Season 2: Episode 27 - Ms. Ruth Ballweg

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Season 2: Episode 27 - Ruth Ballweg

SUMMARY KEYWORDS

pa, people, profession, medics, program, pdas, doc, program directors, medical school, role, internationally, grew, work, pilots, international, interesting, oregon, hospital, tas, physician

00:08

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.

00:25

A lot of things in life you can't plan anything but you want to be able to take advantage of if you had the chance.

00:32

Well, welcome to Season Two for the PA path podcasts. My partner in crime Stephane VanderMeulen and I are excited to bring the new insights into the profession, including the international growth of the profession, some of the roles that PAs have evolved into in our country and additional insights into PA programs around the United States as well. In the coming weeks, we'll be introducing you to the profession in Canada, Great Britain, Germany, Ireland and the Netherlands before delving into some of the clinical leadership roles that PAs have assumed before navigating back to some of the other outstanding PA programs throughout the United States. Today, we are thrilled to speak with a national treasure in our profession. Miss Ruth ballweg. Ruth is a professor emeritus for the University of Washington MedX, Northwest Department of Family Medicine. She was one of the first trained PAs in southern Oregon and is the editor and contributor to the first textbook written on pa training, which has now been named after her. Ballweg's Physician assistant: A guide to clinical practice has been the key textbook for PA programs nationally. And the work she has done over the past 40 plus years in both our country and internationally has helped our profession grow immensely.

Top of the morning to you, Ruth, how are you? I'm fine. How are you doing?

01:49

Are you in California or Arizona?

01:51

I'm in California today. Well, Ruth, thank you so much for joining us today. It is such an honor to have you join us on the podcast, you have done such impressive things over the course of your career as a PA and really, you know, in all honesty, any pa worth their salt knows your name because of the impact that you have made in their own education related to the textbook that you've contributed to our profession to the scholarly publications. There's just so much we have so much to talk about. Let's start by just talking about your path to becoming a PA. It's an impressive story. And I'd love for you to share with the audience.

02:25

Well, so I grew up in Southern Oregon, on the Oregon California border town called Medford basically halfway between San Francisco and Portland. But the problem is, if people were really sick, they had to go to San Francisco or Portland walk one it was you know, it had two small community hospitals. But then the polio epidemic killed, I was five. And people a number of people died because they couldn't get to the nearest iron lungs. And so my father, who was a control tower operator, FAA was ca and and islet himself and and world war two veteran created America's first not for profit air ambulance service. Wow. Yeah. And they raised money from the community. They had all these characters on the board. You know, they had a couple of ministers, a couple of doctors of love nurses, a couple of more judges. Anyway. So first, they got twins Justin, and they got a single engine in sin reliant where you could land in very, very tiny places. So that was 1949. And I basically grew up as part of Mercy flights hanging out at the airport, doing all kinds of things from running the scrapbook to cleaning the planes to yada yada, yada forever. So interesting. Yeah. And it was really good experience, because I sort of got adopted by all these world war two pilots. It turned out that was a really good benefit if you're going to work in medicine with male doctors at the time.

03:49

You had some skills that you learned from those guys. Yeah, I

03:51

was kind of thick skinned and I Dell. So just kind of give it back to them. And so that was that's still an important part. Mercy flights exists still today.

04:01

What a tremendous legacy. Yeah.

04:03

And my daughter is now who lives here in Seattle, but she's on the board of Mercy flights. Oh, that was fantastic. Yeah. So anyway, that was that was my growing up years. And I had originally thought about going to medical school. But first of all, going to medical school for a woman in the early 60s, late 50s. And 60s was a horrible experience. I know, you probably know some of the doctors who were trained during that time. And, boy, it was it was a struggle. Just they didn't have their own bathrooms. They didn't have dressing rooms. I mean, just to make this simple. But it turned out that wasn't going to work for me. I still had my mother was very ill. And I was old as kids. So once again. Many of them have a history of being the sort of responsible leader in their family, which is interesting. And so instead I decided to be a state in Ashland, Oregon. I had a couple of kids my kids are now 51 and 53. I don't know how that happened, and I became a social worker, a childbirth educator, a breastfeeding counselor and an advocate for policies about that and to hospitals. And once my kids got older, that actually when, when my first child, my daughter was born, and I was sitting up in the night nursing her, and reading all of a sudden an article about this pa movement, and I thought, bingo, I'm going to do that. And it turned out to be all those things and more but anyway, so then I went to MedX. And I think 76 and back I was, I think the first woman pa in Oregon, and in Ashland, Oregon and and what was fun about that was, I was a female PA, which they were hardly any. Sure. A good friend who was a nurse, a male nurse, became a nurse practitioner, one honors position. And, and, and we stuck together, we'd known each other forever. So while the director of nursing tried to disenfranchise us would never work. We also did all the sex education in town for the five, the five grade schools. Wow, which puts a pretty steady and gave us a lot of visibility and putting one day Steve came out and he's just he's laughing so hard. He just can't stand him straight. And I said, what happened? He said, Well, it finally happened. A little boy asked me a question I've been waiting for a while now. For Mr. dries on you and your wife have two kids. So that means you must have done it three, maybe five times. No. And then the little boy says how many in Steve's as millions of times Jeff and hit enter their desk. I think the whole town heard about that. And I'm sure they're within about 10 minutes. So anyway,

06:48

that is that is really precious. Anyways, so

06:51

then finally I decided and so I in Ashland, I was the first pa as I told you, I worked for a family doc that I worked with before. And back in the day, when you were chosen to go to PA school, they chose your preceptor at the same time. And they slight visited them ahead of time because, of course, these were labs that had to be created. And if you didn't have an advocate, in this case, there were 12 Doc's in this town. And eventually I spent time with all of them during. But eventually my husband and I got divorced. And it turned out family divorce. We were, by the way, one of the first thing couples, or again, to have a joint custody arrangement, which was very successful. We thought we could still write a book about that. And pretty funny.

07:32

You probably should.

07:34

So then I took a job up in Bremerton in the Health Department, which is a navy town right across from Seattle, I'm sure you know, again, I was the first VA and I did this for two, two years. The interesting thing about that job was again, when we came in, there had been some nurses that were it was another nurse practitioner came in at the same time design. But it turned out the nurses were lying and wait for us. They were just waiting for us. And they assumed we'd hate each other. Well, that's not the case. I was later at the delivery of both both of the signs and I still see or three or four times a year. So so much for that. Yeah, yeah. And I think that's kind of theme that a lot of PDAs. Early on will locale you want to okay, that experience but but you know, the people that want well, they wanted to separate us people that were opposed to peace. But in reality, we had good friends and we made good friends.

08:27

I was a second PMI Hospital in Medfield, Illinois, and I found that the the we got along fabulously because the docs were always they didn't want to bother the dogs for work. Right.

08:38

So your advantage? Yeah,

08:41

yeah, we were kind of their helper by proxy. And they were just, and I also think I had this conversation with a sociologist from Stanford a few episodes ago. I think we're just different sociological. Yeah, I'm curious. Your background as a social worker, I would imagine, that was great preparation for this kind of concept of bringing on a new profession.

09:01

Right. It was and, and, you know, a lot of the skill set was very similar, you know, asking unpopular questions, and, and also following up and, you know, breaking those down for the client. Not too different. Really? Yeah, more hands on literally, with the same sort of advocacy and which was, I still think the best part about all of our roles is amazing that what we've accomplished by having a certain attitude, sure, while I was there, my goal, by the way, in moving up to Washington State, aside from that, it was a good job and public health, that my real goal was to get to do some teaching at the medics. Because at the time, there weren't that many great teachers in the medics program as a matter of fact that at the time that we went to medics, all of us were older than the program director and the medical director, which is always a challenge. And they were very insecure about that. So sure. Unfortunately, there were 24 of us and only two of them So that didn't work. But and eventually, of course, peds became program directors and that problem went away. But so I began giving lectures I begin, there was a opening position. So I applied and became a faculty position, medics and late 19. At that time, there were three PhDs that were the regular faculty there still was a physician director. And by the way, the interesting thing at that particular time was that there were some TAs from East Coast, or were trained in some of the New York programs that didn't raise hell with state licensing board because they didn't feel that people trained in medics model the West Coast model, where the good is they were intercell. Yeah, right? But fortunately, the original Doc's that were the first preceptor for medic, were all in rural areas where there was a huge need for us, or they were Group Health long Kaiser. And so they weren't quite the right people to argue with. But we spent quite a bit of time testifying at the legislative board and so forth. And in 1985, I became the program

11:06

1985 Yeah.

11:09

That was a while ago. So I think an important thing to know about the University of Washington Medical School is it is until just recently, was the only medical school for five states 27% of alumnus.

11:24

Yeah, yeah, that that was one of the key things of your kind of development of the PA profession because of that, right? Because you were able to expand in satellites to other areas, when there was a need.

11:35

That's right. areas also, because the medical school, I had some really strong, wonderful family Doc's or Dean's and associate Dean's and chairs. And they would travel to those other states, go to legislative hearings, yada, yada, yada. So I first went along and got to know all the people on the other side, it was just really interesting to think, and I'm still on the admissions committee for the medical school, which I think is a good investment. Doc's to be good preceptor

12:07

to say that your your experiences in building satellites, and in those relationships you developed in Alaska, and in Spokane, and Tacoma, and, and LA and other places as medics really helped other states grow their own programs,

12:22

Utah mission originally, you know, yeah. Do

12:25

you think that's where you developed your interest in taking it internationally? Because I would imagine some of those same skill sets really applied to helping countries think about this as a solution.

12:36

I think I think that's probably true and didn't feel scary to me in any way. And also, I think, the thing to know about and you know, this from having worked in a number of states, that what works, one place doesn't always work the next place, you know, up to you have to personalize it, first of all, to the people you're working with. And then and then you have to. So I think it's still kind of funny that there are some people in his in us that think that peas are all alike, and all the training programs are all alike. And it wouldn't work. First of all, no, we wouldn't like it as well, either. But

13:12

we're a bit Mustang, our socio logic band, I think.

13:16

Yeah. And so I think I think from there to jump to the international stuff didn't seem too strange. And it still doesn't seem too strange. Because I think the same principles still apply. And, you know, it's, even if PA program somes in the US somewhere in medical school somewhere, you know, they've kind of bloom where they're planted. Yeah. And I think the role varies more across the US and people think, I mean, it's not just one role. And we wouldn't like it if it was actually.

13:48

Yeah, I agree. I think you having having done my training in Chicago, and then then I moved to Arizona, and then I moved to LA, there are variations Right. And, and, and the utilization is slightly different across all three areas. So so so I fast forwarded a little bit, but But essentially, from MedX, you know, you you develop this this great program that started to really meet the needs of the of the communities around those five states. And you also lended your expertise to some of the programs that I mentioned, like you PAP and Charles Drew. Right. Right. And and when did you really start to get involved in the national leadership team? Well, I

14:28

think back in the day that I became 85, let's say when I was a programmer, there were only 50 programs. So and we were all both supporting each other and fighting with each other because there was only so much federal money available and we had to get that money. I would say one of the first things I got involved in was the federal government HERSA decided to offer some classes at a PAM, still a PAP and ops on how to write grants.

15:00

So this is the association of PA programs. Right? Yeah.

15:03

But but nobody knew how to write grants. And also before that they'd had, you know, that was the turnover I think of when there were fewer fewer Doc's that were program directors and more and more of us. I think there were 12 people that became program directors a year that I became programmable. And we all had to write a grant to stay alive. Sure. And what we decided to do at this workshop they taught that we went to, we decided to enter lock our grants. So they, if they turn one down, they have to turn down six or seven of them. We had an o'clock. It was a fun was very crafty, was and we got to know each other even better. So we would have some exchange teachers. I worked a lot with Richard, rare and Galveston and airy Stolberg, and ottoman and Reggie a little bit anyway.

15:54

So Rich Carter at Duke. Yeah.

15:57

So we were all trying to learn how to write these grants. So they sit. And then a number of us ended up being in the grant review teams. And anyway, one thing led to another. And then I started being asked to go to, you know, help out some programs that were in trouble for variety of reasons. And then there weren't that many people to run for PAA for a pap, whatever the board, there weren't that many people that had either the ability or the time, whatever, but I just decided, well, what the heck, you know, it's I had some things I wanted to accomplish. And we did decide to offer some workshops for universities that wanted to and that became very successful. You know, one thing leads to another leads to another. And Hammond and I were pretty much in charge of, and we did four or five of them all around the country. And lo and behold, they programs didn't want emerge out of those. And sometimes there were some consultant jobs that people were willing to take it on. And we decided that unless some of us were willing to do that, we'd be missing opportunities, and we wouldn't be getting it. So that is kind of how that happened. And but at the same time, the Netherlands is would be the example of the first project happening. And then I went to the UK, we spoke at some international pa conferences. One of the reasons we decided to do that is it, we wanted to be sure that the right institutions develop PA programs. And we couldn't actually make that choice, but we could bring them and help them and you know, so.

17:37

So the workshop almost stood as a way to craft content that helped them understand the realities of doing an excellent program.

17:45

Yeah, in the middle of that also, again, not my intention, I decided to run for the board for Group Health Cooperative here in Seattle. And I spent nine years on their board, including two years of the chair. It was it was a wonderful experience

18:01

was fascinating, right, because you had a chance to see healthcare from a totally different perspective.

18:05

Right. And, and innovative, you know, not money grabbing perspective, but really from a community base. So yeah, so that was that was another thing that also probably led me to think about the international stuff, because that was sort of more similar. How do you I mean, we were all you know, after you've been a program director for a while, I don't mean that you've learned it all. But you know what the culture is. But that's not all you have to do. And so working and developing things internationally, you really have to think about, you have to interact with with the employers, you have to interact with the UN, every country has its own issue, and it's working on right,

18:42

and their own ministry of health and approach to licensure and recognition. Yeah, it's very complex. Right.

18:49

It is also, though, it wouldn't have been as much fun if they were all doing the same thing. Yeah. And and I don't know that it would have been in the same way that I think that our success in the US means that we were able to adapt to the regions and that's.

19:07

So you'd alluded to the Netherlands where they really the first international community to establish the PA profession

19:14

that really got it up and running. I think there were some others that talked about it along the way. Okay, in talking about people in Canada, for example, by the way, still working on getting PhDs in British Columbia. Oh, my goodness.

19:26

Yeah. Yeah. And yet they're so organized across the other provinces. It's really interesting to watch how strong they become so quickly. That's right. So one point you ended up being asked by Janet Lathrop at the NCCPA to head up an international exploratory opportunity is that when you really started to formalize that role, and really become sort of our ambassador of the profession, internationally,

19:53

halfway. So in the meantime, and the interesting thing about that i was i I don't know if you remember, but I was chair elect for the NCCPA bowl, asked me, you know, she sort of dreamed up this job, which was perfect, and it was perfect for me. And so I stepped down as being the chair. But I'm still in that role. As you know, the nice thing about that is that it's still a job that I'm kind of making up as I go along. I mean, for example, I haven't been traveling this last couple of years course. But I was talking to some people, things are heating up again, in a good way in Australia. And I'm hoping to get over there. Mid Year, perhaps but, but also at the same time, I had gotten to know, a bunch of the docs that were interested in getting pa started in both Australia, Queensland, Australia, and also in New Zealand. So before I was doing the NCCPA thing, I had a consulting job that I was paid for, to help them set up their pilot projects. Nice. Yeah. And that was really fun. So it had to do with, there were six or seven American PDAs, that went to New Zealand, that was the second pilot, the first are about eight, they were in pain, some people down in Adelaide, they were only there for one year. So that was, by the way, the first mistake, that wasn't long enough. Sure, it was long enough. Some of them felt they need to return home and be with their aging parents. But so the second one doing it for years, and New Zealand was much better. We also sort of chose people, I helped to recruit Jews to the people for both of

21:36

these were American PDAs that you you'd place there so that they could get a chance to experience what the PA is knowledge and skills were.

21:45

That's right. And so the second the New Zealand people were all people that didn't have a lot of family responsibilities to read that. So they were they knew they're going to be there for two years. And that was that work that they all did go back except for one who had already married kiwis, and there are their PhD, they're working. Even though there isn't officially APA law, yet. They're working on it. That's exciting. Oh, it was really fun to work on those pilots. As a matter of fact, in New Zealand, back to my small airplane days, I did. I think I visited every small rural hospital in New Zealand can't buy that kind of experience, oh, my God, it was wonderful, and some really amazing places. And a lot of them reminded me of, you know, Northern California, Oregon, you know, the same kind of small towns with the same kind of people. You know, we're wanting the interesting thing about both of these, is we tried to keep them at a generalist primary care role. And that was, I think, very wise, is new that the docs initially were afraid that they were going to take come and take over their specialty roles. But that didn't happen. So so. So I had already been doing those two projects as its installed. First one, and then the other, still in touch with all those people, a lot of things in life, you can't plan, you know, but you want to be able to take advantage of them if you have had the chance. So this just kind of grew a little bit at a time. And then more and more of the PA either new PA is or potential TAs or more leaders that really didn't start coming to both APA and Pa meetings. They met some other people. That was me. Yeah. And then sometimes their institutions already had relationships. That's one of the reasons Colorado got involved in the programs in South Africa, because their, especially their Department of Pediatrics had links to both of the universities. And

23:45

yeah, that makes a lot of sense. You'd already have that linkage. So

23:49

back to your original question. The first outside of us PA programs would be in India. And the reason is that we didn't couldn't find this out until we actually were in India. But it turns out that there the person there I'm sorry, can't tell you his name right now was India's number one pediatric cardiac surgeon did his residency in Alabama. And while he was there, he meant the director of the PA program will also be pushing the method. And so he basically gave him the curriculum. And he went back but it was very much a surgery model and still is very much a surgery model. And there's some other Doc's that went over some Doc's from Portland, Oregon, also were involved in this. They were all cardiac surgeons, so and there is no primary care in India.

24:41

Yeah, it's an interesting health system. Right from what I understand. There is a real strong emphasis on building your own hospital. If you're successful surgeon, you have your own hospital and you you so it's a lot of specialty hospitals rather than a primary care concept. So

24:58

and big egos also involved them haven't done that. Sure. But they're very interesting. And they're now you know, wanting to rethink that a little bit. So but

25:08

I don't mean to take us off off track here. But but I'm just it's just an observation when you joined the profession, the profession was, what when I joined the profession in 1994, it was 70%, male, 30% female. So I suspect that when you joined the profession might have even been higher on the male side. Yeah. And now as a Program Director with a program where it's 70% women, 30% men, you know, I think it's a really interesting observation, just just to have you have navigated through that all those years and into my own observations of your roof. I think maybe I'm mischaracterizing you. But my sense is, you just don't pay attention to that you just kind of ignore it and keep going to your point. Right. And and people finally say, you know, we're not going to knock her off track. So let's just learn to deal with her and to work with her.

25:58

I think that's true. I, I noticed it by the way, I file it away. And I'm always looking for allies and so forth. But I don't, I don't take it personally, very seldom do I take it really personally, that doesn't mean there hasn't happened, but sure. But I do think it's interesting when I was at the medics program as a student, it was a first year will two years before that. They had made a deal on the end medics program trained nurses and what became an a&p program. And two or three years later, in my class, there were 21 of us, I think there were seven or eight women, right. And so we went to the state, Pa Academy were invited to go to their meeting, whatever. And they always invited the president of the Medical Association to come and give a luncheon talk. And he came in, he said, Oh, my goodness, this is a different look than usual. I'm so glad you guys brought your wife so they could.

26:56

Oh, my God,

26:57

oh, well, you know, I know I can only respond your eyes, excuse me. saved himself actually, as a matter of fact, he was the first black physician to be in the present state Medical Association's Wow, wow. Yeah. But anyway, first people are seeing this, and I'm gonna say something. Yes. Oh, my God.

27:17

Yeah. Yeah. I think it's something to admire, that you were able to become so successful, despite that obvious challenge that women today still experience. On the on the sad note, you know, I I've served on the gender equity medicine science group at USC. And, and I see these brilliant, brilliant physicians and PhDs and leaders, who are also women. And I see the trauma and pain that they've experienced through this lens, which is just sad. And they outnumber the men now, but yet, the men are still just not appropriate. And it's really frustrating.

27:56

Right. And I think it is true. I, you know, I was really glad in retrospect that I did not go to medical school for that reason. Yeah. And I have friends, women friends, who are peers of mine, who did go to medical school, and they are still bruised about it. I mean, after all this time, and there were no, for example, there were no no women's bathrooms and a lot of hospitals. And

28:18

so we so we really haven't come a long way. I mean, you we've come aways, but not a long way. We still,

28:24

I still think though that that needs to be emphasized more in PA school than it is. Because I think I mean, first of all nurses have their own culture of how they battled that some of the same techniques or, but, but I still think it was interesting when we moved in Back to the medical school. One of the things I negotiated was, I thought, What the hell, I'll ask for a seat on the medical school executive committee. Well, damned if they didn't say yes. So anyway, that is the chairs of all the clinical departments and also all the basic science department. Yeah.

29:00

Boy, I wonder what they were thinking when you asked that. That's fantastic. You, you had the audacity to ask for something like that, which I think is admirable. And so and so often, we talked about the Yeah, of course, of course. But But what a great way to get in there, and then make sure that they are seeing the world through a different lens.

29:19

And what was cool as it were, their family medicine and the dean for regional affairs, they really pushed it. They were friends of mine. And when I first went there, I had never thought that I would be the only woman and there was a secretary at the other end of the table. And this is like 30 people, right? Yeah. And fortunately, one of these Doc's that was my sponsor, Ron Toombs, who used to be an RPA. Among other things, he said, You think they don't treat you nicely? Watch how they treat each other. They're not very nice to each other either. Yeah. So what I would do is I would go I made a rule, I would go 15 minutes early, hang around around the coffee pot, and I stay 15 minutes later and finish the conversation. And I would challenge myself to ask at least three, three public questions every meeting. That's good. And that was that was doable. And you know, so one on one, you could say, Well, can I get an appointment with you and give me give my name to your secretary. So she'll do that, and, and that sort of thing. But one thing I found out that they were, they were three or four of them were men in their 60s and 70s. And they all had prostate problems. only way you could tell was that they get up and leave really quickly. And, and at first, these guys were wondering whether I noticed that you know, and of course, I didn't say anything for a while, but then I started talking about menopause. And all of a sudden, I passed and they just kept talking about it. After that, because they realized I wasn't gonna freak out, you know?

30:50

Yeah, yeah. Yeah. And maybe audacity is not the right word. But chutzpah. Like you, you you had no fear, which was, at least not outwardly.

30:59

It was well, I noticed it, but it was, it was it was what you learned from most, your five year old girl with we're working pilots. I mean, I'm serious. That really made a big difference about how you think about things.

31:10

Oh, I have no doubt just having hung around pilots for my Navy career. It's it is a it's a special unique world very, very myopic in some ways. Oh, they

31:19

are, they are in, in in part of my job. Part of my role when I was growing up was that they had to help me learn to drive man meaning and I had to demonstrate before them that I could change a tire. There's like 10 pilots watching me change a tire. And I learned, I had to, I had to learn, I had to paint the oil and Volkswagen, were required before I could my dad would take me to get my driver's license. So you know, you could be pissed about that, or whatever. And they were just keys and yeah, you can imagine.

31:54

Oh, of course, they loved it. I'm sure it kept me on

31:58

payment. Yeah, I was partly the chairman. So.

32:00

So when you look back at the where you were at when you first started working the NCCPA on international things. And you look at where we're at today, Canada is growing exponentially, and what an impressive group they have up there in terms of their PR and really advocating for you. We just celebrated National Physician Assistant day up there last weekend. And the UK is growing like crazy Ireland with Lisa Alexander and and their group over there. You've got the, you know, the Germans with Marcus Hoffman, the Netherlands, of course, you know, what do you think it's gonna look like maybe five to 10 years from now?

32:40

I still think I would say in terms of what we could do national internationally if the world was all right. I think we're only about 25% of what the amount of work that still can be done. And there are different countries in different stages, you know, I mean, and so we get setbacks, just like we got setbacks in the United States, periodic Lee. So I think it's, it's going well, but it's also about getting the next generation of leaders because I don't plan to stop doing this as long as I can. But you want to get more people also. So there's mentoring of people, there is potential leaders too. Sure. Interesting. So I don't think we're going to run out of work to do and I think, but I do think that it's important that we the specific things we do are less important, because they're, but I think still we should, we should still be about access. And if we're not about access, and I'm not so interested, you know, because whether it's access because people don't have money, or because they don't have hospital, you know, whatever. So, so what's interesting is you get wound up in a good way of wound up when you're in these places, of how this actually fits in the larger system. And then you end up meeting more people that want to know, what do you think we could do? I mean, what's happening? So that's, that's exciting.

34:03

I don't know how you answer this question. But what are maybe the two or three things that you are most proud of as you look back?

34:12

Well, I think I think I'm most proud of carrying on Dick Smith's tradition in the medics program, as well as carrying his points of view to other programs. I mean, if you think about why I'm interested, or God interested or felt flexible enough to do the international stuff, a lot of it had to do with learning from him and how he, how he, you know, promoted the medics program both domestically and internationally. And, and he also, a lot of people don't remember that. When he left the Peace Corps. He was assigned by Johnson Lyndon Johnson to desegregate the US hospital system. In the deep south for Medicare. Yeah, yeah. Yeah. And he did that. His life was threatened many times. But anyway, he just had such a great way of Meeting people putting forth their ideas, making them stronger, you know what I mean? And being extremely culturally competent and doing it. So. Anyway, I'm especially happy to enable and, and even at MedX, because when I came to medical director and a medical director that really hadn't been physicians very long, you know, sort of how do you deal with difficult people I've got between thinking about how I learned from two people who aren't anything alike, but one is one was my father who could talk anybody into anything. And was famous for that. And Rs, people said, you can make your friends do things that you'd never in their right mind if done, which is a good skill if you work in PA programs, right? Anyway, and also so Dick Smith, those are, you know, two people to sort of take their their work goals, just their ways of operating. And if you could apply that it actually makes you pretty safe, intellectually or not threatened to it, it helps to do international stuff, it helps them go into some new places where you've never been before. And so a lot of places I've been, I would never have guessed. So I'm especially proud of that I'm proud of getting the medics program back into school medicine from the School of Public Health. I don't think it would have survived, not because there was anything bad about the School of Public Health, we just didn't fit in a culture. And then I think I'm especially proud of all the people I've mentored men, women, Tas over time, and I hear from a lot of people, even if it's just an email, updating me about what's going on with them or something like that, because I just think the people that we choose for a school in terms of at least medically, I think our processes are are correct. And we're picking the right, the right. And so I'm working on that. And I where I do worry sometimes that some of the newer program leaders don't know that I would like to see VA do something about that. But yeah, by us old farts to talk about that. Because it's not something you can put a write down legally, I wouldn't write it down, I think. But anyway,

37:17

I think I think if you think about the concept of the coaching tree, your tree is vast, the number of people that you have mentored that became program directors that are scholars that are respected in our profession is is incredible. If you think about the culture, as you described it coming up, how collaborative it was, at the beginning, the DNA of our profession is very collaborative for the educational tree. And I've seen that with all the people you've mentioned, Jim Hammond, Rod hooker, Jim Collie, Tony Miller, I need a quick and it's always been about us, not just about my program. So and I think you all deserve a lot of credit for setting the stage that way.

37:58

Thank you. I think those are those are both things that came from Dick and my dad, those are points of view of each of them that they really valued the various individuals that were, you know, in the trenches with them, wherever, wherever that was as good leadership. It is and and even was kind of fun, despite whatever the trauma was. So there you go.

38:20

Ruth, thank you so much. This has been really insightful really helpful for our audience. And I just, I'm so thankful for your time and talents with the podcast, it's to have somebody like you to share your time is really, really a special treat. So wish you the very best in the coming year. And thank you again. Well, we want to thank our guest Miss Republic for her tremendous insights into not only the creation of our profession here in the United States, but also the work that she's been doing internationally. And the incredible story she had to share about the way she grew up to tune in next week as we speak with Ian Jones, as we discussed the development of the PA profession in Canada. 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 news and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the official position or policy of the University of Arizona.