Physician assistants need a new name. Here's what it should be

By Peter A. YoungJune 2, 2023

I’m standing over an operating table, excising a skin cancer from the forehead of an elderly gentleman while soft piano music echoes off the floor tiles. I’ve performed this procedure thousands of times, and I always enjoy the placid focus and deep satisfaction performing cutaneous surgery brings me. All I’ve done in adulthood has brought me here: cadaver prosections in anatomy labs, mentorship from dermatologic surgeons, and mastering various knot-tying techniques. Suturing this wound also reminds me of my first exposure to the health care system at age 6, when a tall white man, who I presume was a doctor, repaired a laceration on my own forehead.

My patient's wife, seated in the corner, breaks the silence.

"You know, Peter, you could easily be a physician," she says.

"That is kind of you, but I am a physician assistant, which is very different," I reply.

"Why don't you go back to school, and become a full M.D.?" she asks.

"I actually still consider doing that, and would probably love it. The main reason I don't is that my patients need me," I tell her. I explain that becoming a physician would take me out of the workforce for at least nine years, but I already have the skills needed to care for many patients who are waiting months just to get an appointment for straightforward problems. If all optometrists (whom the American Medical Association considers non-physicians) went back to school to become ophthalmologists (M.D.s), there would be no one to perform routine eye care. Going to medical school would also require a break from my research and mentorship of medical students in scientific writing, which are both causing positive impacts to patient care.

Several times a week, I have similar conversations about what it means to be a physician assistant (PA). Having "assistant" on my name tag doesn't prevent me from serving patients; most couldn't care less about my title and just want someone willing and able to help. That said, I was intrigued in 2018 when the American Academy of PAs (AAPA) announced plans to change the profession's title, starting with a three-year investigation of alternative options.

Though I didn't strongly feel that a title change would help patients, it did seem like a worthy undertaking to address the common (and understandable) misperception that PAs merely "assist" physicians. A name change also seemed timely, given the potential for PAs to be confused with "assistant physicians," an innovative role for doctors who have yet to enter formal residency programs. Unfortunately, the AAPA fumbled this historic opportunity by limiting the agency of its members and selecting a new title ("physician associate") that ignores expert advice, clarifies nothing for patients, and offends the very professionals AAPA purports to be collegially "associated" with: physicians.

In 2018, the AAPA hired the renowned marketing firm WPP, which then investigated more than 150 potential new titles for the profession. As an AAPA member, I submitted suggestions to the organization's title change investigation, but never saw evidence that these were actually considered in WPP's process; the firm's proprietary research was never subjected to peer review like a scientific manuscript, nor published in any form. Most PAs, including me, know almost nothing of its contents, except what was summarized for AAPA members in a brief slideshow in 2021.

With WPP's research kept confidential, PAs weren't fully informed of how their membership fees had been used. AAPA members couldn't have made an informed decision regarding a new title even if given a vote in the ultimate decision — which didn't happen. Only the AAPA's national delegates, not the 168,300 PA members, were allowed to vote on the two final title options: "physician associate" and "medical care practitioner." This goes against the ethical principles foundational to our work: health care professionals are taught that knowingly withholding pertinent information precludes informed consent, and that doing so in the clinical setting constitutes unacceptable patient care. Obviously this principle applies to important society-level decisions as well.

In 2021, WPP recommended changing the PA title to "medical care practitioner." But because the majority (74%) of AAPA's 266 delegates wished to retain the PA acronym and a "halo effect" from having physician in the title, they rejected WPP's descriptive title and chose "physician associate" instead. Once the AAPA's decision was announced, several large physician organizations stated their opposition to the planned change, believing it would obscure the public from readily distinguishing PAs from physicians. One reason for this is, physicians already use the word "associate" widely, for example in reference to professors of medicine or partners of a private practice. Mutual consent of both parties is a prerequisite for sharing the neighborly type of relationship implied by the word "associate." This seems impossible so long as the AAPA continues to disregard physician perspectives on the matter, by pursuing legislative changes to legalize using the "physician associate" title in clinical settings.

It is understandable why some would argue that the original "assistant" title of PAs is outdated and confusing. When the profession was created in the 1960s, PAs were trained as an extra set of hands to "extend" the physician's mind by performing straightforward tasks for uncomplicated patients, and joining the field required only a two-year associate's degree.

Sixty years later, the average newly certified PA has about six years of university education and more than 5,200 hours of health care experience. Acceptance to PA school has gradually become more competitive over the decades, and bright people naturally want to use their faculties. Combined with our country's physician shortage, this may partially explain why PAs have gradually evolved from pseudo-technicians into clinicians who practice quasi-autonomously with physician supervision. But replacing the antiquated "assistant" misnomer with a nondescript euphemism will be equally confusing, just in novel ways that are unacceptable to M.D.s. This is clear in statements from the American Medical Association (AMA) and other physician stakeholders, who have pledged to stop the AAPA's title change from becoming legally recognized in government legislation.

I occasionally get a sense that some advocacy-inclined non-physician clinicians perceive eliciting negative reactions from the AMA as a sign of desirable, meaningful progress. There is historic precedent for this heuristic perception. For example, the AMA officially branded doctors of osteopathic medicine (DOs) "non-physician cultists" until 1965. DOs now represent 25% of U.S. medical school graduates annually; they have become an indispensable portion of the primary care physician workforce. But the AMA's statement on the AAPA's title change actually seems reasonable and fair to me: They openly state their commitment to team-based care, respect for the knowledge and contributions of all health professionals, and a simple desire for clarity in titles — which should be a top priority for everyone.

The AAPA defines PAs as "licensed clinicians who practice medicine in every specialty and setting," but the term physician associate literally means "person frequently in the company of physicians." Being curious about the meaning behind other occupations’ names, I analyzed and tabulated the word roots of 24 different health care professional titles using the Oxford English Dictionary. Twenty-three (96%) of these titles’ word roots were descriptive of the licensee's area of expertise, work duties, or both. PAs are the only health care professional whose title is not inherently descriptive of their daily activities or field of study, and which inherently self-defines in relation to a separate, distinct profession. The descriptive title recommended by WPP would have corrected this unique discrepancy.

Patients deserve to readily understand the qualifications of their clinicians based on the established, intuitive language principles which all other health professionals adhere to. So, I sent my analysis to the AAPA's national leadership. Unfortunately, I received no reply, aside from confirmation of receipt. When I submitted my analysis as a manuscript to the Journal of the AAPA, it was rejected for not being well-suited to their readers. Taking this as advice, I sought a broader audience and approached STAT.

To clarify the PA role and disambiguate us from physicians, PAs must adopt a self-descriptive title — just as all other health professionals have done. So far as I’m aware, M.D.s have no objection to the title of nurse practitioners. The meaning of the word "practitioner" is not inherently related to physicians; it is used by several professions which, despite using this word, are not mistaken for M.D.s. For example, dentists and attorneys are practitioners of dentistry and law, respectively. The word "allopathic" was originally popularized by homeopathic practitioners in the 1800s, as a pejorative term for mainstream physicians. But today "allopathy" is synonymous with the dominant form of medicine practiced by contemporary M.D.s, and is defined as "orthodox medical treatment or practice."

I propose that PAs and the greater medical community consider the title "practitioner of allopathy." This term literally translates from its word roots as "a person with practical knowledge of contemporary orthodox medicine." Practitioner of allopathy can also be abbreviated PA, and thus could easily carry forward the profession's existing brand. The "practitioner" title could also serve as an intuitive, understandable means of immediately disambiguating PAs from physicians, who are doctors of (allopathic) medicine.

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If the broader medical community became amenable to this term, I might explain it to patients as follows: "I am a PA, which stands for practitioner of allopathy. ‘Allopathy’ is a fancy word for the way modern M.D.s approach health issues. My role is somewhat like a nurse practitioner, but I am trained to think more similarly to physicians. I am supervised by doctors, whose longer training and deeper knowledge is often beneficial. For example, if your diagnosis is unclear, I can easily seek guidance from my supervising physician, to ensure that you receive only excellent care. You can call me Peter, or if you prefer, Mr. Young, PA Young, or Practitioner Young — all are acceptable ways to address PAs."

This alternative title succinctly and intuitively confers the role of PAs, disambiguates them from assistant physicians, and is concordant with the AAPA's professional definition. It might also facilitate more harmonious relations with some apprehensive physicians, with whom PAs are destined to share close quarters, and who may understandably be protective of their hard-won credentials. Pausing title change-related legislative efforts to explore further discussion between all stakeholders might serve everyone's interests.

Though some of my fellow PAs may perceive this opinion as holding back the profession's progress, I trust in the wisdom of Kurt Vonnegut when he wrote: "A step backward, after making a wrong turn, is a step in the right direction."

Peter A. Young is a certified physician assistant in Northern California. In 2022, he was named Dermatology PA of the Year by the Society of Dermatology PAs, the largest constituent organization of the American Academy of PAs. His opinions are his own and do not represent any organization.

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