Season 1: Episode 23: Quinnipiac University - Dr. Kohlhepp

Unknown Speaker  0:08  
Welcome to this episode of the PA path podcast. I'm your host, Kevin Lohenry. We are glad you could join us as we seek to better understand the PA profession

Unknown Speaker  0:24  
if it becomes more about me, and I need to do this for me then what are the needs of the patients or needs of the nation then I work

Unknown Speaker  0:34  
well hello and welcome to the 23rd episode of the PA path podcast. I'm your host Kevin Lohenry. And today, Stephanie joins us again to speak with Dr. Bill Colette from Quinnipiac University. Dr. Cole hip has been a physician assistant for more than 40 years, and he is a well known national leader who has led the APA there House of Delegates, the NCCPA and PA to name a few. Dr. kolab was published in the New England Journal of Medicine. And his scholarly contributions to the profession continued for well over 40 years. He is also the 2020, recipient of the PA Lifetime Achievement Award. We speak with Dr. Cole HepB about his path to becoming a PA, his history with the profession, Quinnipiac University and about his thoughts on the future of the profession. As always, you may learn more about our guests and their institution on our PA path podcast.com website under the blog section for show notes. Bill, thank you so much for taking the time to join Stephen. today. It is so good to see you and to hear your voice. It's been a few years since we all served together on the board. And we're really excited to get your perspectives on the profession and learn more about Quinnipiac University as well. Why don't we start with your path to becoming a PA because you've been paid for a long time. And I think you have a lot of a lot of various offshoots on your story that you can share with us

Unknown Speaker  1:57  
a long time indeed 40 plus years. So I think my story is typical of many of those who are trying to find their way into the some position in the health care system. I knew in high school, I was really good in science. And I had an inclination that I wanted to help others. But I wasn't really very clear on what to do. Obviously, you know, the world thinks healthcare is doctors and nurses. And we all know that that's not the case. And somehow I landed on becoming a pharmacy major. So I went to the University of Connecticut as a pharmacy major. And either because I didn't really understand the possibilities of Pharmacy at that time, or I'm not sure what I changed, and I changed to being a pre med major. And at that time in the 1970s. I don't know if it's the case now, but it was extremely competitive. And people who wanted to go to medical school often got there by stepping on others. And I had my eyes opened real wide when somebody stole one of my dissections that I was doing to slow me down and it was like, Oh, I guess I don't, I'm not really sure I want to play this game. And also, you know, many times as I've seen over the years looking at applicants, sometimes college boys are a little goofy and I probably didn't apply myself as well to when I finished with my biology degree and I really wasn't clear on where I was going. That my junior year in college I met a friend of met someone who became my lifelong friend who was also pre med from New Jersey. And we decided to live together and we did that for junior year and part of senior year. He was a year ahead of me but he graduated a semester late and he said Bill, I'm going to go to PA school and he was applying to the Columbia Presbyterian ophthalmology assistant program when the PA profession was very specialized and not focused on generalist education. And I said good luck, Frank have a good life. I don't know what that is never heard of it. And he went off and did his didactic work. And when he was on his clinicals that he had a weekend and we drove to the University of Connecticut to watch UConn play Navy in a football game. And he just told me about all the things that he was doing on clinical rotations and the things that were possible for PhDs and as I say to applicants all the time, if you shadow a PA or learn about PA and you think about what it takes to be a PA and what it means in the healthcare system, and then you really reflect on yourself, and what really makes you jazzed and it feels like a nice comfortable glove. And it's kind of like an aha thing. And you say, This really does make sense for me and it absolutely positively did. At that time I had I was working as a pharmacologist, I had finished my undergrad degree and I was working for a pharmaceutical company in a lab bench doing experiments with mice and guinea pigs and rats and sitting there on my lab bench saying, oh my god, I can't do this for the rest of my life. I really hope I get into PA school. And I was listening to your one of your podcasts the other day and somebody said the same thing that happened to me it was, I only applied to one PA program, I was scrambling very quickly with the idea when I heard about it. And I applied to the Rutgers PA program in New Jersey. Frank, my friend was in the first class, and I was in the third class and maybe later on, we can talk about, you know what it's like to be a pioneer in PA school. I was in a small town, I was volunteering as an EMT, and firefighter. So some of those things made sense. I had worked in a hospital in both back in Connecticut and New Jersey, so I had some health care experience. And I had reasonable grades, not great grades, and I just excelled when I got to Rutgers because it was the right thing. But going to Rutgers was a turning point for my life that if I went anywhere else, I don't think it would have been my path would not have been the same. The Medical Practice Act in New Jersey was so strict that for you to touch someone even to cut their hair, you needed to be named as an exception to the Medical Practice Act. When the first class was accepted at Rutgers, the doctors and nurses in New Jersey said, Oh, fine idea. When the second class it was accepted. They said, Yeah, fine idea. There were no TAs in New Jersey, there was one in the Naval Air Station because it's a federal system. And there was one in a VA hospital. And there was one at Princeton University. And the the first class was about to graduate when we got accepted. And the doctors and nurses said, timeout, this is a terrible idea. We do not want PAC in New Jersey, and they objected. And everybody in the first class had to leave the state, I had to leave the state when I graduated 1979 Because it was illegal to be a PA in New Jersey until the early 1990s. It took that long and it really fell to the myself and my classmates in the in the third class to advocate for APA law in the state. I testified before the New Jersey legislature. But we key thing was we went to the APA annual conference and we thought we we needed to figure out who could help us and somehow I still I was not drinking that much. So I don't really know I can't blame it on that. I went to Houston, I came home from Houston elected as the National Student Academy secretary. I had a really good campaign manager. And I don't really know how that happened. But that was pretty key. And then I had met some PhDs from Connecticut. And when I was asked to pick a border, any border, but you can't stay in New Jersey, I went to Connecticut and I think my career as a PA has been a great example of what path is available to individuals who choose this profession. I've been in four specialties, and I've been in a variety of settings. My first specialty was actually not a clinical practice, it was clinical research. I was hired by the Yale University School of Medicine to do clinical research in the emergency room at Yale New Haven Hospital looking to create a approach to injuries of the arms and legs that would reduce the number of X rays, it's now called the auto ankle rules. But our work pre predated that by many, many, many, many years. And I actually have my I got another bug out of that experience, which was the desire to publish because my first publication was in New England Journal of Medicine.

Unknown Speaker  8:28  
So not a bad one to start

Unknown Speaker  8:32  
my own small publication in a journal called de pharmacologist as well. And then I moved from there to being a PA in the emergency room at Yale New Haven Hospital in the surgical section did that for about four years. And then I went to what is now an HMO. But it was an idea before its time and I worked for prepaid group practice in Connecticut in internal medicine, working with a team of two physicians and myself taking care of a panel of a couple 1000 patients. And we did everything for him. It was absolutely fantastic, best experience ever. But it didn't survive because people were not used to I want my doctor, I want to make my decisions. I don't want to have it be part of a system. You know, at that point, I had done a number of years working in APA and other places where I started to show some glimmers of leadership and some glimmers of management skills. And my practice asked me to start at to be the halftime pa halftime practice manager of a brand new facility. They were opening up for this prepaid group practice. And I did that for four years before the practice was sold to Blue Cross Blue Shield. And that I moved from there to start a practice and so that was a surgical emergency medicine, internal medicine that was family practice, because it was pediatrics gynecology podiatry. Your adult medicine, everything. And I left there and went to start a practice in a occupation, a hospital based occupational occupational medicine practice that was very successful and very proud of that one. That was my fourth specialty. I continue to work as a BA, you know, a couple days a week after halftime quarter time. And then I was supervising the outpatient therapy, PT and OT, and one of my occupational therapist said to me, Bill, I'm, I'm going to leave the hospital, I'm going to teach full time and I had been teaching pretty much since the day I left PA school, a to PA that I work with in the emergency room, Jeff Heinrich and Bruce Chandler, we always had students as preceptors, mostly from Yale, but also from GW and other places. And they also ran the surgery and emergency medicine course for the LPA program. I got hooked and started to work with them doing that. And that really was the bug that I knew I enjoyed teaching, but I never really thought about full time teaching. And when and when Katie left the hospital, I said, huh, I know that Quinnipiac starting a PA program, if they ever have a position, give me a call. And she did. And that really was the start of the best part of my career, which was inspiring, I hope, I hope I was inspiring, at least educating the future of our profession by countless classes. I, as I count that I think we graduated our first class in 1977, or 1997. So I think we're up to 25 years now. So been a long time I've been associated with them. And I dabbled in academic administration, because of some of the things that I did. I like to do things for a little period of time. And then I ended up in my career as a dean and retired recently, but I'm still involved. Yes, Steph

Unknown Speaker  11:54  
and I were just talking about this the other day, and these themes that keep coming up in our podcast, one of them being the reluctant leader or the leader, that leadership comes and finds you when you're trying to help solve a problem, but not necessarily you go and look for. It sounds like that might be true for you, at least early on in your career with the ADA and student Academy role. Do I think

Unknown Speaker  12:16  
you know, I heard a commencement speaker once at UConn, who said Your life will be much more fulfilled? If you say yes, more than you say no. And that's a really good piece of advice. You know, we all get my wife Peggy always tells me often that I should say no. But saying yes has led me in all sorts of interesting places over my career. So

Unknown Speaker  12:39  
it seems like your blog for advocacy was sparked a little bit maybe before that, but certainly with that, that trip to the student Academy and your your early role in the student Academy. And you certainly have had a long and storied career and leadership. What would you say to students who, you know, maybe have a propensity towards leadership, but you know, maybe kind of reticent to say yes to some of those calls.

Unknown Speaker  13:04  
I've talked to students a lot who were thinking about getting involved while they were in PA school, and they thought it would be too much of a distraction. And for me, when I watch PA students get involved in either their students, society and projects of their students society, or in graduate student counselor, something with the university or even with, you know, some of the PA organizations, they can see in front of them the profession that they're studying for, or the role that they're studying for an healthcare system. And I think when their batteries are low down a little bit in and drained from all the hard work it takes to be a PA student, it re energizes them and refocuses them in a way that I think while in PA school is great. And I think you know, many PA programs today are talking more and more about fostering leadership. And I think that's absolutely essential. You know, there's a rumor that everything solved in our PA profession, since it's over 50 years old, and there's no work to be done. And we don't need to join our professional organizations, or support them or get involved in them. But it's still an extremely young profession, compared to many, many others. And there still is a lot of work to be done. And there's a lot of changes going on in the profession and in the healthcare system, and then higher education that if you're not paying attention and you're not at the table, you're going to you're going to be overlooked. And I have often said to people, you know, why did I get involved and I I truly felt a sense of ownership for the future of my profession. And I felt if I didn't at least say here are my ideas for where we should be heading. You don't need to take them but I really hope you've considered them. I would feel like I had to let myself down in terms of if things turned out away that I didn't really particularly like or whatever, that I would have been disappointed in myself for at least not trying and I think it's a perfect, it's something that all of us, you know, obviously, I'm singing to the choir with YouTube. But, you know, it really is something that people need to embrace, to the level that they can I grant people's lives are more and more complicated these days. And there's lots and lots of polls on their attention. But you got it, you got to carve out a slice of your time and attention to do something to advocate for the profession or, or for your community or for your institution or something where you show a leadership role.

Unknown Speaker  15:33  
They'll shift gears and talk a little bit about Quinnipiac, as I recall you, you've served in a lot of different capacities that couldn't be asked, but one of the things that I remember you had a lot of passion about was guiding the undergraduate students towards the PA profession, and also mentoring and kind of helping the pre PA and then the PA students through their career. Can you talk a little bit about those conversations that you've had with the various student levels and now, one, you prepare students to think about the PA profession as a career and to what are some of those key tips that you provide those pre pa aides to help them be successful in entering pa education?

Unknown Speaker  16:11  
Well, fortunately, for me, the Quinnipiac PA program has a structured undergraduate feeder program is one of about 30 in the nation. So we accept college freshmen who if they do everything they're supposed to do four years later, they're in the graduate PA program. For the most part, many of them already know they want to be a big, which absolutely blows my mind, as somebody who's 1516 years old, already knows what they want to do for the rest of their life, Having wandered around through three or four different ideas myself, and most of them do follow through on that and do really well. But in talking to them about the hard work that goes into not only preparing to be successful as a PA in PA school, but also later on what it takes, there's a level of myth busting. The concept of what a PA is sometimes is lost on is, I would say, they look at it with a glimmer, you know of reality in their eyes. And sometimes they really need to be helped to understand it. And I'm a big believer in shadowing, I think anybody who wants to be in a health profession should find it's a little harder these days with COVID, a little harder with HIPAA, and but I think I always say to PA students, people who want to be in PA school, that it's a level of problem solving, that if you can't solve that problem of have find finding somebody you don't have the grit and the gumption to go do it, maybe you're not going to be successful in PA school, that's a little maybe a little harsh, but is where I'm coming from. So Shadowing is key. And then the myth busting, you know, the concept of OPA is they have work life balance that physicians don't have. And I always tell them, that's about the specialty you pick. And whether you decide to be an owner or a leader of the practice or some other things. There's nothing inherent in PA versus physicians in terms of work life balance, M if you're a surgical PA, you're going to be called all hours of the day and night. And the other is that PA is get to spend more time with patients. And I haven't seen that to be true. I believe that patients feel like they had more time spent with them. Because I truly believe that pa education focuses students on building a trusting relationship with their patients so that the patient feels like they've been listened to heard all dimensions of their life considered. And I think that makes them feel like it's been productive time. Maybe not if you put the watch on more time, but I think it's productive. And

Unknown Speaker  18:43  
then the other is this whole idea of prerequisites. People who are looking to go to PA school get so frustrated by all the prerequisites. I wish we'd narrowed them I just worked with Stephanie on some things where we're trying to have that conversation or lead that conversation in PA education to try and narrow those prerequisite. coursework is designed to create a foundation for future learning. It's not a checkbox for hoops, or hurdle. It really are courses that we think will make you more successful. And you've tried to learn later on about disease and health and illness and how to diagnose and treat and all those kinds of things. The other issue is direct patient contact, there's a level of maturity that goes on and direct patient contact, but there's also a level of situational awareness, the ability to walk into a room and figure out what to say and whether to just listen for a second, whatever. And I think direct patient contact also gives you some things to hang future learning on. So I talked to them about those two major things, picking the coursework that they need to take that I think is foundational, and I talked to them I said you you don't need to get straight A's but you do need to get B plus A minus aids over your career. So the end up with a three, five plus or minus to show some capacity for graduate work, and then do the direct patient contact for the reasons I said, but the one that I really hang my hat on as a test is, is community service. And again, they look at it as a hoop or a checkbox. But it really is about altruism. If you are going into the PA profession, you have to put the care of others before yourself throughout your career. And if you've never put others before yourself, I'm not sure how you can make a case that you can. So I just think those are key. Just to go back to direct patient contact. Again, I think it's an area to test many of the things that I know, Kevin, you thought about way back when with the PA President's Commission noncognitive variables and some of those kinds of things. And Stephanie was involved in that as well. You know, the emotional intelligence, the critical thinking, the ability to reflect, learn from your mistakes, and then be humble. None of those are hoops. And then another area that we've been talking about is leadership. I think that's the one that I still think is a wild card for many PA programs. Not sure how we value that. But I think for the future of our profession, we need to figure out a way to look at leadership. And one of the things that we're doing it at Quinnipiac, at the undergraduate level, is interprofessional. Education. And that I think, also, you know, we we were team players before team was fashionable. And the interprofessional education piece just shows them that there's a level of understanding of the role of other professions. And moving forward, I mentioned that occupational therapists and physical therapists earlier in my career, and I constantly walked out of my practice down to down the hall to go ask them, you know, what was their take on my patients. And I also did the same thing in the emergency room. Half the time the social worker was the person who solved the problem for me, but if you don't know what they do, and have any understanding of what they do, and and respect for them, it's going to challenge you. So I think most people who want to go to PA school are smart enough, but it really is, I often tell them, It's about time management. It's about making sure that you're thinking through the effectiveness of your work in terms of taking notes and studying them. I encourage them to study together because I think that's one of the success the things that make them successful in PA school. And I've been, you know, when people have done what I've asked them to do in regards to GPA coursework, direct patient contact community service leadership, interprofessional education, for the most part, a PA program, and the nation has said yes, many times they need to take a gap year because it's hard to get, you know, many of these are college undergrads and the profession started with people who, you know, went out and worked in a different career for three, four or five years before they applied to PA school. So there's an element of, you know, I don't want to delay gratification, I want to go now. And that's often often hard for them. That's the hardest, which is, what do you mean, I need 1500 to 2000 hours? I want to go now I see that some PA programs, say they only require 100 hours? And I say that's not the question you want to ask. The question is, what does the competitive applicant at this PA program have in terms of GPA and direct patient contact? Because that's really not the minimum? Because if you have the minimums you're not going to get into PA school.

Unknown Speaker  23:33  
Excellent points. Excellent points. I'll just say before I turn it over to Steph, from a leadership perspective, you alluded to this, it seems to me not everybody is has the DNA to be up front in front of the microphone at the podium, which is totally fine. But all healthcare providers are leaders in their community related to educating the community advocating for their patients advocating for the profession. So that's at least for me, that's how I've always looked at it is show leadership somewhere. You don't have to be the person behind the megaphone, but show that you can actively support helping others get a better situation related to their health or well being.

Unknown Speaker  24:09  
I 100% agree. And I think there's some element of leadership by ideas, not leadership by title. There's been plenty of times in my career when I was in the middle, not no title, no nothing. And I would make a do the research, consider the perspectives, have listened to the objections, and bring forth some ideas and you don't need to be standing in front of the crowd is the person with the gavel to be leading you can lead from the middle, you can lead from the back, you can encourage others to take your ideas and stand at the microphone and give them the information they need to advocate for the ideas to leaders. You know, there's a lot of myths about a leadership is something you're born with. And I think it really is, you know, developed with a wanting to make a difference and just Same. This is your

Unknown Speaker  25:01  
magic potion bill, Steph and I had plenty of opportunities to watch you do just that, where you lean back in your chair around the board table and listen to everybody and and ask clarifying questions, and you held off on inputting an idea until you've had a really good sense of what the depth of the issue is. And then and then whatever you bring forward is usually just so icon again, and like, why didn't we think of that, but I think you have a real gift when it comes to that set of skills that you just talked about.

Unknown Speaker  25:33  
Oh, thank you. It was funny, because during the most recent ta educator meeting, two people sent me texts, saying that they just heard a call hip ism, which is what is the problem we're trying to solve here? I still think that, you know, once you figure out, we often come up with solutions to a half baked idea of what the problem is, and that we create more problems. So I like problem clarity. So, but thank you.

Unknown Speaker  26:00  
Let's talk a little bit about Quinnipiac and your history there and certainly about what sets that program apart. Tell us a little bit about what makes Quinnipiac unique among PA programs and what a competitive applicant for Quinnipiac might look like.

Unknown Speaker  26:16  
When I first joined Quinnipiac, the other person I joined as an academic coordinator was Cindy, Lord and post Cindy Lord and I had long time been involved in the profession. And that element of leadership was very key to what we were trying to foster. The other was just time after time, after time, after time, Cindy would encourage the students to find ways to serve the community, whether it was food banks at homeless shelters, there were foot clinics, there were fundraising efforts. When we built a new building she fought I'll say, I'll use the term force them because architect had to be forced, they don't like to give up space to create a community service room to prepare meals and sandwiches for the taking to the, you know, to the New Haven green downtown. And I think that really was something that really resonated with many of the students. I used to laugh, because we would know we're in Connecticut. And we would always get students from Utah. And I don't know that they were Mormons. But certainly, the Mormon community has a service focus. And I'm not sure if everybody else in Utah does. But it seemed like every year we were attracting people that really had a commitment to service and then some that had a commitment to leadership. And the other was Cindy instilled in all of us when she became program director, setting the bar as high as he can, and really challenging them to learn in many, many different ways. And I in PA school, we often I know many people say it's like drinking from a firehose, because it's just so many things coming at you and filled with so many things to learn. But she was a really, you know, it also comes down to being a good cheer person, I won't say cheer like man, I guess cheerleaders non non gender, but you know, to really encourage the students and cheer them on. When I looked in, so where Quinnipiac got to in the know, I understand national rankings are mostly about reputation and everything else. But I felt very good that we were one of the newer PA programs that was high up in the ranks, and there's long standing PA programs. And I think it was that we attracted people from across the country because of those two commitments, service, leadership and strong academic quality. And then they went back to places and I can point to people who've been presidents of the California Academy, that several people from graduating from Quinnipiac were presidents of that Academy across the nation and in other state being leaders. And I think they're also become great clinician. So it was our graduates that helped our reputation, but it was the faculty that pushed, pulled, cajoled, cheered for encouraged, and perhaps, you know, through our admissions process, accepted people who were, you know, ready for what we were telling them. I thought that worked really well. And then when we got the medical school, our president decided that when we had we purchased a complex that was used to be the state headquarters for BlueCross BlueShield. He had an empty building, and he got it in his head, he wanted to start a medical school. And that really gave us some tremendous resources. We don't have a hospital, but we have a medical school, a school health science that has over 20 health professions in it. A school of nursing and schools of law, business, engineering, and others communications at all have a focus on health. And I think there's a there's something about Quinnipiac, where everybody really thinks that there's the health care system and looking at it from their perspective is something that we all want to do. An AI that working together at schools has been very powerful. And when I was dean of the School of Health Sciences, I really appreciated the opportunity to work with my colleagues in nursing and medicine on some challenging issues. And one of them was clinical rotations and making sure that they were enough for not only the students of our three schools, but also the other schools that were growing in Connecticut and other PA programs and medical school. So I think, you know, and I mentioned earlier, the program that we had for entry level freshmen entry, we were, we started to see that we were having younger and younger applicants, and we decided to create our own farm team, you know, the World Series just ended last night, I know, this will be posted in another day. But we're sitting here today, one day later, and the, you know, the baseball analogy, having our own farm team is true, you know, you're trying to instill in them some of the things that in 27 months, it's harder to do. And you make sure that when they get into PA school, they're really hitting the ground running. That's what I think special about Quinnipiac and been here for been here for 26 years. So

Unknown Speaker  31:04  
and obviously your approach to leadership I'm sure has helped shape that particularly from the pre pa component. I believe you guys call it the prep concentration.

Unknown Speaker  31:14  
Oh, yeah, that's that's actually knew that the first was the people who are guaranteed a seat is called entry level masters, physician assistant Elda. And we were the admissions department was you to know that it's hard, you can't grow a PA program beyond the capacity for clinical rotations. And when the President built this brand new health professions complex, he said, Look, now you have big classrooms, you can take, you can double the size of your class, and it was like, It's not about the classroom just about clinical rotation. And the we didn't, we thought the magic was to have about half the classroom help and half the class from direct entry to grad school. And they wanted to grow the Alpha program. So then we said, Okay, we'll create this other thing, which is PA prep, which I'm now part of, and there is no guarantee three of them are guaranteed to transfer later on three to five are guaranteed to transfer later on, if they do all the things that we asked them to do in terms of the things we talked about earlier. And you know, it's something where, you know, I've retired and my wife would like me to do things and be able to do the things on the honey do list. But I've said You know, this, this pa prep thing, and having 1012 advisees every year from each class is something that still keeps me going and energize.

Unknown Speaker  32:32  
That's good. Well, it's good to have you still part of the profession. Bill, you have served in a wide variety of leadership roles. And you you're the past president, the American Academy of Physician Assistants, past president for PA past speaker of the American Academy, his house of delegates, past chair of their board, you also had leadership roles in Connecticut as well. So I'm certainly you keep your ears to the ground related to all the changes going on in the profession, particularly the House of Delegates in the name change from last May and conversations about the role of the doctorate in our education. Could you share with our audience a little bit about your perspectives of the future of the profession and what excites you and what areas might bring some consternation of any?

Unknown Speaker  33:16  
I guess, for me, what I think will ensure the future of the profession is strict focus, laser, like focus on what are the values of our profession. And early on, we have always said patient focus is number one, if it's something that will advance the PA profession, but it's not going to be good for patients who don't want to do it. And I think our patient focus and the focus on them and their families and their work and home life and and all of those dimensions is extremely key. We have a commitment to lifelong learning and from that high quality care. And I think the one thing that I'm worried about in terms of our commitment to adhering to it is meaningful collaboration with physicians. And I understand that there are laws in this country that were made in the 1960s before the PA profession or laws that were made to keep the PA profession in check. As we were trying as states were trying to figure out whether this was a good idea or bad idea, they really did not give us much free rein. So there's a lot of changes to make in laws, but our profession was started by physicians supported by physicians in the early days. Anybody who works in PA education knows that physicians as part of our programs as part time faculty as preceptors we could not do this if it was just PA is trying to educate other PA and physicians were the ones who have the highest level of training of all health professions and they have a lot to offer. So I believe, you know, paid commitment to that collaboration is key. The three of us have always talked about in many, many conferences. in PE about competency based education, I also think the anything that challenges our generalist education, and pushes us in the direction of specialty, needing specialty credentials is key. And then the last one is ego. If it becomes more about me, and I need to do this for me, then what are the needs of the patients or needs of the nation, then I worry, I think if we, I'm very, I believe we have always been committed to those things for our 50 plus years, I'm very optimistic that as we met need may need to morph some of them that we will continue to thrive. Were the number one profession not number one health profession number one profession in US News and World Report. And you can't screw that up. We have to, we have to, we have to do that. But we do need to address the barriers that prevent us from practicing at the top of our education and training. And we need to do things that relieve those who work with us of unnecessary burdens participate, particularly physicians who are trying to work with us and he team practice and it's onerous, and in a productivity world takes them away from doing things that they're expected to do. And then the other is there is a clear belief that some of these situations, laws and regulations that are creating barriers are an advantage in other health professionals in the marketplace. And we need to fix that as well. But I hope we can find a way forward to maintain a strong relationship with our physician colleagues. With that said, I thought it was important that when we changed our name, I know there was confusion about physician assistant, our original name was Physician Associate, organized medicine didn't like that. So we changed the physician assistant, which wasn't a problem too much, until people to put too much into the word assistant medical assistants were created. It just got confusing, I guess. We didn't want to change the name way back when because if that was the only thing we were opening up the law for that was crazy. But we're trying to modernize our laws to address all the things that we talked about. The American Academy PAC has called that optimal team practice. The one area that continue to question is whether we truly do value our team practice with physicians. I know we're in team practice with lots and lots of other people. But we have a special relationship with physicians that I hope we continue to honor, if we're going to open up the law to modernize things, it's reminds us to change our name. Some of the suggestions did not include physician. And I don't, I'll trust that my colleagues who were advancing those were not doing that on purpose. But I think it was good to have positioned still in our name. And I think it's tremendously smart had pa be our initials, because that's what we're known. If we change it, some of the other names that would have been lost. So the other issue that came out of the conversation of optimal team practice was physician assistants taking responsibility for themselves creating their own evaluation of scope and practice their own system for evaluating quality of care, their own system for mentoring each other their own system for providing consultations, when you don't know what you need to do for patients. And out of that conversation came some thoughts that perhaps for us to compete with other health professionals, we needed to go in the direction of the nurse practitioner profession, which initially went to the doctor. Now I think people need to realize that while the nurse practitioner profession, advanced practice, registered nurses said we will all need to be at the doctorate level by x date. It's my understanding that they've backed off from that and they're also accepting a master's threat. So I'm for us, I think we need to have the right reasons to go for the doctor, Pts went for the doctor to compete with chiropractors, occupational therapists are going for the doctorate and they're really struggling. But I think there's a level of degree creep, where it's not advancing clinical skills. And I think one of the things that PhDs have always been focused on well, we want PhDs in education. We want PhDs in research. We want PhDs in leadership and administrative practice. We want PhDs in government, and maybe we need to have higher level of education, we have always been focused on being clinicians, and most of us do want to be clinician. So will the doctorate an entry level Doctor, I have my doctorate, but mine was a post clinical doctor. And I think for educators that makes a lot of sense. You're playing in the sandbox with a whole bunch of other people who had their doctorates and value your credentials based on what whether you do or don't. But I'm not convinced at all that increasing the number of years of training beyond 27 months to add some research capabilities or something to entry level PDAs will make them better clinicians. I think it will add to educational debt, it will. We worried when we went to the Masters about whether it would have impact the diversity of the profession and some of the pathways to the profession that those with less formal education had. I've watched other professions, they've added more and more years, and that has not advantaged them in terms of salary or anything back in return on investment. And I think, you know, the whole idea of calling people doc doctor in the healthcare setting confuses space patients are confused enough. So I don't know, I think it has some dice in it, I 100%, fully support post, you know, Post Entry Level doctrines. But as our entry credential, I am very comfortable with the master's degree. But most important for me is that the PA profession decided and that we not allow individual PA programs to say I'm going to get a leg up by giving a different credential than the rest of you. And I'm going to outmaneuver you by offering your credential, I think we need to make sure that we use whatever accreditation, leverage or PA leverage, we have to make a thoughtful decision rather than be forced into something which I thought, because what happened with the master's degree, I'm still very optimistic the PA profession just makes so much sense. You know, you look and you say 27 months when we have had needs in this nation for a change in our approach to healthcare, whether it was the Clinton Health Care, Obamacare, the change in work hours for House staff and surgical residents, the generalist training and the short term training, 27 months of PA that intensive training has allowed individual PhDs and the profession to say the nation has a need, let's move in this direction. And if you were to make a change in medical education, it would take you at least eight years to have an impact when you made that change. So I think the PA profession is really well positioned. It gets people out in practice. When I talk to applicants, you know, they know there's a rumor that you don't have to work at work as hard in PA school, PA school is as hard as medical school. And it's even shorter in terms of compressed. It's four years versus 27 months, but it's 20 Compress 27 months. And it's same topics. But what it does is it gets you out into the workforce quicker.

Unknown Speaker  42:26  
One of the priorities of the profession that we you know, you and I both in leadership positions, and I know at our program levels have been addressing, and it's an important one is diversity. So talk a little bit about your perceptions of the diversification of the profession, and what what needs to happen for us to really move the needle on diversity.

Unknown Speaker  42:47  
I think we've we're at the end of having simple problems that have simple solutions. I wish I had a quick and simple answer to increasing the diversity of our profession. But I think the first step was to create a strong, clear commitment to doing that. And I think the RPA standard on requiring each PA program to reflect on what it means to have diversity initiatives at their programs was extremely key. For PA students who are going to a PA program that's early in their efforts to diversify ethnicity, or culture, it's challenging to be the only one of particular race sitting in the classroom, people don't share your experience, it's hard to explain your experience. So I think there is a need to create an environment that's welcoming and affirming for those who perhaps for the short term might be a minority in the classroom. And we also need to have an education system that creates a level of cultural sensitivity for everybody that's in the classroom so that when they go out and practice they understand how to deal with different cultures and races and, and social groups. And for me, while many people talk about diversity in a variety of ways, you know, first generation how many people first generation college students in the class are coming from a small community or even gender when trying to have enough men in the classroom. For me, I I really think our focus needs to be on ethnicity and race in the classroom. The ethnic and racial patterns in our country are changing, and there's very clear evidence and it came from COVID that our healthcare system has left some groups behind. And some groups do not trust healthcare professionals that don't look like that. And that's leading to poor outcomes. So I think there is a COVID and other things have really shown us that we need to focus on increasing diversity in terms of ethnicity and race in our classrooms. In the healthcare system, partly it's creating an environment for everyone in the classroom. But it's also about attracting people to the profession who want to be educators. There is an old adage that if you can't see it, you don't know you can be it. And if you have people of brown and black people of color in that are educators, people can see that that is a possibility. And I think there's also just one, one thing that I've often struggled with is whether there's a misunderstanding of the PA role where people who are from communities that perhaps has felt like they've been forced to settle in the past and parts of their lives, say, Well, if I can't be a physician, I don't want to be in the healthcare system, because I'll be settling. And I this pa thing sounds like, I don't want it. So I think there's some education that we need to do to attract people to our profession as well. And I, I know, Project Access in the PA profession has gone out to high school students and others, but I really think we need to start earlier and fifth, fifth and sixth grade doing that education to the important role of the PA so that they see it as a viable profession. And then we need to create a equitable, unjust environment in our classrooms and supportive environment in our classrooms, so that people who, you know, may be even differences of sexual orientation, feel comfortable in our classroom, or, you know, there's times when in Connecticut at the undergraduate level, people from different states feel like oh, the northeast, that's kind of weird, guys are weird up there, and they don't feel welcome. So I think there takes some work to make people feel welcome in your educational system. And then there also needs to be some support for people who as they're trying to, if they've been disadvantaged in the past, from their educational system, or their you know, socio economic status, that they're they feel supported. And not just oh, yeah, you didn't cut it too bad. See you later. But we need to really extend ourselves. But I think the first thing was our diversity standard and RPA. And I'm, I'm thrilled that we're starting to have that conversation. I think that was clearly the first step. And even we need, I think the diversity standard, help us help us understand what it was holistic admissions is one thing that I just we talked about it, I'm just not sure that all of us are doing it as well as we should, and really looking to figure out ways to make sure that there are minimal standards for GPA and whatever else that once we hit that minimal standard, one of our goals has to be creating a diverse class, whether we're talking about gender, race, ethnicity, sexual orientation, part of the country they came from, how much healthcare experience they add, whatever it is, I think we need to tweak our systems I had it stopped for me it started with admissions.

Unknown Speaker  47:55  
Yeah, I think I think you bring up some really good points, the aspect of making sure that the profession is a landing spot for people from all backgrounds, and that it has the prestige and attractiveness to people from multi generational families that historically been marginalized, often, as you said, build a look at physician, lawyer, dentist, all very common professions that that matter, and the term assistant I think is always likely to have been some challenge for us. And then when we recruit from those communities to make them feel included in the classroom, and a viable part of what we're trying to do as a profession is equally important. So really good perspectives. Bill, we always like to ask you if there's any questions that you hoped we would cover that we didn't, so that we give you a chance to share any of the thoughts you might have?

Unknown Speaker  48:43  
No, I think we've had some, we've gone in a variety of different directions for our conversation. I've appreciated the the questions that you two have asked and appreciated the opportunity to be a part of the PA path podcast, I applaud the two of you for creating an accessible vehicle for people to learn about the profession, and not charging people who are trying to learn about the profession and ways to get in the profession and giving them some perspectives. And, and for me, it's pretty cool. At my age to be part of a podcast. My computer son was impressed that I actually even knew what a podcast or that's fantastic.

Unknown Speaker  49:23  
I think it's so silly, right? There's not a lot of mystique to this, but because we haven't been as accessible as we maybe should have been part of that I think is is probably sheer laziness. We just had so many applicants that we were already drowning in application. So we need to try to make ourselves more accessible. But But I appreciate your perspective on that. Because I think that was Steph and I really were just saying this shouldn't be hard. It should be very obvious to all all people from all backgrounds and we should be welcoming everybody to to give it a shot.

Unknown Speaker  49:52  
Yeah. And you know, it goes back to our conversation about diversity. If you're our first generation college Students from an underrepresented in medicine, no ethnicity or racial group, and you're trying to figure this out, it's sometimes isn't easy. And your PA path podcast, as you know created had a number of conversations on topics that I hope will really open the eyes of people who didn't realize that this was an option for them and your shows showing them the way forward. So thank you for doing

Unknown Speaker  50:25  
well, it's really important for us as well, that there's information available from the people who are actually in the programs, the leadership of the programs, that people who are are running the admissions processes, and that really the programs and educators themselves should be the foremost authority on what it takes to be a great applicant and to prepare for PA school and the things that we're looking for. And that was it was important for us to make sure that that voice was was being represented and accessible to to to all pre PA students.

Unknown Speaker  50:55  
Thank you for doing it.

Unknown Speaker  50:56  
Bill. Thanks so much for being with us today. You are truly a giant in the profession and a legend among among TAs and we are truly honored to have had you with us today. So thanks for joining us and we will hope to be able to join you again in person sometime soon.

Unknown Speaker  51:11  
I look forward to getting together with you too. Sometimes.

Unknown Speaker  51:15  
We want to thank our guest, Dr. Bill Kohut, for sharing his time in insights with us today. His take on the profession comes from over four decades of sitting around the tables of many, many professional meetings, listening and learning from his colleagues. And from our own experience, he is always thoughtful about his perspectives which can shaped by plenty of data and discussion. He is the consummate professional and a cherished leader for our profession. Tune in next week when we speak with Mr. Harrison Reed from George Washington University. Harrison speaks with us about his take on holistic admissions, diversity and the need to provide better information to prospective applicants. Stephanie and I talked with him about a social media presence and his passion for writing.

Unknown Speaker  52:04  
Until next time, we wish you success with whatever path you are walking in life. And thank you for joining us. The purpose of this podcast is to provide news and information on the PA profession and is for informational purposes only. The views and opinions expressed in this podcast are those of the speakers and guests and do not necessarily reflect the official position or policy of the University of Southern California.