Although I’m a physician assistant, I’ve always had so much respect for the nurses and nurse practitioners that I’ve had the pleasure of knowing and working with. My late brother was a nurse (think Jack Nicholson in scrubs), and it was through his eyes and often-hilarious nursing stories that I became interested in medicine.
This brings me to a surprisingly moving event that I was recently a part of at the University of Washington Medical Center, where the medical staff granted PAs admitting privileges in what may be an unprecedented move. Without the support of NPs, who already had the privileges we were seeking, the PA admitting issue could not have moved forward.
One of the obstacles to PAs gaining admitting privileges was the need to have a quorum, without which a vote could not be taken. A strong turnout by NPs helped achieve quorum at the recent meeting where the vote was taken, and the NP contingent was also very aligned with the PAs on the vote for the change.
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PAs and NPs at UWMC, along with Certified Nurse Anesthetists and Certified Nurse Midwives, have recently joined forces and created a unified practice-focused group with the support and engagement of institutional physicians and administration. When I looked around the room and saw the strong support from our NP colleagues, it really moved me, and made me feel optimistic about the future of PA and NP collaboration.
I have also observed that PAs and NPs have often had slightly strained organizational relationships and that tradition is not completely absent at UWMC. I think these difficulties have a lot to do with the fact that PAs and NPs sometimes struggle at getting inside each other’s culture.
The PA profession was created by the once a male-dominated physician world. In fact, the PA profession was almost entirely male for many years. Of course this has changed dramatically, and there are now more female PAs practicing than male. In contrast, the NP profession comes from the nursing model and the NP workforce is still primarily female.
This gender gap between the PA and NP professions has not been an easy one to bridge, at least organizationally. Throw in the on-again, off-again tension about scope of practice for various groups, and it’s not hard to understand the challenges of integrating the two professions seamlessly. But honestly, who cares?
Both NPs and PAs have chosen this field because we love caring for patients and facing the challenges involved. As time goes on, I see PAs and NPs becoming more allied in ways that are exciting. There is so much more the two professions can do together, both here at the UWMC and across the nation, as the U.S. healthcare system hurdles toward massive changes.
Another reason PAs and NPs succeed at UWMC is because we are deeply connected to the physicians here, who clearly support our groups. There is an MD liaison for the group, an idea that I think is genius because it underscores the tone of the PA-NP mission — to integrate, not separate. We want to stand shoulder to shoulder with our physician colleagues and march together into what may be a wild and woolly next few years.
At the UWMC meeting where PAs earned admitting privileges, I not only felt proud of the NPs who were there, but also gratitude to the MDs and their progressive vision of what the future looks like. One word described the process best: unflinching. Our progress is the result of PAs, NPs and MDs standing together, looking squarely into the eyes of the future of American health care, and saying “We’ll be ready when you are.”
Jim Anderson, MPAS, PA-C, ATC, is chair of the American Academy of Physician Assistants Health Disparities Work Group, founder of Physician Assistants for Health Equity and faculty of the Department of Anesthesia and Pain Medicine at the University of Washington School of Medicine in Seattle.
