Lifetime Achievement Award

Remarks upon receipt of the Lifetime Achievement Award from PAEA
October 27, 2017I am exceedingly grateful for this honor. I am especially pleased to be joined here at the table by my son, Geoffrey, by my daughters, Jennifer and Karen, by my sister, Lois, and her husband, Bruce. Also at the table are my long-time comrades, Fred Sadler and Greg Thomas, both of whom I’ve worked with for more than 40 years, and my more recent colleagues, Dawn Morton-Rias and Lori Konopka-Sauer of the NCCPA and the PA History Society.None of us ever does these sorts of things alone. There are many other partners over the years who might have been here. Some are now no longer with us at all. After all, I was a Young Turk when all of this began (for me: 51 years ago); now I’m just an old fossil.

Those of you who think you have your career planned out for you may well be mistaken. I certainly was. When I embarked upon academic medicine in 1966, I had no intention of doing what I ultimately did. I had been trained as a cardiologist in Boston, and was fresh out of the US Air Force where I did research on adaptation to a weightless environment in anticipation of the Apollo space missions. Then, life became a sequence of accidental encounters: the happenstance of being in the right place at the right time.

An unknown dinner companion: Upon joining the faculty at the University of Pittsburgh, I was selected as a Markle Foundation Scholar in Academic Medicine. My dinner companion at the first meeting I attended in October 1966 was Andy Wallace, the faculty member at Duke who had chaired the committee that approved the first PA program a year earlier. I had never encountered an idea that was as intuitively obvious in my life. My academic interest turned to issues of health care delivery.

An encounter with a former teacher: Three years later, I was presenting at a small research conference when I encountered a former faculty member who had just become the chair of medicine at the George Washington University. He was looking for someone to assume responsibility for ambulatory medical services in the new Division of General Medicine, funded by a special project grant from the Bureau of Health Manpower. He invited me to visit. Having been assured that I could develop a new clinical model that involved physician assistants, I moved to Washington, DC.

A meeting I hadn’t planned to attend: I was present at the last of the Duke conferences in April 1972 when I learned that the directors of PA programs would be meeting to consider a new organization to address common interests. I changed plans. I was there when the Association of Physician Assistant Programs was formed and Fred Sadler was elected president. He and I began planning a new nationwide national conference on “new health practitioners” the following year. That led to a lasting partnership between us. At that meeting in Wichita Falls, Texas, I succeeded Fred as president. Following a favorable tax ruling, together we visited foundations in New York, raising the equivalent of more than a million in 2017 inflation-adjusted dollars to establish a national office and recruit staff to serve both the Education Association and the Academy.

An unexpected proposition from a respected national leader: It was August 1974, the evening before the National Commission on Certification was formed and officers were to be elected. While sitting at dinner, John Hubbard, president of the National Board of Medical Examiners, suggested that if I were willing to be nominated for the presidency, he and other representatives would support me. Until then, it had not occurred to me; I had assumed that the AMA representative would be elected. We began to count. The next morning, bylaws were approved, and I was elected president of the new Commission.

Every one of these encounters has led to another chapter in my life. Now, here I am, receiving an award for a cascade of accidents. But in every instance where I seized the opportunity, I was assisted by people who knew more than I did, who were more diplomatic than I was, and were highly creative. I was fortunately able to find exceptionally talented people, who in turn became leaders.

I will share a piece of advice: One needs to be prepared to take advantage of opportunities that present themselves, however unexpected they may be. I used to keep a file of contacts with talented young people who had the promise of leadership. From that file, I was able to recruit Don Fisher to be the first CEO of both PAEA and AAPA and to recruit Dave Glazer to become the first CEO of the NCCPA. Moreover, I kept apprised of federal and foundation sources of funding for innovative programs and concepts — applying for some, and mentoring others to do the same.

As it turned out, most of the organizations I’ve worked with have done very well. That certainly has been true of the Physician Assistant Education Association. Last night at the dinner with the past presidents, I learned of continuous reinvention and yet another strategic plan. After 45 years — still full of energy.

I’m not at all sure I deserve this more than other early leaders I could name … but I’ll take it. Thank you.

Remarks upon receipt of the Lifetime Achievement Award from PAEA
October 14, 2016Thanks for this recognition.I am very humbled and very honored. I’m especially thankful to have my family present to share in this event. Especially my wife Kathy, who has been my partner in our adventures over the past four decades. Adventures that have taken us to the desperate conditions along the Thai/Burma border and to the majesty and unfortunate tragedy in the mountains of Nepal. Kathy — it’s been wonderful to share a life and to share a career.

Thanks also to my brilliant University of Utah PA Program colleagues. Thanks for allowing me the freedom to be creative and to be involved. Thanks to my friends and colleagues from across the country — thanks for your friendship, your mentorship, your support and encouragement over the years.

What we do as PA educators is vitally important in making the world a better place. As you are well aware, your students and graduates play an extremely important role, not only in caring for patients on an individual level but also by serving their communities, the nation, and our world as they improve the human condition by engaging in a myriad of service activities that improve the health of populations. There is a quote I like by President Woodrow Wilson that goes like this:

“You are not here merely to earn a living.
You are here to enable the world to live more amply
With a greater vision
With a finer vision of hope and achievement
You are here to enrich the world
And
You impoverish yourself if you forget that errand”

The PA profession has not forgotten this errand. I believe the PA profession embodies the sentiment conveyed in President Wilson’s message.

Our noble profession, now celebrating 50 years of healing and service, is unequivocally a resounding success.

Thank you for all that you do and thank you for this recognition.

Remarks upon receipt of the Lifetime Achievement Award from PAEA
October 2015Greetings everyone, and thank you! I can only begin to tell you how honored I am by this award — and especially to be its first recipient!I also congratulate and thank the PAEA Board for creating this award. At a time when the first generation of program directors, who are also PAs, retire or prepare to retire, this award recognizes the contributions that so many of us have made.This “first” award is also a symbol — and another example — of how many of us have spent our careers joining licensing boards, administrative committees, executive boards, committees or commissions where we were “the first PA,” or “the first woman” — or both!As part of this honor, I was invited to give a TED-style talk earlier in this conference about “Why I’ve Loved My Job.” In thinking about that, I realized that senior PAs, in talking about their career, often say “Who Knew?” Who knew where this career would take us? Who knew what massive challenges there would be? Who knew what opportunities would appear to influence health care access, social change, and innovations medical education? Who knew what experiences our families — and especially our children — would benefit from because we chose this career? And, as I look out at all of you here today, who knew of the many good friends we’d make because of our shared journey! I celebrate all of us!

When I became a PA, there were few role models and almost no women role models. If we expected women physicians to support us, we were wrong! They had their own battles to fight. We worked to gain acceptance from “the men,” meaning not just male physicians, but more importantly the men in our PA classes, some of whom thought that this was “their career” and “no women need apply.” Fortunately, in most places, that battle was quickly won and the PA career began to be seen as one where both men and women would personify our new role.

By the early-to-mid 1980s, PAs had acquired enough experience and advanced degrees to begin to take over the leadership of PA programs. For many of us, our first assignment was to
write our program’s federal grant that typically supplied up to 50 percent of the program’s income. We were scared to death! At that time, “the Feds” provided grant writing workshops to
advise grant writers about the rules for each specific grant program. In 1985, the program directors — including about 15 PAs new to the role — attended a grant workshop in St. Louis.
Before, during, and after the workshops, we gathered together and decided informally that we should collaborate with each other rather than compete with each other by writing grants with similar goals and sometimes even linked together with other grants being submitted. This strategy worked, and we moved forward in new networks and relationships as “peer mentors.”

Partially because of the GMENAC Report issued in 1981 predicting an “over-supply of doctors,” the debate began about whether we had not enough PAs or too many PAs. APAP decided to offer a series of workshops for presidents and provosts from institutions considering the development of new PA programs. We convinced some, we discouraged others, and we helped to create some strategic alliances between others. We even established PATH, our own consulting service (based on a similar structure in family medicine), to assist new and established programs in development or expansion.

When I was APAP president in 19✓, we were still a small organization housed within the AAPA office. We employed a half-time secretary, a retired federal employee who worked from 9:00 a.m. to 12:00 p.m. Eastern Time daily. In order to work together, I routinely called her at 6:30 a.m. Pacific Time. We were a totally volunteer organization in its strictest sense, with almost no money but a lot of great work to do!

As we grew, it became important for us to more clearly differentiate ourselves from AAPA.
Here’s my take on it: AAPA’s goal is to promote the profession and serve individual PAs. The work of APAP/PAEA is different. Not only are we an organization of programs rather than individuals, we exist to “Design the PA of the Future.” This includes not only curriculum development but also diversity initiatives, support for advocacy, outreach to health care systems, hospitals, and clinics, and the assessment of outcomes and quality.

Part of designing the PA of the future played out when several of us (Sherry Stolberg, Ed Sullivan, and myself) were asked by the W.B. Saunders Co. to create the first overarching
textbook for PAs. This was a significant risk for Saunders, however their risk paid off. Not only for themselves, but for other publishing companies that now offer a number of PA-specific titles. The three of us visited the W.B. Saunders offices in Philadelphia to try to learn how books are created. It seemed overwhelming! We decided that the best strategy was for the book to have input and chapters from multiple authors across multiple programs. Over 52 authors contributed to the first edition. The book also created publishing opportunities and experiences for faculty members who had never previously written for the public. The tradition of multiple authors has continued in newer editions.

As PAs became more visible in health care systems, PA educators were invited or appointed as representatives of the PA profession to federal and foundation committees and commissions. My own experience included serving on federal Advisory Committee to the National Health Service Corps, the Title 7 Advisory Committee, and the Primary Care Health Policy Fellowship.
I also served on the fourth Commission on Health Professions for the Pew Family Charitable Trusts, on the Macy Foundation Workgroup on Interprofessional Learning, and on Pew, Kellogg, and Rasmussen committees to support the creation of the new oral health profession, Dental Health Therapists. I know many of you have had similar experiences.
What we’ve done in these roles is to “work the room,” tell the story of PAs, and develop long-term connections with policy-makers, researchers, and other educators to improve access to care. My advice to you: If given the opportunity to serve on these types of committees or commissions, always say yes!

New opportunities and options now exist for PA faculty that were less developed in the past.
Individual PAs and some PA programs are involved in the international development of our role.
Students and young PAs, especially, view this growth as evidence of the value of PAs. While the original view was that PA programs (or their equivalents) should be identical around the world, there is now greater understanding that the flexibility of our career provides a model that can be adapted to an individual country’s health care needs rather than adopted as an identical duplicate of the US model. As the director of international affairs for the NCCPA, I’ve had the opportunity to provide technical support and develop networking relationships with the emerging PA profession in Canada, the UK, South Africa, The Netherlands, Mozambique, Australia, New Zealand, Ireland, and India. Who knew?

As educators, we’ve also led the way in creating the PA History Society. Reg Carter and I serve as historians for the organization, and we’re always looking for PAs to join us in our search for historical materials, research, and stories. Keep your eyes open for History Society-sponsored conference sessions and workshops to build a historian’s skill set. We invite you to join us as collectors, writers, researchers, and catalysts.

Finally, we can’t talk about the development of PAs (or the development of any new career) without talking about conflict! We’ve had a number of major conflicts, some of which continue. One “battle” was and is about degrees; first bachelor’s, then master’s, and now (for some of you) the doctorate. Currently, some conflicts are being played out in the Four Orgs’ structure. It is important that PAEA continue to be strong in these discussions.

As I close my remarks, I have some more personal thank yous to make. First I’d like thank my kids, Pirkko Terao and Dayan Ballweg. Pirkko is here today. I’d also like to specifically thank all of you who have served alongside me jointly as members of the profession’s boards, committees, and work groups. It was worthwhile work to do, but even more importantly we’ve become each other’s friends, peer mentors, and confidants.

Finally, I’d like to thank all of you for joining me in looking back on some examples of our joint accomplishments. As a teacher, I feel compelled to give you an assignment, and that is that you use this conference as an opportunity to develop interactions and relationships with at least five people you’ve never met before, outside your own program. Have fun! And again, thank you very much!