As my fellow PA students and I compared notes after our first cadaver dissection session with our medical student colleagues here at Stanford University, we discovered that more than a few of us had fielded slightly abashed questions from our MD student counterparts along the lines of, “So, what exactly is a PA?”
The opportunity for the question arose because Stanford University School of Medicine has a unique arrangement for its PA training program, which underwent a complete transformation in recent years to become integrated into the medical school, rather than operating as its own distinct entity.
There are compelling reasons for doing this. Stanford has a state-of-the-art medical simulation training lab, a world-class cadaver lab, dozens of high-tech classrooms and all of the other amenities anyone could ever want. Rather than training PAs in a less-resourced separate entity, we’re brought together with our MD student colleagues from the first day of orientation. In our first term, we take gross anatomy, embryology, histology and clinical skills together. We work alongside each other as we practice our introductions on our first day with standardized patients — “Hi, I’m Sophi Scarnewman, and I’m the PA student on your care team today.” We give each other feedback as we learn to take a history and complete a physical exam. In mixed groups of six students in the anatomy lab, we work together over the cadavers, taking turns with the bone saw and the scalpels.
If all you looked at were the bulletins from the AAPA and the AMA — and, if you really loved to punish yourself, the comments sections on social media — you might have the impression that physicians and PAs are deeply skeptical of one another, two competing professions with a mutual disregard. But you would be wrong. At Stanford University School of Medicine, we prove the opposite, every day.
I didn’t see myself in medicine in college, and I satisfied my undergraduate science requirement with an astrophysics-for-non-majors class. I worked on a tech team at Google when I graduated from college, serving in a role that was a dream job — for someone else. I hated it. I broke down, I quit and I took a beat to decide what to do next. I wanted to do something with immediate, profound meaning. I wanted to work closely with women. And I didn’t want to go to grad school just yet. I became a birth doula, which was incredible. I found that my favorite part of it was the medicine. I loved the anatomy, physiology, pharmacology and all the rest of it. In a room full of doctors just five to ten years older than I was, I felt like I was meant to be part of their cohort. I loved working with my clients, but I felt like I should be in the scrubs, assessing and planning.
I didn’t want to be a doctor, but I knew I wanted to become a healthcare provider. Getting that far along the decision tree was easy enough. I have bipolar disorder, and I was pregnant with my first child. Between those two factors, I couldn’t see how I could get through residency without having several mood episodes and being away from my child more than I could bear to be. And all that aside, I was going to need to take a year of biology, math, physics, chemistry and organic chemistry apiece, plus the MCAT. If I was realistic, with all of my competing responsibilities, it was going to take three years at least. Then I would apply, and then it would take another year to start if I were lucky enough to get in on the first round.
Looking back now, the funny part is that I don’t think I saved much time even after picking the PA path. It still took two and a half years to do my prerequisites, from August 2017 to June 2020, and I didn’t end up starting my program until August 2021. But the PA path has been the one for me from the start, even when it hasn’t been easy. Becoming a PA meant dedicating at least 1000 hours to working in healthcare to gain experience in the field, a hard-and-fast requirement for just about every program out there. It means taking many of the same basic science prerequisites in chemistry and biology that MD/DO programs require, but with additional requirements in anatomy, physiology and microbiology.
So it was that I showed up for my first day of orientation at Stanford Medicine a few weeks before I turned 30, fresh off of two years in administration at a community clinic, 1 year of emergency department scribing, one year of birth doula-ing and a master’s degree worth of prerequisite credits spread throughout a few years. My son was about to turn five, and he picked out a blue suit to wear to my White Coat Ceremony at the end of orientation week.
Part of what I love so much about the PA profession is that it so readily accommodates not only career-changers like me, but also those who have had to climb steeper hills than some others. I count among my brilliant classmates many students who attended community college and transferred to state universities for their Bachelor’s degrees. It’s good that it isn’t easy to become a healthcare provider because what we do is so consequential for the lives of others. But it may be a bit too hard, to the point of being exclusionary. The PA profession was developed in the 1960s in response to Army medics and Navy corpsmen returning home from Vietnam with advanced medical training and no way to put their skills to use. PA school was envisioned as an accelerated medical school, building off of experience students had going in and focusing on adaptability and care gaps. And I think my classmates embody that ideal so much — those who come in with a tremendous amount of experience that may not always be appropriately recognized by academic power structures.
Even though we don’t spend as much time together academically with the MD students as we did in the first term of our training, we still take our clinical skills class and our electives together. Many of us have friends across programs, and we know each other’s names. We run interest groups and student associations together. I’ve never once felt dismissed on the basis of being a PA student. I imagine not everyone has had such uniformly welcoming experiences, and I have to say that sometimes it can be a bit of an uphill battle. It feels like we remind people over and over that we exist, like event speakers who address everything to the “future doctors.”
For the pre-clinical phase, we’re partners. For us PA students, the full-time clerkship year features several end-of-rotation exams and culminates after graduation in our licensing exam, the PANCE. From there, we’ll go out into the working world. I don’t envy the USMLE-triple-whammy of medical education or the stress of residency matching. But I’m so glad that there are people out there who have made that choice, who are going to put themselves and their partners and families through those challenges because healthcare teams need physicians. We need those experts, those visionaries, those leaders. I want to work with people like my MD classmates someday.
PAs play an important role, too. There’s no shortage of work that needs to be done in healthcare, and PAs are ready and willing to make it happen. We take care of patients in the hospital in every setting. We’re primary care providers and outpatient specialty providers. Primary care PAs and outpatient specialty PAs often have their own panels, consulting with a physician as appropriate. PAs see surgery patients pre- and post-operatively so that the surgeon, with all their hard-won expertise, can operate on more patients. ER PAs sew lacerations, diagnose and treat extremity injuries, take care of all manner of febrile children and step up to address higher-acuity cases as needed. We’ve been on the front lines of the COVID-19 pandemic from day one.
Permutations on these and similar patterns are found throughout the healthcare system. There are care shortages in every specialty, and PAs help to fill those gaps by working as a team with physicians and other key contributors like nursing, social work, occupational and physical therapy, dieticians, and more. Sometimes I can hardly believe that a few years of training will equip me for my role, but by how grueling things are as a preclinical PA student and how high the expectations are of my performance on my clerkships are, I am reassured that the reason our profession has persisted for all these decades is that PA training will prepare me. I don’t expect to start my first post-grad job knowing it all. Rather, I’ll go in hungry to learn anything and everything I can to serve my patients and support the care team. We improve the system for everyone, patients and physicians alike.
So what do I want you to know? I want you to know that your PA colleagues are always eager to learn and to teach. Some of us are new to our specialities, and others have decades of experience. I want you to know that we are people who chose a profession that gave us a way in when other doors were closed, or much harder to open. I want you to know that we are drawn to medicine for those same reasons that bring us all toward it: the chance to make a difference, to relieve suffering, to witness and to heal. Don’t get tripped up on the name. We’re not assistants, we’re partners in care.