On Friday, August 8, Dr. Jacqueline S. Barnett, DHSc, MSHS, PA-C officially closed an extraordinary chapter in her book and retired from the Duke Physician Assistant Program. Barnett has been at Duke for 10 years, serving in various leadership roles along the way. She was hired as the Associate Program Director in 2015 and following a national search, she was appointed Program Director in 2018. In 2021, she was promoted to full professor in the Department of Family Medicine and Community Health, and in 2022 she was named Division Chief. Dr. Barnett made history as the first Black Program Director and Division Chief of the Duke PA Program. She reflects deeply on her PA career, her legacy, and the profound impact of her time at Duke.
In this blog, we will share an interview held with Dr. Barnett as she reflects on her transition from Duke University and her grand entrance into retirement.
What first inspired you to become a physician assistant?
So, two things really inspired me to become a PA. The first was in the mid-80s when I worked at a community hospital on a psychiatric unit. Part of my job that I loved was helping with patient intake in the ER, because I got to work with a wonderful provider, who was an amazing teacher, compassionate, and excellent with patients. Later, I found out he was actually a PA. Although I had no idea of the PA profession, this stuck with me.
The second PA inspiration was a bit later in the 80s. I was a staunch advocate for the deinstitutionalization of patients from state operated psychiatric hospitals and to community-based care programs and services. 
During that time, I met a PA who provided healthcare to individuals with developmental disorders, many with Down syndrome. Watching the care this PA provided further inspired me.
A psychiatrist I’d worked with suggested I consider medical school but also recommended the PA program at George Washington University. This was the early 90s, before the internet, so I called, got the application, and applied. I had no idea what it really meant then, but I got in and was lucky to receive National Health Service Corps funding since I couldn’t afford tuition.
I’m grateful to GW for the opportunity to attend the program and for my wonderful experiences as a student. I returned to the program in 2001 and served on faculty for 14 years before coming to Duke. That’s a bit of my history on what inspired me to become a PA.
Can you share a bit about your path to becoming Program Director at Duke?
I never wanted to be a program director or a director of anything. For most of my career, I had been the first at something or a director overseeing personnel, budgets, and administrative duties, which often took me away from the people, patients, or students I cared about. So honestly, I wasn’t interested in being a director anymore.
A few years after earning my doctorate, the associate program director position became available at Duke. I was at George Washington University at the time, and I had said the only program I would leave GW for was Duke because I respected the mission so much. The Duke PA program focuses on increasing access to care, especially for rural and underserved communities, and supports veterans. That really aligned with my personal mission. I come from a disadvantaged rural tobacco farming community of about 1,200 people. I was the first in my family to graduate from college, and I watched many uncles return from war, wounded with little access to care.
When I arrived at Duke, I saw the program leaned strongly into that mission. I had ideas to better align program activities, especially admissions and student services. After about two years, the program director position opened up. I didn’t apply at first because I wasn’t interested, but after encouragement from program alumni and PA leaders, I put my name in on the second posting. By then, I was already in leadership roles managing a large grant, supporting accreditation, revising admissions, addressing health equity in the curriculum, and increasing the program’s digital footprint and use of technology, especially in admission and a federal grant.
I’m grateful I accepted the PD position. It has been a career and life changer for me and allowed me to create significant opportunities as well as access to PA education for many others.
Looking back, what were some of the most rewarding aspects of being a PA?
Some of the most rewarding aspects of being a PA are too many to name. Since high school, my goal has been to promote access to education, healthcare, and public health for all. The work I’ve done as a PA reflects what I consider my purpose in life.
I’ve often been the first in many ways: the first PA on a rotation, the first to receive an award, the first African American hired in a specific job, including this one.
Some of the most rewarding work came from my public health efforts. In 1996, I was a National Health Service Corps scholar at Johns Hopkins during the syphilis and HIV epidemic. We developed a curriculum to teach providers how to manage syphilis and HIV. I regularly used darkfield microscopy to diagnose syphilis and wrote one of the early grants for the Baltimore City Health Department to secure medication vouchers to promote patient access to these very expensive medications to treat HIV.
Other highlights include increasing student rotations in rural and underserved communities, developing the University of Maryland Eastern Shore PA program, volunteering with many organizations to advance PA practice and state laws, and advocating on Capitol Hill to increase National Health Service Corps funding. For example, I helped write PA practice laws and worked to create loan repayment programs for PAs in DC.
Serving on boards and advisory groups has been rewarding, but perhaps the most meaningful has been mentoring many PAs who have become leaders in the profession and creating many opportunities for others.
How has the PA profession changed since you first entered the field?
Okay. Lots and lots of change. When I entered the profession, there were about 50 accredited PA programs. Today, there are 318. The profession's growth has been phenomenal. In the early 1990s, there were around 20,000 PAs. Today, there are about 190,000 working in every state and specialty, seeing an average of 11.4 million patients per week, or 592 million per year, according to the NCCPA 2024 statistical profile.
Fewer PAs go directly into primary care now, although within our Duke PA program, about 40% of the past two graduating classes have done so. There are fewer veterans in the profession. The first three classes here at Duke were 100% veterans. Now I believe that number is closer to 4 or 5%.
PA education is much more expensive now. Tuition for many two-year programs is over $100,000, with total education costs often reaching $170,000 to $180,000. The degree has evolved from a certificate to a bachelor's, then a master’s, and now there’s talk of entry-level doctorates.
The name has always been an issue. The move from physician assistant to physician associate is ongoing. I think three states have adopted the new title, and about 30 constituent organizations in AAPA have changed their names to physician associate.
In 1992, only 44 states allowed prescription authority for PAs. Now every state, plus DC and US territories, allows it. The profession has gained more recognition and is often ranked a top healthcare career by Forbes and U.S. News. The PA model has expanded globally to places like Canada, the UK, and South Africa.
More PAs are in telemedicine. In 2020, 21% were participating, and that number is now 44%. There’s also been improved pay and reimbursement policies in Medicare, Medicaid, and TriCare.
Some challenges remain. Scope of practice laws vary by state, which can limit a PA’s ability to practice to their full training. While job satisfaction is high at 83.6%, about 6% report feeling burned out. The versatility and indispensability of PAs can lead to long hours and blurred boundaries between work and personal life.
So those are some of the changes across the profession. It’s very interesting.
Leadership and Legacy
What are some accomplishments you're most proud of during your time leading the Duke PA Program? How would you describe the evolution of the program under your leadership?
Leading the program through the 2020 COVID period and the successful submission of a modified self-study for accreditation, which all happened in 2020, was a tremendous time. We came out of COVID a stronger and more adaptable program with better integrated technology.
I aligned many aspects of the program to the mission, including scholarships, faculty searches, and admission, elevated staff positions, supported faculty promotions, created a framework and criteria for student scholarships, and worked with development offices for funding.
In 2023, I received a $500,000 pledge to support student scholarships from an alumnus and $75,000 to support longitudinal community events. Students used $800 of that $75,000 this year for a community event.
I directed changes to the curriculum that would better promote health equity and educate those who teach our students on what that looks like from an instruction and curriculum development perspective.
I created a committee structure to better monitor students in effort to promote their professional development academic success, and to better document and track the program ‘s continuous improvement efforts in alignment with the accreditation needs.
Transitioned the program data storage and management process from a primarily excel-based system to a software system that allows for better data visualization and analytics and that process is continuous.
I helped establish the Hamilton Carter Scholarship Fund with mission-based selection criteria. We now award $360,000 in student scholarships annually.
I helped write and served as the PI on a $2.3 million HRSA primary care training grant. We trained 41 clinicians in a mini fellowship and created a curriculum on substance use, evidence-based practice, and quality improvement, which was accessed by over 5,600 providers.
I worked with leaders across Duke to support student services, to create an environment of respect and inclusion, development of the IPEC Center, and served on committees to advance Duke Health.
Under my leadership, the program maintained the program’s high ranking and respect as a top PA education program. I collaborated with faculty and staff to expand the use of technology across the curriculum to support both student learning and patient care.
I think all became more appreciative of health equity and what it meant in PA education. We implemented more systemic processes, digitized student files, and used various educational platforms to better manage and manipulate data. We implemented a committee structure to better monitor student success. Everything was more aligned to the mission. We tried to make sure many curriculum-based decisions were based on data and not opinions, and better managed, collected, analyzed, and implemented it so that decisions were more data driven.
What do you hope your legacy will be at Duke and within the broader PA community?
I am a very hard worker, dedicated to a lifelong mission of service, and I look at that as my purpose in life. I am a straight shooter, an advocate, and an activist for health equity. I focus on developing faculty and staff and proving a student-centered education. I believe that all decisions related to curriculum, admission, scholarships, awards, and activities are about students and student-centered opportunities. Opportunities are created to support faculty and staff development and elevate them within the program and across Duke.
I worked to advance PA education, create opportunities, invested in uplifting others, and collaborated with many leaders across Duke and the PA community to support PAs and all the health professions programs. For example, last year, I worked with the NC Institute of Medicine supporting a Strong Nursing Workforce and payment models, which was published by the IOM.
Mentorship and Teaching
What has it meant to you to mentor students and future PAs over the years?
I would say mentoring students and future PAs over the years has meant everything to me to support those who will be the future of the profession. It’s really helped them understand the responsibilities it carries.
I have worked with PA students across the country who face various challenges within their PA education programs and were able to successfully graduate and are doing great things as PAs.
I have been a successful mentor to many faculty. I remember one faculty who basically given up on PA education. She reached out to me for advice about the next steps and opportunities. We spent about five hours on the phone, with me helping this individual see this was just a very difficult and challenging moment and to not allow it to ruin what could be and will be a great career.
As I sit here now, I can tell you this person is having a wonderful PA career. She’s one of the leaders in our profession and regularly speaks about my mentorship and how it changed her life’s career and trajectory. That’s what I can say about mentorship.
Reflection and Advice
What has this role taught you about leadership and education?
I think we need to do better educating others that PA education is not a cushy job. Leadership is not a cushy job. Many think PA educators get summers off and long breaks, but it’s hard work.
This role has taught me the importance of active listening and understanding the needs of the people you lead. Education and healthcare are ever-evolving, so you have to be adaptable and foster continuous processes of improvement. The 2020 COVID era taught us to adapt to change to survive.
You must manage conflict and understand the impact of misinformation on individuals and communities, and as a leader, help ensure our programs don’t perpetuate misinformation.
I think resource allocation is a struggle for most leaders and trying to make sure we are making the best investments to promote the success and professional development of faculty, staff, and students. Sometimes even if the funding is needed for a new software, piece of equipment, I always try to consider the value and if its overall impact is value added or value needed at the time.
It’s important to invest in and develop leadership capacity in others to advance the profession, especially PAs because we are young compared to nursing and physicians.
I see leadership as a responsibility to uplift and create opportunities for others, not just a position of power. I’ve tried to use any authority I have to advance the program, invest in faculty and staff, and bring in good people. It’s never been about me.
There is no perfect leader. I told people when I interviewed that I am an imperfect leader and will make mistakes but work hard to lead well and bring out success in everyone.
Shared governance is important. Leaders must trust those they lead, provide growth opportunities, and share leadership responsibilities because you can’t do everything yourself.
If you could give one piece of advice to the next generation of PAs, what would it be?
To get a mentor early in your career. It’s such a phenomenal career with so many opportunities and to really sit down with a mentor to help you think about your own strengths, your areas of growth, and to help you set that path early.
I was so fortunate to have a mentor who was my program director, who made many sacrifices to open doors for me. When I was not going the right way, she would say, “Nope, pull it up, pull it back.”
To this day, she’s still my mentor, and I probably give 90 percent of the success of my career to her guidance, mentorship, and support with both time and many resources.
To ask for help is not a sign of incompetence but one of professional growth. Medicine is challenging. Healthcare is a multi-aspect, fragmented system. People are sick and need help. Staffing shortages are everywhere in hospitals and communities. You can’t do it all, so you have to ask for help. That’s for PAs, nurses, physicians, and anybody in healthcare.
As the next generation of PAs, you need to be prepared to make sacrifices to promote success. You will have to make many sacrifices. As a student, you will have to make a lot of sacrifices to get through any PA program. It’s hard work, a lot of courses, a lot of credit hours, and in two years you have to learn how to take care of patients.
You won’t be able to work full-time, hang out regularly during the week or weekends with family and friends. You have to hit the books and not take shortcuts because it could impact patient health and outcomes.
You must invest in lifelong learning.
One of the most important things is not just to provide care to patients but to care about the patients who look to you for guidance and healing.
Looking Ahead
What are you most looking forward to in retirement?
I’m most looking forward to family time. I’ve sacrificed so much time with family and friends over my career, and especially the past 10 years. I’m blessed to still have two living parents, and I feel it’s my duty to support them.
I look forward to meeting with their healthcare providers, taking them to appointments, and driving them around. I’ll probably be their chef, cook, and maid, doing all kinds of fun stuff with them, and they are thrilled.
My godson and his family are in Japan, and we have a second grandbaby on the way. I hope to spend a lot of time in Japan soon with them.
I used to be very active and look forward to getting back to the gym, more walks, joining a tennis or pickleball team, and revisiting golf lessons I started over 10 years ago.
I live in a community with golf, tennis, swimming, walking trails, and pickleball, but haven’t taken advantage because I’ve been too busy. That will change soon.
I look forward to continuing my service work, advocating for the PA profession and rural and underserved communities, and working with various PA and health professional organizations to raise money for student scholarships.
With loan options decreasing, supporting scholarships for those entering healthcare fields will be important. My life goal has been to increase access to healthcare, so helping future health professionals access education will increase more providers in the workforce to provide patient care.
Looking ahead, I will travel soon. Within the next couple of weeks, we are headed to Europe and London to relax and explore other parts of the world besides the United States.
Any final thoughts you'd like to share with the Duke PA community?
I'm so grateful for the opportunity to have joined such a wonderful institution and PA program and to the faculty, staff, and students who are the absolute best PA education has to offer.
I truly believe that the opportunities I’ve had at Duke may not have been available to me anywhere else. As a child growing up, not in my wildest dreams would I have ever thought that I would have had the career that I’ve had.
I’m so grateful for the many people who took interest in me, opened doors, and sacrificed so much of themselves to promote my success. I just want to give back to others and pay it forward, and hope that I can continue to impact others and create opportunities for them.
That is truly the purposeful life that I will continue to live in retirement.
I can honestly say, as long as I have breath in my body, I will be working to support the profession, underserved communities, and as an advocate for health equity.
The PA profession not only changed the trajectory of my life and my family and our community, but so many other lives, families, and communities.
Check out more coverage on Dr. Barnett’s next chapter.
