Dave’s Blog: Let’s Level the Playing Field


by Dave Mittman, PA, DFAAPA

I am not sure why some in the profession do not see why we must grow, must evolve. Why we have to change with the times, not for change sake, but because we have earned the change. Why if we do not, we will leave ourselves behind on so many levels.

What I’m talking about is the need for Full Practice for PAs. No, not practicing ALONE as some would have you believe, just practicing as we do today. No, not rejecting teams, or angering people who in reality have no business being angry, but just being who we already are. Just with a small shift, same as NPs have done in 22 states, PAs being responsible for what we do each day. Signing our names and by doing that saying “I did that”. Full Practice Authority and Responsibility. Something about that notion scares some of us. I am not sure why? Maybe you can tell me? To me it is the natural progression of all groups of people to want to grow and take responsibility for what they do. It’s what professions have always done. It’s what people do. Legally, the majority of NPs need to do this also. It is only in 22 states where they have Full Practice also. PAs now have some sort of collaboration in two and a hybrid of some aspects of FPA in one.

I was reading about the great Jackie Roosevelt Robinson. The man who played baseball for the Brooklyn Dodgers one block from where I grew up. He had limitations placed upon himself because of the color of his skin, not his skill. He was told by many people in his day to not to be the first to enter the major leagues. His life was threatened. He was told it was “too soon”. That there was “no need yet”. The Negro Leagues were fine and had great players with teams that did well economically. That it was too early to “rock the boat”. Jackie continually said he only wanted a chance to show America what he could do. He was not about rocking boats, nor was he trying to anger anyone. He wanted the same thing everyone else in his field had, the ability to determine his own future. His feelings resonated with me. I want the same only in PA terms. I want no parades, no medals, nor do I want to say I am an island, any more than Mr. Robinson could have been able to play baseball alone. He knew he needed teammates. He recognized he was part of a team but until the day he walked on the field, as a free and equal representative of his people, he also knew he was not fully a free man. Until the time when PAs own their own profession, take responsibility for it, and determine our own futures, we simply cannot be a fully free profession. To be beholden upon anyone else for the right to work after five, ten, twenty or fifty years of proving you are totally competent at what you do, robs you of your self-esteem. I don’t think we see what that does to us, but it’s effects are there. To have someone else responsible for your actions as a 35 or 45-year-old person is not healthy. To say that we are responsible for what we do, is all I want.

Full Responsibility or Optimal Team Practice will allow us to grow as a profession and as individuals. Our options will increase. We will walk and talk differently. We will look at everything we do in a different more positive light. And most importantly, we will join the ranks of every other medical, nursing and health profession who determine their own destinies every time their own Boards meet.

You can’t lead if the cards are stacked against you from the start. You can’t lead if the playing field is not level and ours has never been. You can’t lead if you are not willing to be responsible for yourself. You can’t lead if others already have significant advantages over you by legislation and by a system that legislates others to lead you. You can’t lead when the law says others have to “supervise” you every day of your professional life. Allow us to lead and I know we will show the world just how innovative, just how smart and just how committed we are.

All I want is a level playing field. If that angers some people, so be it. I am not worried about someone else’s anger. I believe they will see our point but even if they do not, the sky won’t fall. Everyone will eventually go back to doing what they do best. Our NP colleagues in 22 states have shown us that. But this goes farther than competing with any other profession. This is about who we PAs are and who we want to be. We could “leave well enough alone”. But that’s not how people progress.

Just ask Mr. Robinson.


Dave Mittman has been a PA and later NP leader for thirty years. He co-founded the LIU PA Program student society, was President of the New York State Society of PAs from 1978-1979 and served on the American Academy of Physician Assistants (AAPA) Board of Directors from 1981-1983. Dave was also the first USAF Reserves PA permitted to practice. Dave spent 9 years in primary care in Brooklyn, N.Y. and left to begin a career in medical publishing with Physician Assistant Journal. Dave has also won the AAPA Public Education award for leading the march in Trenton NJ to establish PA practice. Dave left PA Journal to co-found Clinicians Publishing Group (1990) and Clinician Reviews Journal in 1991. Dave has authored papers in publications as diverse as “Chicken Soup for the Expectant Mothers Soul”, “U.S. Pharmacist”, “The British Medical Journal” and others. Dave¹s paper in the BMJ was the first internationally written paper written on PA practice. Dave and a few very close PA colleagues co-founded the PAs For Tomorrow”” in 2012 which is a new national professional organization representing and advocating for PAs in an different way. Dave as spoken at hundreds of NP and PA meetings and always has some interesting thoughts on the future of both professions. Most recently Dave has been busy launching another dream; Clinician 1, the first internet community for PAs and NPs. Dave is married to his sweetheart Bonnie for 32 years and has two wonderful children.

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