience;
- Increase PA participation in regulation of the profession at the state level
- Authorize PAs to be eligible for direct payment by all public and private insurers.
Like every clinical provider, PAs are responsible for the care they provide. Nothing in the law should require or imply that a physician is responsible or liable for care provided by a PA unless the PA is acting on the specific instruction of the physician.
Aspects of OTP policy have been enacted in various states, with some states achieving full OTP. This legislative progress is welcome and has translated to more flexible and dynamic deployment of PAs in the health care space to the benefit of patients and health care systems. As more states achieve OTP, the positive impact on patient care and team-based practice should continue to expand as well.
Q: What aspects of your profession are most rewarding?
PA Watt: PAs are trained as generalists. This means my training allows me to care for patients in a variety of settings over the course of my career. While my career to this point has always been in primary care, my background would enable me to transition to other specialties in the future. This commitment to broad-based clinical training for all PAs is part of our DNA and what makes this profession so unique in the health care system.
PAs are team players. Through our training and ongoing clinical practice, PAs work to collaborate across the health care team every day because we know this is best for patient care. To me, this commitment from the earliest moments on our healthcare journey explicitly encourages PAs to set aside ego in caring for patients and forces a continued effort to identify how we can best support and collaborate with others on the healthcare team to achieve our goals.
Q: What do you know now that you wish you knew coming out of PA school?
PA Watt: Health care is a dynamic and constantly evolving space. What we know today may not be true tomorrow, or at least next year. While PA school committed me to be a lifelong learner and always working to stay current, I wish I had known how critical it was to also participate in professional advocacy.
We all seek out careers in health care for a reason, running the gamut from a transformative personal experience in our earlier years to a simple desire to help others. What so many of us miss in our training is that while our utmost purpose is to serve our patients, we must also serve ourselves. Helping to sustain, grow, and evolve our profession is a critical piece of every health care provider’s journey. Any profession that is not growing and evolving with the health care system at large is one that is eventually destined for failure. However, advocacy is a shared effort that is borne by each individual who is willing to contribute the time, money, or both to advancing their profession. It took me a few years to return to advocacy after graduating from PA school, but I will never look back.
At the risk of exposing my Star Wars fandom, to quote the Mandalorian, “This is the way.”
