The past year or so has seen a virtual explosion of new or renewed interest in the perennial PA name-change discussion. Last year, 100 PA leaders signed a document calling for the profession to change its name to physician associate. This year, more than 5,000 PAs signed an online petition to the American Academy of Physician Assistants (AAPA) calling for the change. Some advocates have taken up the issue on blogs and online discussion forums; even YouTube has videos about this issue!
This is not a new debate, so one must ask why it suddenly became important again. Many have referred to the lines in Shakespeare’s Romeo and Juliet in which Juliet says, “’Tis but thy name that is my enemy…. What’s in a name? That which we call a rose by any other name would smell as sweet.” In other words, a name is an artificial and meaningless convention.
Is this, in fact, analogous to the PA name-change debate? Is it less important what we are called and more important what we do? Or is it both? This certainly lies at the core of our debate. One must ask, as in this case, how a name influences a person’s character and/or profession. Is it just sound and alphabetical symbols? Or is it the intellectual embodiment of who we are? One would think the answer is obvious.
Nevertheless, for the past three or four years, I have remained on the fence regarding this debate. I have been apolitical, except for the occasional comment to close friends that I thought the debate was a colossal waste of time. As with a lot of ideas, however, timing is everything, and I have now come to the realization that the time has come. I have changed my mind. With apologies to my NP colleagues for being so PA-centric in this editorial (although I welcome your comments) and at the risk of alienating some of my close professional friends, I have decided to speak openly and share my thoughts in support of change.
Having been in the profession almost four decades, I have witnessed significant changes in the PA scope of practice, including subtle transitions in the relationship between PAs and their supervising physicians (all positive, I might add). The word assistant may have worked well in the 1970s and ’80s, as we were defining the profession and not wanting to step on the toes of organized medicine. But as PAs became integral members of the health care team, this nomenclature paled.
In fact, the debate is not really for a wholesale name change but for a name modification to provide clarity to our physician colleagues, our patients, regulators, third-party payers, and our current and future students. While many suggest the name-change debate is very egocentric, I actually think we owe it to everyone else to settle this question.
Let me review the issues as I see them, albeit editorial in nature, and share my comments. I do this while sharing what I call the four “Laws of Nature” that I have used in decision-making.
The Law of Perception: People tend to think that in the marketplace of ideas, services, or products, the best will win. However, as Ries and Trout say in their book The 22 Immutable Laws of Marketing, “Marketing is not a battle of products; it’s a battle of perceptions.”1 It has been said that perception is reality—everything else is illusion. While this concept seems unfair, it is fundamental, and we might as well get used to it.
If indeed, as many have suggested, the term assistant does not describe what PAs do, and the public (ie, patients) has trouble understanding the distinction between physician assistant and medical assistant, then we have a perception problem. And thus, we also have a reality problem. I’m not sure that the old solution—throwing more money at public education to redefine or further explain the term assistant—will yield much reward. In fact, it may only further confound the situation if we wind up convincing the public that their medical assistant can do what PAs do.
The Law of Focus: Again, according to Ries and Trout, the most powerful concept in marketing is owning a word or a phrase.1 Once a word or phrase is ingrained in the mind of the public and is associated with a product (or in this case, a profession), it becomes an incredible success. Nurse practitioners have accomplished this with their name. There are few people I have met who do not understand what an NP is or does. The same is true for RNs and physicians and attorneys.