Dean Sharon Anderson's message to graduating Physician Assistants

Aug. 7, 2018

Good morning and welcome, everyone! In addition to having the honor of serving as the dean of the School of Medicine, I am also a nephrologist (kidney specialist). You may recall that I explained the mysteries of the anion gap in your acid-base lecture early in your first year. And I have enjoyed working with some of you on rotations on the renal consult service.

I am truly honored and thrilled to be today to celebrate with you.

Before I say a few words to our graduates, I too want to say something to their families and friends:

Thank you!!

For many of you, the dream that your students are about to realize has been a shared dream. Your steadfast belief in your students has been the wind in their sails. You helped them get through.

I also want to thank our teaching faculty, the staff, and the P.A. program leadership. Dr. Ted Ruback and now Dr. Glenn Forister, Dr. Pat Kenny-Moore, and Dr. Gopal Allada are deeply committed to teaching the next generation. Their commitment shows in the success of each and every one of you.

I am also grateful to our many volunteer faculty and community providers, who give their time to teach our students.

And now I have some words for our students.

You are here today because you want to make a positive difference. But altruism is not the only reason.

You are here because you successfully competed for a spot in a program in which only about 3 percent of applicants are accepted.

And you are here today because YOU DID IT! You have earned your Master of Physician Assistant Studies degree.

CONGRATULATIONS!

Now, a little bit more about why it means so much to me to be here today.

First of all: in my book, P.A.s are rock stars.

The OHSU P.A. Program was founded in 1995 – under the leadership of its founding director, Ted Ruback – and in this short period of time, the program has risen to be ranked #5 in the nation.

And I want you to know that I personally have the greatest respect for you as individuals, for this P.A. program specifically, and for the P.A. profession in general. You are a critical part of the health care team, and that will be even more true in the future.

You go where you're needed, and you do the work that needs to be done. You are key to meeting health care needs across our communities.

23 percent of our P.A. graduates practice in rural settings, and 19 percent practice in medically underserved communities.

Your can-do culture is shaped by your history, and the story of your profession is truly inspirational. There is a great video on the website of the American Academy of Physician Assistants, as well as an interesting article in JAAPA in 2012, which I learned about from Pat Kenney-Moore's article on the Oregon Medical Association website.

These sources note that in the mid-1960s, it was recognized that there was a shortage of primary care physicians.

To help remedy this, Dr. Eugene Stead, who was chair of the department of medicine at Duke, put together the first class of P.A.s. Dr. Stead was truly ahead of his time – he had long been interested in breaking down barriers in medical education – think interprofessional education.

While at Emory University, he had worked with third- and fourth-year medical students as hospital staff at a time when all the interns had been drafted into World War II. He also tried to develop a program that could have led to nurse practitioner training, but that was opposed by the National League of Nursing.

Undeterred, he went on to create the first P.A. program, with a class consisting of four veterans who had been military medics in the Vietnam war. He based the curriculum on his knowledge of the fast-track training of doctors during World War II. The first P.A. class graduated at Duke in 1967, and the profession has grown worldwide ever since.

The fact that many Vietnam war medics found meaning and well-being as P.A.s shows that your profession is rooted in honor, opportunity, compassion and service.

As you know, veterans remain a significant part of your cohort today. Nearly 5 percent of last year's incoming P.A. class are veterans.

Could all of our students and audience members who are veterans please raise their hands? Let's give them a round of applause, to thank them for their service.

Your veteran origins are one reason why I identify with you. My first experience caring for veterans was in medical school, during my third-year medicine clerkship at the New Orleans VA. I have been proud to care for veterans during most of my career, including serving at the Portland VA since 1991.

Many veterans who become P.A.s go on to care for other veterans.

P.A.s are a critical component of the workforce in VA hospitals. I can personally attest to their essential role in rural Oregon. Two days every month, I travel to the Roseburg VA (about 180 miles south of here), where I am the only kidney specialist for all veterans south of Salem.

In Roseburg and its affiliated, very rural community-based outpatient clinics, many of the primary care providers are P.A.s. In fact, a number of veterans in southern Oregon actually get their primary care through telehealth visits with a P.A. at the Boise VA, believe it or not! That might not sound optimal to you – but it's a heck of a lot better than not having primary care at all, and the veterans are provided with all VA services including medications and access to specialists, such as myself. All of these P.A.s are enthusiastic, engaged and ready to do whatever it takes to help their patients, in the true spirit of service. It is my great pleasure to work with them.

You have also carried forth your commitment to service well beyond your individual patients.

You are engaged in a whole range of outreach projects – from food and clothing distribution, to vaccination clinics for kids, to policy writing for the Oregon Medical Association, to engaging middle- and high school students in the health sciences. And you joined students from other OHSU programs to open the entirely student-run Bridges Collaborative Care Clinic last year, caring for the underserved. And those are in addition to all the health promotion and disease prevention projects listed in the program. These are wonderful accomplishments.

You are also leading our health professions schools at OHSU in diversifying the face of medicine.

In your class, 73 percent are women, 22 percent are from rural areas, 17 percent are first-generation college students, and 17 percent identify as belonging to a minority group that is underrepresented in medicine.

Your program leaders worked to achieve this diversity;they understand that it takes multiple perspectives and backgrounds to devise innovative solutions to complex problems, and to meet the needs of all of our patients.

It's also just a whole lot more exciting to be part of a class, and a profession, where you can expand each other's horizons.

What you are doing is working.

P.A.s are now practicing not only in primary care, but across multiple specialties and in a broad range of patient settings, including very acute inpatient care.

Just recently, the Oregon Medical Association appointed its first ever P.A. to its executive committee: Dr. Pat Kenney-Moore, your associate program director.

In addition, the OHSU Practice Plan, which includes all providers at OHSU, just elected the first P.A. to its board of directors. Alex Nydahl is a 2015 graduate of this program, and a clinical preceptor for P.A. students on their inpatient hospital medicine rotation at OHSU. Kudos to Alex.

We are delighted to have Alex join us in leadership of the practice plan, and this is further affirmation of the importance of P.A.s in our modern healthcare teams.

Going forward, there are many challenges facing the health care profession nowadays.

There are not enough of us to be able to care effectively for a population which is aging and therefore needing more health care as they experience heart failure, dementia, kidney disease, and other diseases that are over-expressed in the elderly.

We need to continually get better at designing our healthcare teams to maximize our efficiency, and to develop innovative new ways to care for patients beyond the traditional face-to-face visit.

External stresses, such as continuing downward pressures on hospital, clinic, and provider reimbursement, and wavering support for universal coverage, will further challenge us to care for all of our patients.

We all need to use our voices to advocate for what's best for the patient – including fighting for continued movement away from fee-for-service and toward value-based care reimbursement. I applaud you for helping us participate in these important national conversations, and we need your voices going forward.

As you go forth, I encourage you to keep pushing the envelope. Keep looking for more ways that you as P.A.s, we as physicians, and the other members of our interdisciplinary healthcare team can always do the best for patients.

You are the future: for health care, for our society, and for our planet.

Use your voices.

Share your insights about what your patients really need.

Advocate for best practices with your healthcare team, your hospital or clinic administration, your professional society, and our legislators.

If you are offered a chance to take an administrative role and increase your voice and your influence that way, talk to a mentor to see if it's right for you and if so, take that opportunity – just as Pat and Alex have done.

When you see a call from your professional society to send a letter to legislators advocating for something you believe in, click the button and send the letter.

And, always, ALWAYS vote!

It's who you are, and it's what you do.

Thank you again for having me as your speaker. You are a treasured asset of the School of Medicine, and I am so very proud of you.

Congratulations, and I look forward to working with you in the next phase in your careers!

Photo: School of Medicine Dean Sharon Anderson gave the keynote address at the Physician Assistant Program Graduation Aug. 4. Photo by Aaron Bieleck.