In many disciplines, argument is considered to be a tool for arriving at a good decision.

Oct 1, 2012

In many disciplines, argument is considered to be a tool for arriving at a good decision. It may or may not be associated with anger or conflict. It does imply disagreement about a specific topic or issue. Today, at the Institute, we are engaged in a discussion that rises to the level of an argument. We are debating the pros and cons of the inclusion of a Master of Physician Assistant Studies Program in our portfolio of academic offerings. Why the debate?

Those who support the addition of PA Education to the offerings in the School of Health and Rehabilitation Sciences see this as an important response to call for an increase in the number of health providers for primary care as suggested by a number of national leadership voices in the health care reform movement. As the SHRS grows and looks to expand its breadth and depth, PA Education provides a new dimension for connection across the care continuum and with colleagues in the School of Nursing and CIPSI. Increased enrollment in the SHRS benefits the whole Institute, as the burden of needed growth is spread away from current programs operating at or near capacity. The opportunities for supporting needs within Partners HealthCare institutions is yet another rationale cited to support PA Education at the IHP.

Those who do not support the addition of PA Education at the IHP have raised a number of relevant questions about launch of this new program. Concerns that have been raised are primarily pragmatic ones: Will this program be able to find appropriate clinical placements? Will the demand for PA placements compete with our current placements for students in the Nurse Practitioner programs? Will the addition of this new program confuse the community? Will there be jobs for PAs and for NPs in the Boston community and beyond? A few voices in this group also cite philosophical issues that are related to the historical tensions between the nursing and medical professions.

Sometimes when arguments are intense there is a tendency to attack the opposition, as opposed to the evidence being considered. Angry voices can sometimes overshadow the facts, or lack thereof. This tactic is one that is played out every day on television as we watch the electoral ads that play incessantly. Accusations of being misinformed, naïve, or self-serving reflect more on the accuser than they do on the accused. While we all know this in a rational sense, when our arguments are fueled by strong belief and conviction, then it is easy to rely on the instinct to criticize anyone who sees the facts and the situation in a different light. We shouldn’t back away from an argument, but we should all strive to do our best to remain civil, respectful, and evidence-oriented. There is no place for name calling at the Institute, even when we feel strongly about an issue.

As is true in every debate, both sides must look at the evidence, considering the goals and possible consequences of every choice. The reality is that numerous voices outside the Institute and within have asked us to consider this important question at this time. I believe that we are up to the challenge presented by the question, “should we have Physician Assistant Education?” In the end, the Institute and both of our fantastic schools will be fine. We cannot let our anxieties interfere with the goal of making reasonable decisions, using wisdom and evidence, to advance health care.

Later this year, probably in December, our Board’s Academic and Student Affairs Committee will make a recommendation to the full Board about PA Education at the Institute. At that point they will have the recommendation of the the School of Health and Rehabilitation Sciences, the Faculty Senate, and the Academic Council. The arguments will be heard and the Board will have the opportunity to weigh the pros and the cons of PA Education. The larger question, of doing the right thing at the right time, will most likely be front and center in their discussion.

The IHP’s wonderful tradition of innovation and leadership in health care should be continued, and it will. Life will go on at the IHP and our current programs will thrive, either way.



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