FINALLY AAPA is starting to get it

[Guest Paula]

There was an article about the title change history and the story is that when the "Associate" title was proposed the AMA was notified and asked their opinion of the title.  There was no response so the title was patented and the first journal was published,  The Physician's Associate Journal.  The cover of the journal is on the PAHX site and also pictures of the emblem worn on the sleeve of PAs that says Physician's Associate.  After about a year and a half the AMA decided they didn't like the title and they thought we would be confused with Physicians.  

 

You can read all about it in the PA Professional publication, January 2012  pp. 26, 27, written by Dr. Thomas Piemme and Dr. Alfred Sadler, Jr. 

 

Every PA should read this article as it would enlighten everyone as to the stronghold the AMA had over the PA Association.  I suppose we can forgive the AAPA for buckling to the pressure of the AMAs Board of Trustees who issued a statement against the term Associate as they were a young organization.

 

  The one person who was an ardent defender of the term "associate" was Dr. Robert Howard, Director of the Duke PA program.  The authors of the article at the time of writing felt the term assistant  was a well recognized brand within the health professions.  

 

Here is the last paragraph of the article:

 

"More important, the factors that motivated the change in 1971 no longer exist.  "Physician assistant" has become a virtually exclusive and well-recognized brand within the health professions and among the public.  It is universally licensed in all jurisdictions.  In our view there is  nothing remotely demeaning in the name.  Let's all continue to embrace it proudly. "

 

 

Does anyone see the irony in that last statement given the title of the authors?

[ventana]

https://aapa.org/WorkArea/DownloadAsset.aspx?id=3066

 

This is what we need A LOT more of!!

[ventana]

August 12, 2014

Honorable Ron Wyden Honorable Charles Grassley

US Senate US Senate

221 Dirksen Senate Office Building 135 Hart Senate Office Building

Washington, DC 20510-3703 Washington, DC 20510-1501

Dear Senators Wyden and Grassley:

On behalf of the more than 95,000 clinically practicing physician assistants (PAs) represented by the American 

Academy of Physician Assistants (AAPA), thank you for the opportunity to submit comments to your letter to 

stakeholders regarding greater healthcare data transparency. AAPA applauds your ongoing efforts to enhance the 

availability and utility of healthcare data.

Healthcare data transparency is an important tool in our quest to provide effective and efficient high quality 

healthcare to all Americans. PAs play a special role in the healthcare system. Understanding the benefit that PAs 

provide not just to their patients, but to the healthcare system overall and the Medicare program specifically will help 

us move towards our greater goal of providing Americans with access to effective, efficient high-quality healthcare. 

Unfortunately, the Medicare program’s outdated practices hide critical information about the quantity and quality of 

care provided by PAs to Medicare beneficiaries. Information about medical care provided by PAs will become 

increasingly important as the healthcare system moves towards a model that relies more on team-based delivery of 

care, requires evidence-based clinical benchmarks, and demands reliable and accurate patient data. As such, 

AAPA’s comments are specific to the need for increased transparency of the medical care (and cost of care) 

provided by PAs through the Medicare program, and promote recommendations such as adding a billing modifier 

for medical care provided by PAs that could, with greater accuracy, establish a baseline for future Medicare 

payment models and improve our understanding of how we spend our Medicare dollars to improve healthcare 

delivery. 

AAPA asserts that greater transparency of data regarding medical care provided by PAs will improve understanding 

of the healthcare delivery system and may be achieved by –

 Modernizing reimbursement practices to reimburse PAs directly for patient care in the same manner as all 

other Medicare providers

 Requiring a billing modifier(s) for medical care provided by PAs that would distinguish specialty care 

provided by PAs, as well as PA involvement with physicians in incident to and shared visits

 Encouraging private insurers and third party payers to adopt standards of transparency and accountability 

by identifying PAs when they deliver care to patients. Enrolling and credentialing PAs along with the use of 

appropriate modifier codes for tracking purposes will enhance the availability of healthcare data for meeting 

quality and outcomes metrics which will lead to improved care

 Permitting PAs, like other primary care providers reimbursed through Medicare, to order and provide 

hospice and home healthcare for their patients and to be held directly accountable for the care they order The Honorable Ron Wyden and Charles Grassley

August 12, 2014

Page Two

and provide, eliminating the current practice of requiring physician certification for hospice and home 

healthcare, durable medical equipment, and hospital admissions.

AAPA believes these modernizations will provide greater transparency of medical care provided by PAs, benefitting 

healthcare consumers, healthcare systems, policymakers, and the PA profession. The ability of PAs to be held 

directly accountable for the care they order and provide holds great promise for adding greater efficiency to the 

healthcare system by eliminating unnecessary steps and costs for medical care when a PA is the patient’s principal 

healthcare professional and manages the medical care. Identifying the care provided by PAs to Medicare 

beneficiaries is important as we work to improve the Medicare program. 

Current Law 

A relic of a bygone era, Medicare reimbursement for medical services provided by PAs is restricted to the PA’s 

employer. (Reimbursement may also be made to a PA-owned, federally certified rural health clinic. See SSA § 

1842(b)(6)©). This payment restriction to the PA’s employer limits the efficient provision of care, restricts the 

business arrangements in which PAs practice, creates barriers to care in medically underserved communities in 

which PAs own medical practices, and prevents transparent tracking of the volume and quality of medical and 

surgical services provided by PAs through Medicare. Improving PA reimbursement procedures will not change the 

current reimbursement schedule or increase costs to the Medicare program, but it will align the recipient of the 

reimbursement with the actual healthcare provider to the benefit of the broader healthcare system. 

History of PA Medicare Reimbursement 

The historical development of Medicare reimbursement procedures for PAs has obscured the value and quality of 

the care provided by PAs to Medicare beneficiaries. Medicare coverage of physician services provided by PAs was 

first authorized in 1977 through the Rural Health Clinic Act. The PA profession was very young at the time --

approximately 10 years old. Early PA practice laws required the supervising physician to be the PA’s employer. As 

a result, the Medicare statute required that reimbursement for the medical care provided by PAs be made to the 

PA’s employer.

As the need for providers and the understanding of the PA profession expanded, Medicare coverage of medical 

care provided by PAs was also gradually expanded to include medical services in Medicare-certified health 

maintenance organizations (1982); services provided in skilled nursing facilities, hospitals, and assisting at surgery 

(1986); and services provided in rural health manpower shortage areas (1987). In 1997, Congress authorized 

coverage of services provided by PAs, as allowed by state law, in all settings, and at a uniform rate. Unfortunately, 

barriers still remain. 

As the profession has matured, PAs have moved from physicians’ outpatient clinics into hospitals, group practices 

and other business entities. Today, PAs are employed across the spectrum of medical settings and typically 

practice with physicians who are not their employers. State practice laws also have expanded the role of PAs, and 

many states have passed laws allowing PAs to own medical practices. In states that permit PAs to be sole owners 

of a medical practice, a PA-owned practice entity can structure its relationship with an employed or contracted 

physician in a manner that preserves the role of the physician as clinical supervisor. In many of these clinics, 

particularly in rural areas, the physician may be available electronically, rather than physically, for consultation. 

Improvements for a Modernized Medicare Payment System

1. Modernize reimbursement practices to s directly for patient care in the same 

manner as all other Medicare providers.

2. Permit PAs, like other primary care providers reimbursed under Medicare, to order 

and provide hospice and home healthcare for their patients. The Honorable Ron Wyden and Charles Grassley

August 12, 2014

Page Three

Not a single state law currently links the role of a PA’s supervising physician with a PA’s employer. However, the 

Medicare statute continues to require that payment for medical care provided by PAs be made to the employer or to 

a PA owner of a federally certified rural health clinic (RHC). Neither does state law restrict a PA from ordering and 

providing hospice and home healthcare. The Medicare payment restriction linking reimbursement to the PA’s 

employer is not imposed on any other healthcare professional authorized to provide medical care through the 

program, including physicians, nurse practitioners, psychologists, clinical social workers, speech and language 

pathologists, dieticians, physical therapists, etc. In the case of ordering and providing hospice and home healthcare, 

Medicare imposes barriers on access to care provided by PAs that do not exist in state law. These anachronistic 

practices hide the value and quality of care provided by PAs to the Medicare system and inhibits the potential for 

greater delivery system reforms that rely on the coordinated team-based delivery of care.

Modernizing the Medicare Payment System to Improve Health Care Data and 

Transparency

We can improve transparency and patient care and remove outdated barriers by:

 Amending Sec. 1832(a)(2)(B) to add the services of a physician assistant; and 

adding a conforming amendment by amending Sec. 1842(b)(6)(3) to clarify that 

payment may be made to the physician assistant, the employer of the physician 

assistant, or the physician assistant owner of a rural health clinic

 Adding a billing modifier for medical care provided by PAs

 Encouraging private insurers and third party payers to adopt standards of 

transparency and accountability by identifying PAs when they deliver care to patients. 

Enrolling and credentialing PAs along with the use of appropriate modifier codes for 

tracking purposes will enhance the availability of healthcare data for meeting quality 

and outcomes metrics which will lead to improved care

 Amending Sec. 1814(a)(7)(A) to permit PAs to order hospice care

 Amending Sec. 1861(dd)(3)(B) to provide authority to PAs to provide hospice care

 Amending Sections 1814(a), 1835(a), 1861(m), 1861(o)(2), and 1895 to allow PAs to 

order home health services

 Eliminating third party certification requirements for medical care provided and/or 

ordered by PAs.The Honorable Ron Wyden and Charles Grassley

August 12, 2014

Page Four

Conclusion

PAs have been part of the healthcare workforce for almost 50 years. As experience with PA team practice grows, 

laws are being modernized to reflect the current understanding of the broad scope of high quality medical care 

provided by PAs and the growing need for quality providers. Adopting best practice language into laws and 

regulations enables PAs and physicians to extend care to patients more effectively. Additionally, any time PAs are 

treated differently, it creates a disincentive in the healthcare marketplace to utilize PAs. Updating Medicare’s 

payment system to treat PAs the same way as all other healthcare providers will enable greater access to the 

quality medical care provided by PAs, particularly in medically underserved areas; allow for greater flexibility and 

efficient utilization of PAs, and provide for increased transparency regarding the medical care, cost, and outcomes 

of covered Medicare services provided by PAs.

AAPA looks forward to working with you in your efforts to expand transparency of Medicare healthcare data, as well 

as in creating greater efficiencies in Medicare’s healthcare delivery system. Please do not hesitate to have your 

staff contact Sandy Harding, AAPA senior director, federal advocacy, at 571-319-4338 or sharding@aapa.org for 

additional information on the PA profession and AAPA’s comments. 

Sincerely yours,

John McGinnity, MS, PA-C, DFAAPA

[KMD16]

Wondering if there was ever a response or follow-up.

[burnpac]

There was an article about the title change history and the story is that when the "Associate" title was proposed the AMA was notified and asked their opinion of the title.  There was no response so the title was patented and the first journal was published,  The Physician's Associate Journal.  The cover of the journal is on the PAHX site and also pictures of the emblem worn on the sleeve of PAs that says Physician's Associate.  After about a year and a half the AMA decided they didn't like the title and they thought we would be confused with Physicians.  

 

You can read all about it in the PA Professional publication, January 2012  pp. 26, 27, written by Dr. Thomas Piemme and Dr. Alfred Sadler, Jr. 

 

Every PA should read this article as it would enlighten everyone as to the stronghold the AMA had over the PA Association.  I suppose we can forgive the AAPA for buckling to the pressure of the AMAs Board of Trustees who issued a statement against the term Associate as they were a young organization.

 

  The one person who was an ardent defender of the term "associate" was Dr. Robert Howard, Director of the Duke PA program.  The authors of the article at the time of writing felt the term assistant  was a well recognized brand within the health professions.  

 

Here is the last paragraph of the article:

 

"More important, the factors that motivated the change in 1971 no longer exist.  "Physician assistant" has become a virtually exclusive and well-recognized brand within the health professions and among the public.  It is universally licensed in all jurisdictions.  In our view there is  nothing remotely demeaning in the name.  Let's all continue to embrace it proudly. "

 

 

Does anyone see the irony in that last statement given the title of the authors?

Paula,

 

Thanks for sharing this vital piece of history about the foundations of our profession. Let's put things into perspective.

 

In 1971 (when the corporate title was changed to "associate"), there couldn't have been more that a handful of PAs in existence, four short years after the "six" graduated from the Duke program.

 

In 1973 (when the corporate title was changed back to "assistant"), six years after the inception of the PA concept, there was likely only 100-200 PAs in the entire nation (I have been unable to pin down the exact amount in the historical documents). 

 

The profession exists because of a few visionary physicians, physicians, who advocated for us and fought all the meaningful battles on our behalf at the inception of our profession. We had literally no power at that time. We wouldn't be here today unless we worked with those physicians, who expended significant political capital on our behalf fighting for us within traditional medicine and against a lot of opposition from organized nursing and others. Is it any wonder or surprise to some that we have worked with organized medicine over the decades, and have a special affinity for our physician colleagues who were there for us at the birth of the profession?

 

Our PA leaders at the time, representing not much more than a concept, and a handful of PAs, did what they had to do for survival. the 100,000 PAs in practice today exist because of a few visionary physicians who believed in us and our potential, and convinced their colleagues of our value. We exist today because of the efforts of the PA leaders at the time doing what they had to do to ensure our future and our profession. The proof is in the pudding.

 

While we have to chart our own course now, let us never forget from where we come, and how we came into being.

[andersenpa]

Ventana,

 

If your only criteria for messaging success is referencing physician assistants as "PAs", then I understand why you feel the way in which you do.

 

Things like the C-Span interview don't just occur in a vacuum. Having worked in both leadership and as a media spokesperson at a variety of levels, I know first hand how much gritty, behind the scenes ground work that it takes to get to this point.  Your mileage may vary....

Well, Steve, c'mon...

The AAPA dogma for YEARS has been "providing health care services"..."under the supervision of a doctor"....etc....That has been their public descriptive for a long time.

 

McGinnity came out of the gate with "PAs practice medicine". Good on him!

 

The way the AAPA got on CSPAN may certainly be due to the years of groundwork that you mention- and kudos for that.

 

But the CONTENT is a welcome change. Practicing medicine. Collaboration. All the things we need out there.

 

No need to knock this altogether though. This was a great PR piece for us on a premier news outlet. McGinnity did a great job.

 

My only critique was I wish a PHYSICIAN had called in- either as a supporter or detractor, it would have been good to hear that exchange.

[andersenpa]

This is a summary I wrote several years ago with info from the PAHx site:

 

Associate Name History

 

The terms assistant and associate had been used when the first programs were being developed. It has been noted that the AMA was one of the first, if not the first, to use the term “assistant”.

 

Early PA programs had significant variability in length, faculty credentials, type of facility housing the program, training modalities, and demographic of students admitted. In 1970, the National Academy of Sciences created a ranking system for PAs (A, B, and C) ranked ”according to their degree of specialization, level of clinical decision-making (judgment) and length of training”. Later that year, leaders of three PA programs- U Texas, Wake Forest (then Bowman Gray), and Duke, founded the first Registry – the American Registry of Physician Associates (somewhat of a hybrid of the AAPA, NCCPA, and PAEA).

 

The purpose of the Registry was to encourage the training and to promote and regulate the activities of Physicians' Associates by determining their competence through examinations and investigative studies. It would grant and issue certificates to graduates of approved educational and training programs and to others who demonstrated by examination that they possessed the background and experience to perform satisfactorily as graduates of approved programs. Duke University and several other programs had changed their name from “assistant” to “associate” to distinguish their programs from the Type B and C programs and the term associate became embedded into the newly incorporated organization’s name.

 

The registry chose the term associate due to its greater applicability to what PAs do, as well as the fact that the term “assistant” was “totally generic”. It was after the programs formally adopted the term “associate” that the AMA took a stance. It should be noted that this was well after multiple attempts over the years to get the AMA in at the ground level in defining and regulating the PA profession (according to records the requests “fell on deaf ears”).

 

In 1972 the Association of Physician Assistant Programs was formed as an “umbrella organization” over the Registry. In 1973 the Registry was placed under the American Academy of Physician Associates.

 

The AAPA is the result of a merger of 4 separate organizations who were vying to be the national representative body for PAs. The original organization which became the AAPA as we know it today was the American Academy of Physician’s Associates. Now, recall how the AMA was an early proponent of “assistant”? Part of the equation which led to the American Academy of Physician’s Associates becoming the representative organization was its alliance with the AMA, which also included a focus on accepting PAs with a primary care focus (MEDEX was named specifically). One must wonder if the AMA affiliation prompted the change in the organization’s name.

 

So when we talk about what our original title is, we can ask- are we are talking about the origins of our profession as an organized and accredited body.

 

The formative years for our profession were a stew of ideas and terms, from which several more definitive terms arose. The key concept is that the core of individuals, organizations and programs which founded the profession dealt with the same identity issues we face now.  As PA programs, assistant programs, of dubious quality and credentials were cropping up, they quickly realized that a term was needed to define our true role. It is interesting to note that many of those early proponents of “Associate” were the physicians who led the way for future PAs.

[Guest Paula]

@Steve...like I said....we can forgive the AAPA for their inability to stand up for the title Associate since it was  a young organization back then......

 

BUT now.....jeesh....there has got to be a better solution for us than to be assistants forever.

 

IF PAs could bill separately under our own NPIs for ALL insurance companies, recognized by CMS as full and separate medical practitioners as physicians, nurse practitioners,etc, get all state restrictions removed that set up artificial barriers, delete dependent status and supervised from laws and recognize the PA profession as one that is a professional medical specialty in its own right, yet collaborative with other medical practitioners, THEN the title PA (assistant) might be a pill I could swallow. 

 

Hind sight is 20/20.  Time to stop looking at our petutties. 

[burnpac]

This is a summary I wrote several years ago with info from the PAHx site:

 

Associate Name History

 

The terms assistant and associate had been used when the first programs were being developed. It has been noted that the AMA was one of the first, if not the first, to use the term “assistant”.

 

Early PA programs had significant variability in length, faculty credentials, type of facility housing the program, training modalities, and demographic of students admitted. In 1970, the National Academy of Sciences created a ranking system for PAs (A, B, and C) ranked ”according to their degree of specialization, level of clinical decision-making (judgment) and length of training”. Later that year, leaders of three PA programs- U Texas, Wake Forest (then Bowman Gray), and Duke, founded the first Registry – the American Registry of Physician Associates (somewhat of a hybrid of the AAPA, NCCPA, and PAEA).

 

The purpose of the Registry was to encourage the training and to promote and regulate the activities of Physicians' Associates by determining their competence through examinations and investigative studies. It would grant and issue certificates to graduates of approved educational and training programs and to others who demonstrated by examination that they possessed the background and experience to perform satisfactorily as graduates of approved programs. Duke University and several other programs had changed their name from “assistant” to “associate” to distinguish their programs from the Type B and C programs and the term associate became embedded into the newly incorporated organization’s name.

 

The registry chose the term associate due to its greater applicability to what PAs do, as well as the fact that the term “assistant” was “totally generic”. It was after the programs formally adopted the term “associate” that the AMA took a stance. It should be noted that this was well after multiple attempts over the years to get the AMA in at the ground level in defining and regulating the PA profession (according to records the requests “fell on deaf ears”).

 

In 1972 the Association of Physician Assistant Programs was formed as an “umbrella organization” over the Registry. In 1973 the Registry was placed under the American Academy of Physician Associates.

 

The AAPA is the result of a merger of 4 separate organizations who were vying to be the national representative body for PAs. The original organization which became the AAPA as we know it today was the American Academy of Physician’s Associates. Now, recall how the AMA was an early proponent of “assistant”? Part of the equation which led to the American Academy of Physician’s Associates becoming the representative organization was its alliance with the AMA, which also included a focus on accepting PAs with a primary care focus (MEDEX was named specifically). One must wonder if the AMA affiliation prompted the change in the organization’s name.

 

So when we talk about what our original title is, we can ask- are we are talking about the origins of our profession as an organized and accredited body.

 

The formative years for our profession were a stew of ideas and terms, from which several more definitive terms arose. The key concept is that the core of individuals, organizations and programs which founded the profession dealt with the same identity issues we face now.  As PA programs, assistant programs, of dubious quality and credentials were cropping up, they quickly realized that a term was needed to define our true role. It is interesting to note that many of those early proponents of “Associate” were the physicians who led the way for future PAs.

Matt:

 

One small problem with the details. The AAPA didn't begin its existence as the "American Academy of Physician's Associates."

 

According to the NC Secretary of State, the AAPA was incorporated on May 20, 1968 as the "American Academy of Physicians' Assistants," 7 months after the first graduating class of PAs from Duke University. You can see all of the original historical filing documents on the linked page.

[burnpac]

Well, Steve, c'mon...

The AAPA dogma for YEARS has been "providing health care services"..."under the supervision of a doctor"....etc....That has been their public descriptive for a long time.

 

McGinnity came out of the gate with "PAs practice medicine". Good on him!

 

The way the AAPA got on CSPAN may certainly be due to the years of groundwork that you mention- and kudos for that.

 

But the CONTENT is a welcome change. Practicing medicine. Collaboration. All the things we need out there.

 

No need to knock this altogether though. This was a great PR piece for us on a premier news outlet. McGinnity did a great job.

 

My only critique was I wish a PHYSICIAN had called in- either as a supporter or detractor, it would have been good to hear that exchange.

Matt:

 

C'mon man. That was then, this is now. :-)

 

Actually, the shift in language has gone through a number of iterations in the House over 20 years, and the real credit for the push to change and de-emphasize supervision, rightfully goes to President Patrick Killeen in 2009-10. He was the first AAPA President to make an issue of this.

[burnpac]

@Steve...like I said....we can forgive the AAPA for their inability to stand up for the title Associate since it was  a young organization back then......

 

BUT now.....jeesh....there has got to be a better solution for us than to be assistants forever.

 

IF PAs could bill separately under our own NPIs for ALL insurance companies, recognized by CMS as full and separate medical practitioners as physicians, nurse practitioners,etc, get all state restrictions removed that set up artificial barriers, delete dependent status and supervised from laws and recognize the PA profession as one that is a professional medical specialty in its own right, yet collaborative with other medical practitioners, THEN the title PA (assistant) might be a pill I could swallow. 

 

Hind sight is 20/20.  Time to stop looking at our petutties. 

Paula,

 

The ball is in your court. I'm for all of those things too. We are reaching critical mass in all areas of the political spectrum. Legislatures are struggling with the human resource shortage of providers in every state, and are initiating scope of practice legislation and improvements to PA practice acts on their own. The political calculus is changing across the nation.

 

PAs graduating today would not recognize PA practice 30, or even 20 years ago. I'm quite certain that I won't recognize PA practice twenty years from now as the pace of positive change accelerates.

 

Some on this forum wrongly interpret my and other "dinosaurs'" cavalier attitude as complacency borne out of not wanting to rock the boat or upset the status quo. Nothing could be further from the truth. I have rocked the boat since 1991, and now it is time for the next generation to pick up the sword and shield to move the profession forward. I am spending the last five years of my PA career working in my community and on medical staff politics to continue to improve the working environment in Bakersfield and at my community hospital.

 

Change happens, and it is up to you all now. All the best.

[Guest Paula]

Yes. We all need to do our part and I am a member of 2 state orgs supporting changes to our laws. I am hopeful the newly minted PAs will have the view of themselves as competent medical providers and will continue to support their state orgs to effect change.

 

[ventana]

Nice to see that others feel the same as far as looking forward to change!

 

 

Please continue to speak up, AAPA is our organization, and they are currently responsive to input and we should take advantage of this

 

visit https://www.facebook.com/AAPA.org

 

reply to all the robo emails you get from AAPA - most the time someone replies

[andersenpa]

Matt:

 

One small problem with the details. The AAPA didn't begin its existence as the "American Academy of Physician's Associates."

 

According to the NC Secretary of State, the AAPA was incorporated on May 20, 1968 as the "American Academy of Physicians' Assistants," 7 months after the first graduating class of PAs from Duke University. You can see all of the original historical filing documents on the linked page.

I don't have the source docs in front of me but there were competing organizations to serve as PA's representative body. Associates may have been another. Will look at work tomorrow.

[stellahead]

Arthur Lamb, Duke PA program graduate of 1970, the fourth class, was our commencement speaker this August. He spoke about the name change as a big regret from the early days. He said many physicians weren't interested in having anything to do with the creation of the PA profession...until they heard the proposed name was "physician associate." Then they were willing to come to the table. Lamb said we shouldn't have let that go, but it seemed necessary at the time to keep moving forward. It was a great speech, and I was happy our class got to hear his point of view. Especially after our Intro to PA class our first semester basically gave us marching orders to reject the idea of a name change.

[jmj11]

I just had the chance to watch the video and getting back to that subject, I will have to say that John did a fantastic job in promoting the profession and answering questions, even some uncomfortable ones.  I wish I had seen it live and could have called in or some other PA-owner had called in to expose another small, but important aspect to the profession.

[db_pavnp]

Especially after our Intro to PA class our first semester basically gave us marching orders to reject the idea of a name change.

 

I feel you should strive they scrap those orders for future students.