Called Up to the Big Leagues
My journey to the American Academy of Physician Associates (AAPA) House of Delegates started last year, when I was elected to our PA program student government. I served as one of Duke’s representatives for the AAPA Student Academy with my classmate Chris Marshall. The Assembly of Representatives (AOR) mimics AAPA’s House of Delegates (HOD) and introduces student leaders to our profession’s governing structure. As the representatives for our program, Chris and I were encouraged to solicit ideas from our student body that we could bring forward in the annual AOR meeting.
What issues do PA students face? What problems would PA students like to solve?
Chris and I raised these questions in our Stead Society officer meetings and monthly program-wide forums. Our fellow Stead officers, Megan Mitchell and Amanda Bassett, raised concerns about our future patients’ access to abortion and gender-affirming care, respectively. Roe v. Wade was overturned during our preclinical year, and we watched as trigger laws banning or restricting abortion took effect across the country. Around the same time, laws restricting access to gender-affirming care were also being enacted in many states. We were reassured that AAPA already has established position statements about patients’ rights to access abortion and gender-affirming care. Our profession also has overarching philosophical statements about patients’ rights to make decisions in partnership with their providers. As PAs, we are all about shared decision-making and patient-centered care. But what else could change, if these new laws were allowed to stand? Laws imposing criminal penalties on providers could jeopardize more than patient care and safety.
Because we were specifically tasked with addressing PA student issues, we began to wonder what downstream impacts these laws could have on PA education, and how we might proactively address foreseeable challenges. For example, there are already OB/GYN provider shortages, and one of the known challenges in PA education is a shortage of clinical sites for required OB/GYN rotations. If providers were going to make a mass exodus from the states that constrained their medical practice, how much worse could our clinical site shortage get? Would the threat of criminal charges also discourage didactic education on abortion and gender-affirming care? What support could the AAPA and the Student Academy provide to PA programs and students in the future, if these laws impact programs’ ability to meet our educational and accreditation standards?
Chris and I drafted two resolutions for the AOR meeting, stating support for PA education in abortion and gender-affirming care. After submitting them, the AAPA Student Academy advisors told us our resolutions should be introduced in the House of Delegates (HOD) next year and should have the opportunity to become AAPA policy! I was encouraged to run for the HOD student delegation. I was not sure how I would juggle an extra responsibility on top of clinical year, but decided to go for it! When I was selected as one of the 31 lucky students who would get to serve on the delegation, I knew that my purpose would be to introduce our resolutions as potential new policies for the AAPA.
Preparing For the House
Early in our term, I found two fellow delegates who were willing to co-author the resolutions with me: Allyson Wirfs of Indiana State University and Courtney Cravens of Emory University. We spent months researching AAPA policies and past actions of the HOD before we drafted our resolutions. We also started to learn about our other delegate responsibilities through frequent Zoom meetings. I’m proud of the way our delegation showed up for our calls, even on nights before big exams or after grueling days on rotation. I owe a big thank-you to our Chief Delegate Alec Williams, our graduate advisor Kaci Hardsock, and our AAPA staff member Caitlin Harrison, who worked all year to support and prepare us.
A few months before the 2024 HOD meeting, we learned about parliamentary procedure and practiced presenting our resolutions to our fellow delegates. We also brainstormed as a group: What con testimony should we anticipate? Where are the holes in our rationale? Our last checkpoint before submitting our resolutions was to meet with the House Officers. The Speaker and Vice Speakers of the House are PAs with many years of experience in HOD leadership, and they were kind enough to go over the resolutions with us and give us feedback. More than anything, our conversation with the House Officers shaped the language of the resolutions we ultimately submitted. Ultimately, my ideas spawned into four resolutions that Ally, Courtney and I co-authored. In total, the student delegation submitted seven resolutions this year.
The Will of the House
Walking onto the House floor, wearing my delegate badge was an exceptional moment. It was so special to have a seat at the table where our profession’s guiding statements are articulated. Of the 70 resolutions we had to address at this year’s meeting, most were pulled from the consent agenda, and that meant we’d have three full days of discussions, revisions, and voting. It was no surprise when all four of the resolutions I co-authored were pulled for discussion the following day.
We were as prepared as possible, but I still felt very nervous when they called my first resolution. My coauthors and I agreed that I would present the pro testimony. I’ve never spoken in front of 300+ people before, so part of my nerves came from just having that many eyes on me! I was also nervous about navigating parliamentary procedure correctly, even though we practiced. But I was most nervous about getting our point across. It was hard to sum up all of our research and rationale in a tight three minutes at the microphone. I knew that I was speaking not for myself, but for all 90 of my classmates, all 30 of my fellow delegates, thousands of current PA students, all future PA students, and by extension, every patient we will care for. Hundreds of PA students from across the country had expressed support for the ideas we were putting forward, and I wanted to convey the magnitude of that sentiment. Here’s an excerpt of what I said about our first resolution, which stated support for PA education about abortion procedures and access:
“As PAs, we are duty-bound to respond to the coming access to care crisis. We are already resolved, as an Academy, that patients have a right to access abortion care. We know that abortion is a safe and effective healthcare service. We know that PAs are qualified to provide abortion. And we know that abortion restrictions endanger our patients, not just by causing riskier and more complicated abortions, but also by exacerbating obstetrical care shortages. More needs to be done to prepare graduating PAs to practice in this climate. We believe that all PAs, regardless of where they train, must learn how to counsel patients about abortion, to care for patients before and after seeking abortion, to provide abortion, and to guide patients through the legal obstacles to care. We can anticipate that patients will struggle to access abortion for a long time to come. It is in line with our profession’s ideals and strategic goals to address gaps in access to care. With more education about the provision of abortion, PAs will be able to step up into this void.”
As soon as I sat down, other delegates started lining up at the microphones. I don’t think I heard much of the testimony of the person who directly followed me because of the blood pounding in my ears. People we had not spoken to in advance lined up at the microphone and provided helpful counterpoints to some of the con testimony. It felt like help and support came out of the woodwork. I got up one more time and added some additional pro testimony, and when everyone who wanted to speak had finished, the meeting moved on to our second resolution.
All of the testimony in the House meeting is addressed to a reference committee, which is composed of about six experienced delegates sitting at the front of the room, facing all of the delegate tables. They make notes throughout the pro and con testimony for each resolution, and try to determine the will of the House. Based on testimony they’ve heard, they provide written recommendations to adopt, amend, or reject the resolutions, and we vote on their recommendations during the last day of the HOD meeting.
My co-author Courtney presented our second resolution, which expressed support for PA education on gender-affirming care. Only one person had con testimony. Everyone else lining up at the microphone was there to speak pro. We were moved that so many people from so many different delegations got up to defend the needs of gender non-conforming patients and the educational needs of PA students who will care for them.
At the next break, other delegates came over to our table faster than I could jot all their names down. Some came to offer us procedural guidance or social and historical context about the past proceedings of the House. Some offered support for our resolutions, or just general words of encouragement. We convened with a few other delegates in the back of the room to work on some amended language, and submitted it for the reference committee to consider.
Our two other resolutions were also pulled for discussion, and we were up at the microphone once again. I was no longer nervous, and felt like I was getting the hang of the parliamentary procedure. Our third and fourth resolutions had to do with the criminalization of medicine - something we thought AAPA should fundamentally oppose. The only debate about these resolutions had to do with language, so we met in the back once again, six or eight of us clustered around a laptop, typing furiously as we tried to nail down the perfect combination of phrases.
After we adjourned for the day, I felt a huge sense of relief. We had said everything we needed to say, stated our cases as clearly as we could, and made good compromises on language with other delegations; the rest was in the capable hands of the reference committee. Our delegation reconvened in a nearby dueling piano bar to belt some classics, eat some pizza, and let our brains disengage. We woke up to fantastic news. The reference committee reports were posted in the night. For several of our resolutions, they recommended some amended language, but they determined that the will of the house supported all of them, and recommended we adopt ALL FOUR! I practically skipped from my hotel to the HOD meeting room.
On the final day of the HOD meeting, we finally voted on the reference committee recommendations. We had to pay close attention, because the voting could get convoluted and confusing as people proposed amendments, and then second-order amendments. It was an honor to have a vote, and I hope that I represented my constituents well. I tried to give all of the other resolutions my attention in turn, even though I was still thinking about how to navigate the amendments to ours. In the end, 6 of the resolutions our delegation put forward passed and became AAPA policy. I believe that we were successful because of how we worked with other delegates to address concerns. We did not end up with the wording we started with, but the language that we passed into policy felt like it was true to our intention, while representing a real consensus.
I’d Like To Thank the Academy
My service in the HOD was easily one of the best experiences I’ve had in PA school.
Everyone I met was generous with their time and ideas. It was awesome, when we wondered how a different organization would interpret our meaning, to be able to walk across the room and just ask them. We were able to collaborate in real time.
Many other delegates went out of their way to encourage us and check on us, the students in the room. They were overwhelmingly welcoming, kind, and receptive. What else would you expect from a room full of PAs?
I was still blown away by the collegiality, respectful discourse, ability to compromise, the patience, the willingness to trust each other, and above all, the kindness that we witnessed during this HOD meeting. Even when we discussed topics that are controversial in our country right now, the respectful discourse never descended into argument. People spoke up for each other. The way we treated each other, even when we disagreed, gave me a little bit more hope for our country on the whole. It was truly so heartening to shake hands with colleagues from all over our country, who practice all across medicine, taking care of all kinds of people, and know that every single one of them has the heart for this work, and is holding the line of human decency in their own corner of the world. We all had different perspectives, and different constituencies to represent, but we shared a common goal of crafting durable and fair resolutions that would serve as policy for the American Academy of Physician Associates.
The last thing I will say about this experience is this:
Don’t let fear of a “no” prevent you from even asking the question.
I was not sure I would be selected as a delegate. I worried that people might not want to touch controversial topics. I did not know if we’d have enough support for our sentiments to carry a vote. I never dreamed that we would have as much support as we did, and that we’d pass all four of my resolutions easily. If I had listened to my doubts or uncertainties last year, I would not have found out. I’m proud of the 2024 HOD meeting, what we were able to achieve, and how it got done, and I’m so grateful to have been a delegate.
Liz Shipman is a second-year student the Duke Physician Assistant Program. Email megan.shipman@duke.edu with questions.
Editor’s note: Duke Physician Assistant Program students blog monthly. Blogs represent the opinion of the author, not the Duke Physician Assistant Program, the Department of Family Medicine and Community Health, or Duke University.
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