I’ve been a proud and engaged member of the American Academy of Physician Assistants since I graduated from PA school in 2000, and have found membership to be many things. One of those things is ”expensive,” and with the post-economic collapse of 2008 still nipping at the heels of all PAs, many have decided not to continue with AAPA membership.

I’ve been engaged in both state and national volunteer leadership for most of my time in the AAPA. I’ve always seen this kind of engagement as mandatory, as something new PAs are obligated to do to help pay back the PA pioneers who came before them such as Ruth Ballweg, Carl Fasser, Thomas Godkins, and the other thousands of PAs who sacrificed so much so others could join such an important profession.

For me AAPA membership has spanned the spectrum of emotions. It has been rewarding, exciting, challenging, exhausting, energizing, alarming and gratifying. As the deep baritone voice used to say during the introduction to ABC’s weekly program Wide World of Sports, “the human drama of athletic competition” –  the AAPA captures all of that and then some.

Current and former AAPA members have watched, and even jumped up and down and hollered from time to time, as a disconnect between membership and leadership has grown. This rift is reflected by an annual voting rate of less than 10% among members when choosing the AAPA Board. Many current and ex-members who support a title change for PA professionals to “Physician Associate,” have felt ignored for years about this and other related issues.

Other members have described concerns about “leather-chair-itis,” a mysterious and apparently dissociative condition, which sometimes strikes leaders as soon as their derrière hits the leather seat in swanky board rooms, often leading to hearing loss and voice amplification. And meanwhile, the AAPA Board has struggled over the last several years to find the right balance between action and reflection, particularly related to the board’s occasionally rocky relationship with the AAPA House of Delegates.

Some members are voting with their feet and simply walking, at both the state and national levels. They’ve had enough, and I’ve had colleagues advise me to do the same.

Growing and functioning, as a large and representative organization is tough work, like being in a family, a marriage or other intimate relationship. And learning to offer, receive and embrace civil, honest and respectful disagreement is extremely challenging.

But as PAs, we don’t have the time or the luxury to personalize every organizational disagreement that comes down the pike. Every single PA who steps forward across the line and says, “You know what? I’m in,” does so, because they believe this crazy idea of a new kind of medical practitioner, just decades old, might just be able to save our massively unstable healthcare system and the patients we serve.

Every single PA who busted their butt to find a way to borrow tens of thousands of dollars, work two jobs, keep their families happy or at least together during the emotional mayhem that is PA school, every single one did so because they want to be part of a solution, because they care about patients who no else cares about, and because they saw in the PA profession a place they could excel, network, heal, comfort and nurture injured, wounded and ill humans of all stripes. They saw a place in this profession that they thought they could call home.

One of the reasons that this profession exists to allow us in is because of those who came before us  –  the Fassers, the Ballwegs, the Cawleys and the Robinsons. And in my mind, it really comes down to this: If you want to be a PA, engagement in state and national membership is not optional. It’s required.

When potential PAs express ambiguity about becoming involved in professional advocacy, when they say, “I’m really not political, I just want to treat patients,” we should be saying to them with great respect and civility, “My friend, this profession is probably not for you.”

If we are not personally and professionally tough enough to stand shoulder-to-shoulder and face-to-face and share with each other our visions of where our profession should go, disagree freely and openly, as any strong family needs to be able to do, then we are probably in the wrong line of work.

Out of free and open discussion comes innovation – ideas that did not exist until two people shared opposing visions. It’s called synthesis, fusion and symbiosis. It is what we have been trying to get right for over four decades, and it may take four more to nail it down.

Have we perfected it yet? Not hardly. But now’s not the time to quit. Millions of patients are counting on each of us, and counting on the AAPA to keep working, keep sharing, keep disagreeing, keep honoring, keep recognizing and keep listening to each other.

If we fail, if we quit and if the AAPA goes away, we also fail ourselves and our chance to be part of an American healthcare system that once and for all will be able deliver on its promise of providing equal access to healthcare.

So when a PA colleague says to me that maybe it’s time to throw in the AAPA towel, maybe it’s time to give up on this idea of a national association that represents 100,000 PAs, I will respectfully and civilly say, “I disagree with you.”

I’m still a member of the AAPA. I’m in today, I will be in tomorrow, and I will continue to be in until the day I can no longer write a check. I’ll take the twists and turns, the unknowns and the annoyances, because the patients, the very reason we became PAs, still need me, need our profession and need our association – now more than ever.

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.