Robert Blumm Physician Associate

Looking at the past and the future of Surgical PAs and NPs  by Bob Blumm, MA, PA-C, DFAAPA - August 30, 2011   From 1999 to 2004, I served as the Liaison to the American College of Surgeons representing the AAPA. Part of my job was to attend all general meetings of the College and particularly to be present at the Allied Health meetings as this is where APCs were discussed and decisions were born. This particular year of which I am writing was a positive forward move as some of the most important people in the College spoke to the issues of assistants at surgery. I am presently discarding all of my writings and paperwork of the last 20 years at my wife’s bequest but I am hanging on to a few so that I can do what I am attempting at this moment which is to bring the current APCs to an understanding of our past history and the projections for the future. On Oct 13, 1999 at 0830, a diverse group of practitioners and administrators descended upon the Mascone center in San Francisco to listen to four speakers who were the assembled first assistants from every group that has this honor. This group consists of surgeons, residents, PAs, NPs, CSAs, CSTCFAs, RNFAs, and Perfusionists, which at that time made up the bulk of assistants at surgery. They were handed a statement or Issue Brief: “The Surgical Physician Assistant---A Summary.” In addition to this brief, they received an article from the Journal of Trauma, Injury, Infection and Critical Care entitled: ”Use of physician assistants (generic) as surgery, Trauma House staff at an American College of Surgeons verified Level ll Trauma Center.” Dr. Fabri of Florida, then Chair of this committee, opened the meeting with a 10-minute talk followed by Dr. Ralph Doerr, who spoke for 35 minutes. Dr. Doerr spoke from his past experience as a Physician Assistant who had now been a surgeon for 25 years but was thoroughly conversant with the subject from a contemporary viewpoint at that time. Although some of his slides were outdated, and even far more a decade later, he spoke from the position of one of our strongest allies. The last two speakers spoke on the Role of the Nurse Practitioner in a surgical practice and the last on “Changing role of the CST in the future.” What would have been a lively discussion period was curtailed by the Chairman for discussion the following year by this same assembled group and additional new people from all surgical professions. Dr Fabri made the following statement: ”The total number of NP and PA graduates exceed that of MD graduates.” Thought: what does the AMA and the ACS think of this? Is this a problem for physicians? Do they perceive us to be a threat? How will they deal with this statistic? Dr Fabri added, ”(at that time) 49 states accept the PA/NP model, have verified their job description and has authorized their reimbursement for services rendered.” Thought: Is this considered competition? Is this considered a rationale for hiring APCs? Are they calculating the deficit to MDs medical reimbursement if both of these groups were independent? Dr. Fabri went on to say, “When MDs are employed in the backdrop of global fees, it allows mid level providers to perform preoperative exams, causes less confusion for family and friends, there is greater documentation, more significant findings, more detail and more communication.” Thought: Now that’s an epitaph! Dr. Fabri continued, ”In a surgical practice it would be usual and customary for a PA (and more recently additionally a NP) to perform and report on all aspects of the pre-operative workup. The PA would give the informed consent (now the duty of only the surgeon) as well, would do per-operative teaching. PAs (and now NPs) would perform the Discharge Directions; do moderation in the form of “rounds.” They would write the prescriptions for patients at discharge and during subsequent visits, orchestrate the post-operative care in both the hospital and the office.” Thought: MDs and DOs must give their own informed consent. If PAs and NPs engaged in the informed consent it would be the grounds for greater litigation's for these clinicians. From Dr. Fabri’s statements, some MDs can be led to believe that they can almost abandon their patients. We need to educate PAs/NPs on this matter as we are the secondary caregivers and the surgeon remains “Captain of the ship.” Dr. Fabri: “Surgery is teamwork. There is a greater affinity to practice as a team in surgery than there is in primary care. The College must look at new and exciting ways to promote the team. ”Thought: Great for PAs and NPs but I consider the Primary Care providers to be an important part of that matrix of the surgical team as they have a role in understanding and communicating their health history and treatment and can encourage the patient by being knowledgeable about the procedures. This needs to be covered in our conferences such as those of the AFPPA and the AANP and AAPA. Dr. Fabri: “Both PAs and NPs are listed as having substantial involvement in the First Assistant Role” Over this past decade, this has proven itself to be true, and Fabri was almost a prophet as his futuristic thinking relates to what has happened up to 2011 and the inclusion of more PAs and NPs into the surgical workplace. More than 2% of NPs are now in surgery, and their numbers will increase precipitously, and 27% of PAs are in this specialty. Dr Doerr than stated, “Issues to PAs relate to cost, competition, accuracy quality and medico legal. All studies suggest that PA employment improved access, efficiency and care. The added benefit is that surgeons can perform more surgery.” Thought: What’s to say? That’s great! He then spoke of the future but the numbers of PAs and NPs were inaccurate as they were out of date and are even more out of date in 2011 where there are 240,000 NPs and PAs .He projected that there would be 65,000 PAs in 2006 and that was correct. He projects that MD candidates will decrease. He has noticed that NPs are increasing every year and almost double the PA number and lastly he said that there would be lower compensation for MLPs. The PEW Paper suggested in that year that PAs should be considered as incorporated into the medical staff of an institution. This is now a reality in 2011. Present conditions (1999) will be modified as the current system undergoes an overhaul—it has! MDs are seeing Privilege Changes as suggested by the Regulatory Board of hospitals and HMOs. These institutions mandate verifiable training, education and competence based upon a clinical practice over a two-year period. Those Boards will determine the appropriate Scope of Practice, define competency standards and perform practice audits. Dr. Doerr believes that this will carry over to the PA/NP professions and that they too will have mandated competency exams to maintain or add to their current privileges. Summary: Dr. Cosgrove, then chief of Cardiovascular surgery at the Cleveland Clinic and I spent fifteen minutes in private conversation about PAs, who I was representing at this meeting. He has an international reputation and is proud that in 1999 he had 55 PAs on his team. I asked his opinion of their value and he stated that, “Neither the hospital or he personally could do without them.” Members of the APACVS and Dana Gray told me that NPs are lumped into this figure also which is interpreted as to their combined value. In closing both then (1999) and today (2011) it is suggested that NPs and PAs continue to develop a better relationship and strive to work in a cooperative collegial manner. We are well on that road as we go to each other’s conferences, share committee work and in general realize that our efforts to work as teammates will enhance patient care in the United States.                                                                 The Parable of the Talents Bob Blumm, MA, PA-C, DFAAPA The world of finance and the general economy took a surprise down spin a few years ago when the infamous Bernie Maedorf admitted to the fact the he could no longer pay his investor’s refunds as his Ponzi scheme had finally run dry. More than 19 Billion Dollars was invested in his huge opportunity to guarantee large dividends on a yearly basis whereas seemingly he and a few others were the recipients of this promise. Charitable institutions bought in, fund managers, hospitals, religious institution, an, in general, people with a dream that soon sounded too good. As early members pulled out, there was just not enough capital to reimburse the investors and his son’s had to turn states evidence on him. He received a 150 year jail sentence but the greater damage is the he destroyed people’s ability to trust. They had trusted him with their entire financial future and this misplaced trust created a bankruptcy situation.      The parable about the talents related to a rich man that gave three servants a large sum of money and told them to invest it wisely as he was going on a long journey and would return to check on their accomplishments. He gave one person 10 talents, another five and the last person received 1.  A talent was an amount of money so let’s call it a million dollars. The guy with the ten million bought a slew of Starbucks shops and people came in large numbers to purchase this superb $4.00 coffee and with his investments he doubled his 10 million which became 20 million. The fellow with 5 million bought many Dunkin donuts enterprises and he charged two dollars for his coffee and 99 cents for his donuts. He managed to double his money and now turned the five million into ten million. The last servant, when approached my his benefactor who had trusted him had placed the money in a safe mattress because he was concerned that his master was a hard task master and was petrified of losing the money. The master’s trust was certainly misplaced as fear and lack of imagination and creativity he did not even bring it to a bank with a minimal interest rating. This fellow lost it all and his one million went to the person who had made 20 million. This entire parable related to trust. What would these people do with their life and with his money?      How in the word does this make a connection with the PA and NP communities? I have sat on many admissions boards and have listened to the earlier members of the professions unfold their plan as it seemed like they would be looking to change the landscape of medical care in America by finding rural areas that needed their services or they would work with the geriatric populations. Years later we discovered that our trust was slightly misguided as they went into surgical specialties, large inner city and suburban practices and gained a reputation for being excellent providers. So, it’s true, they didn’t follow the dictates of their early game plan but they did use their training for the good of the people and entered new fields that embraced them with open arms. There was a small group like the guy with one talent, who took that medical knowledge, shifted careers like gears on a five speed and entered Law school or became creative in the field of Coding and broke down services to their multiple lower denominators to increase insurance reimbursement. This too is part of the American dream in that you can do and become anything as a citizen and the people who became affected were those that trusted their initial mission statement and those that lost the services of what could have been a good medical provider. There are many who like the ten talent person who have expanded their roles, have gone on medical missions, and have volunteered in disasters, functioned from their hearts not their pocketbooks. They are seen in oncology units, geriatric units, research, pediatrics, family practice. Some have become experts in mental health, in every sub-specialty of surgery, they placed their lot in learning cardiology and neurology and endocrinology so that they would be around to care for the baby boomers who would be utilizing all of their services. There is also the small number who joined the nation’s military so that they could both care for and actually be “in harm’s way” because they had strong nationalistic pride. I support all of my colleagues, PAs and NPs alike for your commitment, dedication and trust. You are making this a better health system and a stronger America. Let’s hope that out trust is not misplaced on a legislative level by losing what we have all planned on for our futures, Medicare and social security. If these stay intact we can feel the cozy blanket when we hit the cold  Days.                                                                     Looking at the past and the future of Surgical PAs and NPs Bob Blumm, MA, PA-C, DFAAPA From 1999 to 2004 I served as the Liaison to the American College of Surgeons representing the AAPA. Part of my job was to attend all general meetings of the College and to particularly be present at the Allied Health meetings as this is where APC’s were discussed and decisions were born. This particular year of which I am writing was a positive forward move as some of the most important people in the College spoke to the issues of assistants at surgery. I am presently discarding all of my writings and paperwork of the last 20 years at my wife’s bequest but I am hanging on to a few so that I can do what I am attempting at this moment which is to bring the current APC’s to an understanding of our past history and the projections for the future. On Oct 13, 1999 at 0830, a diverse group of practitioners and administrators descended upon the Mascone center in San Francisco to listen to four speakers who were the assembled first assistants from every group that has this honor. This group consists of surgeons, residents, PAs, NPs, CSA’s, CSTCFA’s, RNFA’s, Perfusionists, which at that time made up the bulk of assistants at surgery. They were handed a statement or Issue Brief; “The Surgical Physician Assistant---A Summary.” In addition to this brief , they received an article from the Journal of Trauma, Injury, Infection and Critical Care entitles;”Use of physician assistants (generic) as  surgery, Trauma House staff at an American College of Surgeons verified Level ll Trauma Center. Dr. Fabri of Florida, then Chair of this committee ,opened the meeting with a 10 minute talk followed by Dr. Ralph Doerr, who spoke for 35 minutes. Dr. Doerr spoke from his past experience as a Physician Assistant who had now been a surgeon for 25 years but was thoroughly conversant with the subject from a contemporary viewpoint at that time. Although some of his slides were outdated and even far more a decade later he spoke from the position of one of our strongest allies.  The last two speakers spoke on the Role of the Nurse Practitioner in a surgical practice and the last on “Changing role of the CST in the future.” What would have been a lively discussion period was curtailed by the Chairman for discussion the following year by this same assembled group and additional new people from all surgical professions. Dr Fabri made the following statement;”The total number of NP and PA graduates exceed that of MD graduates.” Thought- what does the AMA and the ACS think of this? Is this a problem for physicians? Do they perceive us to be a threat? How will they deal with this statistic? Dr Fabri added;” (at that time) 49 states accept the PA/NP model, have verified their job description and has authorized their reimbursement for services rendered.” Thought- Is this considered competition? Is this considered a rationale for hiring APC’s? Are they calculating the deficit to MDs medical reimbursement if both of these groups were independent? Dr. Fabri went on to say; “When MDs are employed in the backdrop of global fees, it allows mid level providers to perform preoperative exams, causes less confusion for family and friends, there is greater documentation, more significant findings, more detail and more communication.” Thought- Now that’s an epitaph!  Dr. Fabri went on to say;” In a surgical practice it would be usual and customary for a PA (and more recently additionally a NP) to perform and report on all aspects of the pre-operative workup. The PA would give the informed consent (now the duty of only the surgeon) as well, would do pre-operative teaching. PAs (and now NPs) would perform the Discharge Directions; do moderation in the form of “rounds.” They would write the prescriptions for patients at discharge and during subsequent visits, orchestrate the post-operative care in both the hospital and the office.” Thought-MDs and Dos must give their own informed consent. If PAs and NPs engaged in the informed consent it would be the grounds for greater litigations for these clinicians. From Dr. Fabri’s statements some MDs can be led to believe that they can almost abandon their patients. We need to educate PAs/NPs on this matter as we are the secondary caregiver and the surgeon remains “Captain of the ship.” Dr. Fabri; “Surgery is teamwork. There is a greater affinity to practice as a team in surgery than there is in primary care. The College must look at new and exciting ways to promote the team.”Thought- Great for PAs and NPs but I consider the Primary Care  providers to be an important part of that matrix of the surgical team as they have a role in understanding and communicating their health history and treatment and can encourage the patient by being knowledgeable about the procedures. This needs to be covered in our conferences such as those of the AFPPA and the AANP and AAPA. Dr. Fabri;”Both PAs and NPs are listed as having substantial involvement in the First Assistant Role”  Over this past decade this has proven itself to be true and Fabri was almost a prophet as his futuristic thinking relates to what has happened up to 2011 and the inclusion of more PAs and NPs into the surgical workplace. More than 2% of NPs are now in surgery and their numbers will increase precipitously and 27% of PAs are in this specialty. Dr Doerr than stated; “Issues to PAs relate to cost, competition, accuracy quality and medico legal. All studies suggest that PA employment improved access, efficiency and care. The added benefit is that surgeons can perform more surgery.” Thought-What’s to say? That’s great! He then spoke of the future but the numbers of PAs and NPs were inaccurate as they were out of date and are even more out of date in 2011 where there are 240,000 NPs and PAs .He projected that there would be 65,000 PAs in 2006 and that was correct. He projects that MD candidates will decrease. He has noticed that NPs are increasing every year and almost double the PA number and lastly he said that there would be lower compensation for MLP’s. The PEW Paper suggested in that year that PAs should be considered as incorporated into the medical staff of an institution. This is now a reality in 2011. Present conditions (1999) will be modified as the current system undergoes an overhaul—it has! MDs are seeing Privilege Changes as suggested by the Regulatory Board of hospitals and HMO’s. These institutions mandate verifiable training, education and competence based upon a a clinical practice over a two year period. Those Boards will determine the appropriate Scope of Practice, define competency standards and perform practice audits. Dr. Doerr believes that this will carry over to the PA/NP professions and that they too will have mandated competency exams to maintain or add to their current privileges. Summary: Dr. Cosgrove, then chief of Cardiovascular surgery at the Cleveland Clinic and I spent fifteen minutes in private conversation about PAs , who I was representing at this meeting. He has an international reputation and is proud that in 1999 he had 55 PAs on his team. I asked his opinion of their value and he stated that “Neither the hospital or he personally could do without them.” Members of the APACVS and Dana Gray told me that NPs are lumped into this figure also which is interpreted as to their combined value. In closing both then (1999) and today (2011) it is suggested that NPs and PAs continue to develop a better relationship and strive to work in a cooperative collegial manner.  We are well on that road as we go to each other’s conferences, share committee work and in general realize that our efforts to work as team mates will enhance patient care in the United States.                                                                                                  A Glimpse in the Mirror Bob Blumm, MA, PA-C, DFAAPA August 15, 2011 In my personal diverse reading program, I am presently engaged in devouring Ian McEwan’s Solar. This novel centers on a Nobel Prize-winning physicist who is fast approaching 60. Although he is no longer an academic titan, his reputation allows him to collect huge speaking fees and impassively head a government program to battle global warming. His personal life is another matter. An incorrigible womanizer, he has chased off four spouses with affairs and now a fifth wife has turned the tables on him. The story begins when the main character, the physicist, takes a shower and walks past a full length mirror and takes a glimpse at the person who stands before him. His hair is gray and starts two inches above his ears with the remainder bald. His chest has become soft and more female, as if he has breasts. His abdomen, which was once flat in his 20-35 years, began to slowly go through a metamorphosis at 35-50: it swelled annually by five pounds and he was caught “sucking it in.” Now, the 50-60 demonstrates the effect of human blubber on the skeleton of a male and he is confronted with a collapsed penniculis and has been unable to see his toes in a shower when looking straight down for the last fifteen years. Suddenly, his self confidence drains from him as the water drains from the shower. What am I trying to share with the readers of this article? Firstly, we have a need to occasionally place aside the medical literature and to read varied novels which give us insights into the realities of life and make us more interesting as professionals both to our peers and our patients. Secondly, from the narrative, I was able to draw an analogy of the effects of self discovery: glimpsing into a mirror, on both our personal and professional demeanors. I can recall when both my wife and kids chided me lovingly about “sucking it in,” as obviously they were far more aware than myself…the egotistical PA moving up the ladder of success, to a metamorphosis in my body habitus. What became a joke later became a matter of concern to those who loved me because I developed diabetes, hypertension and an enlarged heart. This began to equate into concern and the idea that I didn’t care about myself nor did I care that I had a family that loved me and that wanted me to live well into my seventies or eighties and that, at this rate, I was going to leave planet earth earlier than the timetable. This did affect my self confidence to a degree and my ego lessened because of the reality of the wages of lack of self control in diet and exercise. I wore my shirts outside as to not bring attention to what existed below my neck. I found it easy to become the butt of my own jokes concerning weight as I saw I was a lost cause. How does this relate to all of you normal PAs and NPs and your daily practice? Perhaps it’s an early wakeup call if you are at the “suck it in” stage of life. In that case, I am doing what I have always endeavored to accomplish: help my colleagues. But this also falls into a practice setting because we are lacking the ability to set an example for our patients who suffer from the same dilemma. We are not examples of what we are preaching to them. It’s sort of like a surgeon who is trying to convince a balding patient to get a hair transplant, when his own head looks like a shiny dome that can light the darkness. They are saying to themselves, then why has he not visited a colleague who does this procedure? For the obese patient, who is non compliant, it becomes a constant source of worry, agitation and frustration to the health care providers. My IM physician, Dr. Ed Hallal of Bay Shore, NY, maintains a healthy morphology because he constantly encourages his patients concerning diet and exercise. Lastly, what you think of yourself affects your ability to render the type of care that is essential for a health care provider. Focusing on our personal failures takes some of the steam out of our enthusiastic approach to patient care and we lose the ego that is necessary for a leader or clinician. To explain that remark more thoroughly, I mean to say that all leaders, every one of them, have an ego and with it the desire to be the best and to at least be successful in their challenges. As clinicians, we desire to use our knowledge and skills in a manner consistent with the other colleagues that we respect and to do so without impediment. If we discover the impediment, we then chose to focus on it and work hard on making changes. The old saying is that “tomorrow is the first day of the rest of our lives.” We can change personally and encourage our patients to refrain from look at past failures and look to future success. Our old stumbling blocks can become stepping stones to success. So, the end of the message is the same as the beginning. Slow down as we all work too hard, listen to your family that loves you and stop long enough for self evaluation: take a glimpse in the mirror.                                                                                                 Medical Personnel Returning from Combat Duty Position Paper sent by Bob Blumm, PA-C Past President ACC I am sending this paper to all agencies and forums to serve as a reminder that the ACC, which now serves NPs and PAs as an Advocate for the professions scope of practice, did in fact publish a white paper to honor and make a special pathway to those who served “in harm’s way” and upon returning to CONUS desire to further their education and become either NPs or PAs. We feel that they have given a part of their lives to serving in a time of war and that they deserve special consideration when applying to programs of advanced practice clinicians. The following is a joint effort of the executive committee 2-3 years ago demonstrating what we feel would best serve both professions as a “thank you for a job well done.” As we all know, America is involved in military action in the Middle East. This has increased the use of all military nursing and medical personnel. It has also exposed many of these caregivers to combat, trauma and other medical experiences and training that they could not have received in any other way. The physician assistant and nurse practitioner professions have extensive roots in military medicine. In fact, the first three PAs at Duke were Navy Corpsmen and the professions link to the military endures up until today. It is the same with the nurse practitioner profession, as many NPs were former nurses, medics and corpsmen. Today, both the NP and PA professions enjoy commissioned officer status in our armed services and are a vital cog in the wheel of military health care. The American College of clinicians recognizes these roots. Upon their return to our shores, nurses, medics and corpsmen should be greeted warmly and praised for their sacrifices. The College also thinks that their vital experience and training has created a new pool of potential students for NP and PA education. Most of these people possess the tools to become excellent leaders and clinicians. The College asks all PA and NP programs to look favorably on these veterans if they apply to their training programs. We ask that every program work to allow these people get the information needed to become NPs and PAs. We also request that our members reach out to NP and PA programs in their areas to advocate for their local returning veterans with military experience. In the near future, the ACC will design an outreach program to inform potential military of their post service opportunities as advanced practice clinicians. In summary, the College thinks that we are now at a unique period where qualified combat and trained RNs, medics and corpsmen will be returning to America. We would like to see those veterans who feel that they would like to become PAs and NPs embraced by the NP and PA professions, and we call upon our members to request that their local training programs act favorably regarding these applicants for future training.                                                                                   Interpreting Our Words Concerning Being Advanced Practice Clinicians         by Bob Blumm, MA, PA-C, DFAAPA - August 1, 2011          When you are a clinician, a speaker, a writer or politician you are faced with the problem of becoming a target of another individual who has different roots, different religions and traditions, different belief systems in general. My mother in law called it “Joseph’s coat of many colors,” while a fellow called Saul of Tarsus mentioned that he was “all things to all men.” Sounds like Saul would have been an aspiring candidate for public office as that comment would make him a magician, an exaggerator, narcissistic or just a liar. We are all different and our manner of speech reflects something of who we are. I like to write articles that cause people to gain insights but occasionally, because of my style or grammar or the absence of editing from a specialist, I am challenged or subject to slight scolding concerning the English language or perhaps the individual will stop reading altogether on the assumption that if one cannot put a sentence together intelligently then they are probably an ignoramus and not worth reading.    Ten years ago I wrote an editorial and while speaking of being a PA I described it as a "calling." Wow, that word calling can create a “tremor in the Force.” In a scholarly manner, this individual mentioned that he did not mean any disrespect but he had never heard a child say,” Mommy I dreamed that I would be a physician assistant some day.” As I relate his comment to both PAs and NPs, the follow-up was that he could not understand why anyone would do the same work as a physician for a fraction of the pay, a percentage of the respect and all the other fringe deficits that go along with the job. He did have a dream though, as he mentioned that if he were given the chance to convert his PA credential to an MD on just a say-so, he couldn’t think of any reason to decline. I agree to a point as if tomorrow I became Bob Blumm, MD, I would be one of the best advocates for the advanced practice clinician. He concluded his remarks with “I just don’t get it and never did. That’s why I haven’t practiced as a PA since 1982.”  As an author I am expected to reply to comments, so I apologized that I had upset him by using the word “calling.” I then added that although you haven’t practiced for 20 years, I see that you still have an eye for detail. I mentioned that it’s a shame that we lost him as a colleague because somewhere deep beneath the surface is the vestige of a PA. My reply was based upon his signature that still was associated with the PA credential. I have discovered that PAs and NPs choose to take this course of study for special reasons and that they have no desire to become physicians. We certainly are intelligent enough to become physicians but our decisions were made upon things such as lifestyle, limited obligation to a practice setting, less time in academic preparation, less malpractice insurance and more time to make commitments to be functional parents or mates. Some have even professed that they wanted to enter the work force sooner to begin to care for the sick and oppressed.    Another of the commonalities between PAs and NPs is that it is a first choice occupation for some but for others they have served as other types of medical or nursing professionals and this was yet another step up the ladder and may have been a mid-life choice. What we share in common is first that we have an inner commitment or calling or desire to help humanity by healing wounds of sickness, injury and disease. We have a commitment to continued learning and development of clinical skills and a deep belief that what we do and our new skills will make us better clinicians and even more of an influence on the health crisis that we face as a nation and over the earth. I think that many of my colleagues share my emotions and given a choice would make the same decision. Be proud of who and what you are, as you have studied and sacrificed so that you could become bread for those who are hungry and need to be touched by a health care provider who cares.                                                                       Sound the Trumpet, Our Forgotten Weapon Bob Blumm, MA, PA-C, DFAAPA July 31, 2011 Long before the days of telecommunications, military leaders used three strategies to inspire their troops. First, Commanders in the field would lead from the front and be an example and an inspiration as they became vulnerable and visible to both their armies and those of other countries. Secondly, the spoils of victory were displayed in the form of captives, riches and colors. They were not only displayed but they were shared with the troops. Lastly, there was the sound of the trumpet as it was the means of communication and inspiration. The trumpet awakened them, called them to arms, signaled when to turn or charge and gave forth the sound of victory. Today, I am sounding a trumpet utilizing one of the best sites to help PAs to find jobs and make mid career decisions. I am utilizing a website that has blessed many and continues to be a source of blessing as PAs find a livelihood. There are no hidden agenda here and Bill and Karen would like to see a few people that really care take the time to write an article or blog so that we are all communicating. But is there anything to communicate about? As our profession continues to expand there will always be new issues, important matters, difficult choices and a need to share our views. This is where you and I come in. We can share our thoughts agreeing or disagreeing respectfully for the purpose of bringing the PA profession forward. I don’t need to elaborate on the spoils of war as every PA can look into their own state and observe the actions taken by volunteer leaders to expand legislatively and to protect our profession from attacks from other professions. Louisiana is an example of a recent attack and the response is needed from that state’s PAs and their brothers and sisters in the profession across the nation. I am personally very involved with a committee of eight members and possibly two more in a drive to change our name from assistant to associate. The websites are carrying the news and there are places for you to communicate and send your personal message to the AAPA. We have over two thousand messages sent from PAs in one week. All of the advances that you are observing are due to the fact that there are volunteer leaders on a state, specialty and national front. The time spent is beyond your imagination but the fruits of our labors become evident to our members. Leaders need to lead from the front and sometimes take a stance that is important for the profession although members sometimes disagree or are not looking to the future. Leaders need to communicate with their members, their boards and with other leaders across the country such as we are proving with the name change issue. This is becoming the handiwork of this generation of PAs as they move into a place of leadership and servant hood. That’s really what it is all about, serving one another. The last strategy for an effective tactical victory is to sound the trumpet. It is an excellent means of internal communication and requires the cooperation of every website, every journal and every PA who has an address book of other PAs. The trumpet is the tool used to declare unity, pride and victory to the PA universe. This website is willing to be utilized as are many others because this issue will be brought to a successful conclusion. It remains our job to advertise our profession, to tell our patients who we are and what we do by proclaiming the fact that we are indeed caregivers and a part of the answer for a health care system that is spinning out of control. So sound the trumpet and send your letter and let it be a proclamation of what you believe and desire for the future of our profession.  *** www.associatenamechange.com***                                                                            Dilemmas, Opportunities, and Solutions in Common Robert M. Blumm, MA, RPA-C Copyright 2002 Jobson Publishing, LLC. Reprinted with permission by Clinician Reviews. Introduction  Comparing notes with an NP educator/clinician at a national consultants' meeting inspired this veteran PA to consider ways the PA and NP professions can team up to address their shared challenges. For me, this has been an exciting two years. I've had the opportunity to travel to sites around the country, comoderating at national consultants' meetings for a major pharmaceutical company. It was great to meet and befriend so many practitioners from so many places. This also was my first chance to meet Margaret Fitzgerald, MS, APRN, BC, NP-C, an NP educator and practicing clinician-and my comoderator. Margaret and I enjoyed the opportunity, together with some of the meeting participants, to dismantle many of the walls that exist between the PA and NP professions. Throughout our dialogue, I was reminded that we share common dilemmas and common opportunities-and reflected that together, we can find common solutions. Our Shared Dilemmas NPs and PAs share the issue of credibility, thanks to our powerlessness to be properly tracked by the pharmaceutical industry. How can we be credible when so many pharmacists unilaterally override us as the prescriber? Apparently, doctors experience this, too. I recently had a prescription filled at a chain drug store. Printed on my medication bottle, to my amazement, was the name of the first physician on the prescription slip-not the name of my cardiologist. The pharmacist had not made this choice because of a bias about my cardiologist's credentials (she is not a PA or an NP), and hopefully, not because of her gender; it was simply because another physician was listed first on her prescription pad. We first addressed this issue at the 1994 Clinicians' Conference in Connecticut, but to this day it remains a seemingly insurmountable problem. Would it be possible for our two professions to take on this issue-and perhaps come up with a satisfactory solution? Remember, there is strength in numbers. Our reimbursement problems, too, persist. I applaud the American Academy of Physician Assistants for its fine work in getting PAs approval for Medicare reimbursement-and the American Academy of Nurse Practitioners, the American College of Nurse Practitioners, and other NP organizations for diligently pursuing these matters on behalf of NPs. Yet until we have universal reimbursement, until every insurance company in the land is mandated to pay for services provided by an NP or a PA, then we remain restricted and our professions are weakened. This coming year will bring increased malpractice insurance rates for both PAs and NPs. Here, because of dramatic increases in our numbers, our patient loads, and our vulnerability, we shall share a fate similar to that of our physician colleagues. The Opportunities During the rapid metamorphosis of health care, each new challenge can be translated into an opportunity to promote ourselves and extend our overlapping roles. The burden of higher malpractice insurance premiums has impacted all of us-particularly the ob/gyn physicians. There is an acknowledged need for tort reform and a lowering of the malpractice ceiling. And yet, at the same time that we "nonphysician" clinicians partner with our physician colleagues to help, we must also consider the opportunity this situation presents. For instance: In cases where NPs and PAs share insurance companies, perhaps we could offer to help create a top-notch risk reduction course or program that will include a 10% premium reduction for each PA or NP who attends it. With the growing shortage of physicians and declining enrollments in medical schools, a dark cloud is forming on the horizon. Like Dave Mittman, publisher of this journal (and my contemporary, friend, and colleague), I shudder to look into the crystal ball. There, 20 or 30 years in the future, we see ourselves sharing a geriatric suite at University Medical Center. Who will be caring for us, and with what credentials? Will they be compassionate toward us in our motorized wheelchairs, or will they consider us a burden? And who will be staffing critical care areas? Will their roles change? Clearly, we must move together toward a vision of health care as we hope to see it! An additional opportunity arises with the proposed maximum 80-hour workweek for physician residents. It will be nice for residents to "have a life," but they will pay for it in experience-or the lack thereof. I can only reflect on my personal knowledge in surgery and emergency medicine; but after you've worked grueling hours and been pressed to the max, it's that ruptured abdominal aortic aneurysm at 3 AM that defines you and shows just how far you can really go. I've been there; I've felt that adrenaline surge. And I've found within myself the ability to run yet one more mile-to find gold at the end of the rainbow when the patient emerges from the hospital 10 days later. "We pay a price to gain a prize." It concerns me that despite the potential payoff of reduced errors, residents may pay the price of lost experience. Common Solutions How does all this affect each of us, personally and professionally? And how do we respond? Regarding the ob/gyn crisis, we can demonstrate our commitment to the health care team by extending our hands and becoming active partners with our physician colleagues in the realm of tort reform and other malpractice issues. By doing so, perhaps we can dispel the medical societies' fears and doubts concerning "midlevel providers." Of course, this may take time. Meanwhile, if ob/gyn physicians continue to drop obstetrics, this could be catastrophic for the many women who need prenatal and complete ob/gyn care. NPs and PAs will be affected, too-but they can choose to become part of the solution. The care needed for women to bear healthy babies may well be provided by certified nurse-midwives and by PAs and NPs who practice in ob/gyn. These NPs and PAs may then be motivated to pursue postgraduate studies, further qualifying them to take up the slack and fill in the holes-as we have so often done in the past. Likewise, we must find our fit in the shortfall of medical care that will result from the 80-hour workweek for residents. Residency programs are closing almost as rapidly as malpractice companies. Hospitals, medical centers, and government-funded agencies will all need to reach out to other qualified providers. We are those qualified providers. Surgical PAs function as first assistants and perform well in surgical intensive care. The new role of hospitalist has been successfully filled, thanks to board-certified internists and other physicians working in teams with NPs and PAs; this model has proven itself. In emergency departments, experienced PAs and NPs performing in a resident-like role successfully meet the challenges of overcrowding, dumping, and unnecessary visits. Conclusion Nurse practitioners and physician assistants are still the answer to the American health care crisis. We have the education, the experience, the commitment, the passion, the tools, the enthusiasm-and the numbers-to make a difference. If we each take one step forward, America will soon hear the marching steps of thousands from both of our professions, with thousands of voices expressing the urgent medical care needs across our country. Maybe then, people will no longer ask, "What is a PA?" or "What is an NP?"-because they will have experienced firsthand the excellent treatment that defines our roles. Where do we fit in the vision that I have described? Where do we see our respective and collective professions in the next three years? The next ten? Are we ready to risk becoming proactive, working toward a healthier America-starting today? I, for one, vote yes. Together, let's make the years 2001 to 2010 known as the Decade of Progress, forged by our professions! Robert M. Blumm has practiced in plastic surgery for 30 years and owns a private first assistant business. He acts as a preceptor to PA students from the State University of New York-Stonybrook, the New York Institute of Technology in Westbury, and Touro College in New York City. Currently Chairman of the Surgical Congress of the American Academy of Physician Assistants (AAPA) and the AAPA Liaison to the American College of Surgeons, Mr. Blumm is a past president of the New York State Society of Physician Assistants and the American Association of Surgical Physician Assistants.                                                    Copyright 2002 Jobson Publishing, LLC. Reprinted with permission by Clinician Reviews. Physician Associate: A Change Whose Time Has Come We, the undersigned physician assistant leaders assert that the time to change the name of our profession has arrived. While we can debate much about a name change, we have all agreed to the below statements and thoughts. We also fully agree that the name change advocated below will advance the profession. We call on the leaders of the profession and all PAs to announce and start to implement this change as soon as possible. We are leaders who believe it is increasingly unwise to wait longer to make this long-needed change. Collectively, the below-signed PAs have given much of their lives to the profession and are dedicated to its advancement. Why We Need a Change Our profession’s original name was physician associate. Physicians demanded that “associate” be changed on the grounds that it did not properly describe the desired scope of PA practice. Forty years later we have outgrown the "assistant" title. It no longer accurately represents the profession. It is inaccurate and confuses consumers. The title is misleading and carries negative connotations which we can and should avoid. As we move into a new model of healthcare delivery it is of the utmost importance that our profession’s name accurately describes our role. Why a Change Is Justified -- The PA role is truly one of partnership; of association and collegiality. We work as associates and have for many years. Our profession’s birth-name in 1965 was physician associate. -- “Physicians assistant” is a generic term. It can mean anything: a person in the office that bills patients, a records assistant, the person that sets up and cleans the exam room, all the way to a certified, licensed PA. The profession must move from this generic name to one that aptly and more accurately describes our function -- In our society, "assistant" denotes a technical job, not a profession. -- PAs are held to the same legal and medical standards as physicians. -- The title is confusing and misleading to our patients and the public in general. Since the name practically guarantees that “physician assistants” will be confused with “medical assistants”, patients are at risk of thinking they are receiving substandard care or expect that after the “assistant” a physician will also be seeing them. Most times this does not happen, nor does the physician or the PA expect it to happen. It is time to have the name mirror the reality that exists. -- The internationalization of PAs is important to the profession. Having to explain that the common meaning of the name “assistant” under-represents our true practice is a barrier, in international forums, to full understanding. -- The above problems also may keep prospective applicants and others away from becoming PAs as they would not want to go through extensive schooling only to become someone's assistant. -- Almost all professions at the level of training of a PA (pharmacy, PT, OT, NP) are or soon will be at the doctorate level. Our education and practice is professional, as should be our title. -- “Assistant” obscures the PA's true role in the practice. Physicians who might otherwise consider a PA do not hire one as they feel they need someone more than just another "assistant". -- All professions should be able to name their profession. “Physician Assistant” both demeans and misrepresents our profession. It is time to claim the name that is both appropriate and our birthright and discard the one that was forced upon us. The Process -- The profession, ideally through the AAPA Board or HOD, should immediately adopt a policy that states that "Hereafter the profession will work to be retitled "Physician Associate," as it more accurately reflects the profession in the 21st century". -- If the Board or House is reluctant to do this on their own, then the entire profession should be polled using the AAPA's full database. -- This renaming can be done over a number of years, with the ability reserved to use either title in the interim if necessary, depending on state legislation, etc. -- The PA profession should advise organized medicine that this change is not an effort for independent practice but is a move to more accurately describe the scope and status of the profession and place it at a level where it belongs. It should also be explained that the name physician associate had been chosen for us by organized medicine to represent the PA profession 45 years ago. PAs should stress that after 45 years of delivering quality medical care across the entire spectrum of practice, we are choosing a more appropriate name and that we would expect nothing less than the full support of organized medicine, which will also benefit from the change. -- PA programs should include the name physician associate whenever possible--along with the title physician assistant if need be. -- “Physician Associate” allows us continued use of the initials "PA", which are well-known to the public. -- “Associate” does not imply that PAs are equal to physicians. Associate professors are not full professors. Associate deans are not full deans. There are precedents for this. -- The profession should consider funding State-level efforts to effect this change. -- The argument that a change will open laws at the State level is a hollow one. This action can be introduced as a "cosmetic" name change amendment which will have no impact on PA practice law. If opposed, the profession can educate the legislature as to the source of the opposition, that we are asking for no increased privileges, and the current title is confusing consumers and others -- This name change should be done BEFORE the profession embarks upon any large public relations campaign. We can effectively brand the profession through the use of the new name, avoiding any confusion of our status when compared with medical, podiatry, chiropractic and other assistants. Therefore, we the undersigned PAs declare that because of the above reasons and more, the PA profession should adopt the name "Physician Associate" and begin an educational campaign to other medical professionals and the public regarding Physician Associates. 1. Robert M. Blumm, MA, PA-C, DFAAPA, Immediate past president APSPA, Past president AASPA, Immediate past president ACC, Past president NYSSPA, Past AAPA Liaison To ACS, ACC Liaison to ACS, Past Chair Surgical Congress AAPA, Editorial Board Advance for PAs, Clinician 1, Advanced Practice Jobs, past editorial board member Physician Assistant, Clinician News, Author, National Conference Speaker, Consultant, Paragon Award Winner Physician /PA Team, John Kirklin M.D. Award for Excellence in Surgery 2.Robin Morgenstern, PA past AAPA Secretary, past president Illinois Academy of PAs, past Director of the PA Program of Cook County Hospital, Chicago, Past Midwest Advertising manager Clinician Reviews Journal. 3.Maryann Ramos, MPH, PA-C, Founding President NJSSPA, Secretary of the AAPA House of Delegates, Delegate or Alternate for many years; Current Member, Nominating Committee; Current Legislative Chair for Physician Assistants for Latino Health - Puerto Rico; Past President American Academy of Physician Assistants in Occupational Medicine; Established Liaison between occupational physicians and PAs and Affiliate PA Membership in ACOEM; Awarded the Meritorious Civilian Performance Medal, US Army Medical Corps, 2008; Past Federal Civilian PA of the Year 2002(AAPA Veteran's Caucus); Past PA of the Year (AAPA President's Award 1980) 4.Blaine Carmichael, MPAS, PA-C, DFAAPA, Co-Founder Association, Past president, Vice President and current Delegate at Large of Family Practice Physician Assistants, Founder Bexar County PA Society, Founder, Que Paso - What's Happening PAs of San Antonio, Moderator of PRIMARY PA forum, Board Member, American College of Clinicians, Founding member of PA History, Texas PA of the year, 1990, has published widely and speaks at many national, state and local PA conferences 5. Dave Mittman, PA. Past AAPA Director, Past President NY State Society of PAs, Co-Founder and creator Clinician Reviews Journal and Clinician 1. Medical Communications Expert. First PA in the USAF Reserves. Lifetime PA Achievement Award/President'sAward NJSSPA and NYSSPAAAPA National Public Education Award Winner-1983 6. Frank Rodino, PA, MHS, Past Public Education Chair AAPA, Past NYSSPA President. Currently President and CEO Churchill Communications: A Medical/Scientific Communications Company 7. Thomas Roselle, PA-C Past NYSSPA Consultant, PA Entrepreneur, Clinic Owner 8. David M. Jones, PA-C, MPAS, DFAAPA, Member, Past Governmental Affairs Council, AAPA Legislative Co-Chair for at least 10 years, Oregon Society of PAs (Chair for the 2009 session), Past President of OSPA (twice), AAPA Co-Rural PA of the year 1988; second term as a member of the PA Committee, Oregon Medical Board 9. Roy Cary, PA-C, DFAAPA Co-founder and past president of The American Academy of Physician Assistants in Legal Medicine. Co-founder in Cary & Associates, LLC and holds a position as Senior Partner. Mr. Cary is also a member of the Physician Assistant Advisory Committee of the Nevada State Board of Medical Examiners. Retired Air Force Major. 10. James R Piotrowski, PA-C, MS , DFAAPA , Co-founder Association of Neurosurgical Physician Assistants , Past president of ANSPA , Past Vice President and board member of FAPA , Co-founder of the FAPA-PAC , Past member Florida BOM PA Committee, Past Trustee of the AAPA PAC and Chairman of the AAPA-PAC , Past PA member of the council of AANS and CNS, Past editor of the ANSPA 's Journal. 11. Lisa D' Andrea Lenell, PA-C, MPAS. Internal Medicine PA, Adjunct Faculty Midwestern University, National Radio Host ReachMD XM160 12. Michael Halasy, MS, PA-C Health Policy Analyst/Researcher Author of well known PA Blog 13. Gary Falcetano, PA-C, Bariatric Medicine, Stockton NJ, Managing Director – Collaborative Clinical Communications, LLC. Captain (Ret.) US Army Reserve, Past Group Publisher Clinician Reviews / Emergency Medicine / Urgent Care, journals. 14. Charles O'Leary, PA-C, Hominy Family Health Center [FQHC], 35-year practice same site; LTC [Retired] US Army/OKARNG [2 tours Afghanistan, awarded BSM/CMB]; past-OAPA Vice-President, Past OAPA Newsletter Editor, 1992 Oklahoma Rural PA of Year, OU-Tulsa Medical College PA Preceptor, Past Hominy School Board President, Past Commander American Legion Post 142 15. Gerry Keenan PA-C, MMS, Emergency Medicine, Bar Harbor, Maine 16. Martin Morales, PA MHA. Director, Physician Assistant Services, Long Island Jewish Medical Center / North Shore LIJ Health System. 17. Stephen E. Lyons MS, PA-C, W .Cheyenne Clinic Coordinator, Take Care 18. Robert Nelson, PA-C. Executive Director, Island Eye Surgicenter, LI, NY. Administrator a various surgicenters in NY metropolitan area, Author, Speaker, Director at Large-Outpatient Ophthalmic Surgery Society, Member Corporate Development Planning Committee OOSS, Consultant, Surgical PA 30 years. 19. Eric Holden, PA-C, MPA, EMT-P 23 years of practice in emergency medicine.Member of state, federal, and international disaster medical teams. Medical provider at level 1 and 2 trauma ctrs, HMO's, community E.D.'s, rural/under served E.D.'s, and solo provider at high acuity inner city facility. Author of multiple articles in peer reviewed medical journals. 20. Rebecca Rosenberger, MMSc, PA-C, Current President AAPA-AAI 21. j. Michael Jones, MPAS-C, Chair PA Section American Headache Society, Director Cascade Neurologic-Headache Clinic.. 22. Pamela Burwell, MS, PA-C. Distinguished Fellow, AAPA .Founder and Director, Peacework Medical Projects. AAPA Humanitarian of the YearArizona PA of the Year 23. Eleanor H. Abel, RPAC, MS, CRC Upstate Medical University, Syracuse-current District B Director At Large, NYSSPA. Liaison and membership chair for NYRCA. Medical provider with 22 years of experience in Hematology/Oncology and previously employed in Surgery and also Physical Medicine and Rehabilitation. Specialize in pain management, advocacy for people with disabilities, Past coordinator and current assistant coordinator for the NYSSPA Public Education Committee 24. Ronald H. Grubman, PA-C Founder, Conmed Inc., 1984. President and CEO for 23 years. Conmed acquired and currently a public company on the NYSE. 25. Ken Harbert, Ph.D., CHES, PA-C, DFAAPA Dean, School of Physician Assistant Studies. South College, Knoxville, TN 26. Eric Schuman, MPAS, PA-C. Adult & Pediatric Neurology Kaiser Permanente Portland, Oregon. Adjunct Assistant Professor, Oregon Health & Science University Physician Assistant Program 27. Charles A. Moxin, MPAS, PA-C, DFAAPA, Past President Association of Family Practice Physician Assistants, Past AAPA HOD delegate for Family Practice, Past Editorial Board member for Arthritis Practitioner, Author, National Conference Speaker, Pharmaceutical Advisory Board member 28. Kenneth E. Korber, PA PhD(c): Director of Strategic Development - CE Outcomes LLC, Curriculum Architect - First PA Postgraduate Fellowship in Cardiovascular Care, Clinical Associate University of Illinois College of Medicine, Past Member Board of Directors: Association of PAs in Cardiology, Member - Association of Postgraduate PA Programs, Founder - AAPA Medical Writers Special Interest Group; former Faculty - AAPA Chapter Lecture Series. 29. Kenneth DeBarth, RPA-C, Past President NYSSPA, Past NYSSPA Newsletter Editor, Past Secretary/Treasurer South Dakota Academy of PAs, founding editor SDAPA newsletter, past chair AAPA Professional Practices and Relations Committee, former owner Heuvelton Medical Group, NY. 30. Ryan O'Gowan, PA-C, FAPACVS. Acting Manager, NP/PA Critical Care Workgroup. Program Director Physician Assistant Residency In Critical Care Umass Memorial Healthcare 31. Chris Hanifin, PA-C. NJSSPA Immediate Past President 32. Cindy Burghardt, MS, PA-C, Nephrology PA for Renal Associates, San Antonio, Texas. 33. John Sallis, MBA, MMS, PA-C PA consultant -Negotiation management 34. James Doody, PA-C Director of Pediatrics and Primary Care 1st Health Centers, Assistant Clinical Professor University of Colorado Health Science Center, former Director of Pediatrics Lake Grove School, Editorial Board Member Physician Assistant Magazine, Provider liason Medical Home Initiative for State of Colorado. 35. Karen Fields, MSPAS, PA-C Founder of Medical Mentoring (medicalmentors. net); Cofounder PAWorld.net 36. Richard Mayer, PA. Vice President Provider and Network Development. Lenox Hill Hospital, NY NY 37. Sharon Bahrych, PA-C, MPH, listed in Marquis’s Who’s Who of American Women, published author of 60 lay and medical journal articles, state and national CME presenter,co-founder of APAO, clinical trials researcher with a NIH rated grant, currently working on a PhD. 38. George Berry, MPAS, PA-C. Pediatric Trauma Coordinator Regional Pediatric Trauma Center, Schneider Children's Hospital North Shore-Long Island Jewish Health System 39. Lisa F. Campo, MPAS, PA, DFAAPA; Past President NYSSPA. Former Chief Delegate/ delegate AAPA HOD; former Committee member Wagner College PA Program Advisory and Admission Committees; President LCFC-LLC Consulting; Advanced Clinical Physician Associate the Mount Sinai Medical Center; practicing PA 30 years. 40. Kristina Marsack, PA-C, President, Association Plastic Surgery PAs, past-Treasurer, APSPA 41. John W. Bullock, PA-C, DFAAPA. Past Chief Consultant to the US Air Force Surgeon General for Physician Assistants, Founding member and past Vice President of PAs in Orthopaedic Surgery. AAPA Federal Services PA of the Year. 42. William Gentry, MPAS, PA-C Senior Physician Assistant-Neurology Audie L. Murphy Veterans Medical Center 43. Harmony Johnson PA-C, MMS President, PAs for Global Health 44. Cristobal E Perez, PA-C Faculty Associate, Department of Neurosurgery. UTHSCSA 45. Frank Crosby, PA-C One of first PAs to practice in UK 46. David L. Patten, PA-C, COL, SP, TXARNG. Deputy Commander for Texas Medical Command 47. Michael France, CCRC, MPAS, PA-C, Director of Clinical Research, Alamo Medical Research, MAJ USAF Retired 48. Robert L. Hollingsworth, DHSc, MS, PA-C. Owner, Sole Provider Red Springs Family Medicine Clinic, N.C. Preceptor for the Physician Assistant Programs at Methodist College in Fayetteville, N.C, Duke University in Durham N.C. and East Carolina University, in Greenville, N.C. Active preceptor for several Nurse Practitioner Programs within the state. Former Instructor: Methodist College Physician Assistant Program 49. James C. Allen, IV, MPAS, PA-C, DFAAPA; Director, Physician Assistant Clinical Training Programs, University of Texas Medical Branch-Galveston/Correctional Managed Care; Former Secretary Bexar County PA Society 2003-2005; Dual Certified Aerospace Physiologist; US air Force Aerospace Physiologist of the Year 2003; Past President Towner-Shafer Society, US Air Force 1993-1994; Retired US Air Force Major 50. Michelle Ederer, MA, RPA-C Past President, New York State Society of PAs                                                                                                                             Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.