If you’ve been a PA for more than five minutes, you’ve felt it:
You’re trusted to manage complex patients…
but you can’t sign a form you’re perfectly qualified to complete.
You’re expected to move care forward…
but you’re still tethered to rules written when the profession was basically a newborn.
In this episode, I sat down again with Dave Mittman—PA leader, advocate, entrepreneur, and former AAPA President (2020)—to talk about what’s changing in our profession and why. Dave has been in this work for 50 years, and what I love about his perspective is that it’s both big-picture and deeply practical.
This isn’t a debate about ego.
It’s a conversation about access, patient care, and the future of how we practice.
Let’s get into it.
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The real shift: from legislation to the practice level
Here’s one of the most important takeaways from the conversation:
Modern PA practice is moving from being defined by legislation to being defined at the practice level.
In plain terms: instead of your scope being decided by outdated regulations and supervision language, it’s increasingly going to be shaped by things like:
- your training and experience
- your employer’s policies
- hospital bylaws and credentialing
- malpractice and payer requirements
- your specialty-specific skills (and proof of them)
This is how other professions function. Nurses, physicians, pharmacists—they are licensed broadly, and then the real-world “what you do” gets shaped by practice standards and competence.
That’s not chaos.
That’s how mature professions work.
And that brings us to the next point…
Full practice isn’t “scope creep.” It’s growing up.
I brought up “scope creep” in the interview because if you exist in medicine on the internet, you’ve heard the phrase about 700 times.
Dave’s take was blunt:
“Scope creep is an artificial term.”
And honestly? That tracks.
Here’s the difference:
- Scope creep implies PAs are trying to do more medicine than we’re trained for
- Modernization is about removing outdated administrative barriers so we can do what we already do—efficiently, transparently, and legally
annnd if you’re anything like me, and the AMA Campaign on Scope Creep has been pissing you off, check out this podcast episode
Most of us aren’t asking to become surgeons or replace physicians. We’re asking for:
- the ability to sign the forms tied to the care we provide
- billing clarity for the work we actually do
- modern licensure structures that match reality
- a professional framework that doesn’t require someone else’s permission to be competent
In other words: this isn’t expansion for ego. It’s evolution for patient care.
Title change: why this matters more than people want to admit
Let’s talk about the word assistant.
Because whether you love it, hate it, or feel neutral—patients hear it and make assumptions.
Dave made a point that really stuck with me:
Other professions use a public-facing title that makes sense even if their legal licensure wording is different.
Nurse practitioners aren’t licensed as “nurse practitioners” in many states (they may be APRNs), but they still use the title because it’s clear to the public.
Physicians are licensed as physicians, and the public calls them “doctor.”
Meanwhile, we’ve told ourselves, “We can’t use physician associate until it’s legal everywhere,” and that delay has consequences.
Because if the front desk says:
“Dr. Smith isn’t available until March, but you can see Mary next week…”
…what is a patient supposed to think?
Dave’s point wasn’t about being flashy. It was about being legible.
Clear title. Clear role. Clear expectations.
“Stop calling yourself Mary”: the professionalism shift we need
This part of the conversation made me laugh… and then made me cringe… because I’ve seen it too.
Dave’s argument is simple:
We have to stop hiding ourselves.
That looks like:
- being listed on the practice signage and website
- having a clear script for how staff explains what a PA is
- making sure consult and referral reports come back to you
- referring to other excellent PAs (yes—this builds value and visibility)
- introducing yourself clearly in the room every time
And yes, we talked about the white coat.
I started wearing mine after reading about how patients perceive professionalism and credibility—and I’ve noticed a difference. Even long-term patients have commented on it.
Is it required? No.
But the bigger point is this:
If we want to be treated like a profession, we have to show up like one.
Interstate compacts: why this could change everything
If you’re not paying attention to interstate compacts yet, put it on your radar.
Compacts have the potential to make multi-state practice far easier—especially for telemedicine.
Dave made a fascinating point: in the future, a PA might live in a state that still has “supervision language” on the books, but be able to practice (including virtually) in multiple full-practice states through compact participation.
That could be massive for:
- telepsych
- telederm
- rural access
- specialty services that are hard to find locally
It also has a second-order effect:
You’ll care more about legislation beyond your zip code.
And that’s not a bad thing. That’s what happens when a profession grows up.
The “assistant physician” issue: why we should be paying attention
We also touched on a topic that’s getting more attention in certain states: assistant physicians and alternate workforce pathways that attempt to address rural access.
The concern Dave raised wasn’t rooted in turf wars. It was about standards, training, and safety—especially when proposals involve people practicing without traditional residency pathways or standardized testing requirements.
Whether you agree with every angle of that debate or not, the key takeaway is this:
If you don’t pay attention to what’s moving through your state legislature, you don’t get a vote in what your profession becomes.
The doctorate conversation: it’s coming (like it or not)
This might be the most controversial part, and Dave didn’t tiptoe around it:
He believes the PA doctorate is coming because of market forces, parity, and professional evolution.
The argument isn’t “PAs need a doctorate to be competent.”
It’s that:
- PAs carry heavy responsibility in diagnosis/treatment/prescribing
- many healthcare professions have moved toward doctoral credentials
- payers, employers, and patients respond to credentials (fair or not)
- the education-credit reality is hard to ignore
And yes, the “can we call ourselves doctor” question will be a whole messy conversation when the tipping point arrives.
But the bigger point is this:
The profession is changing whether we like it or not.
So we need to participate in shaping it.
What you can do this week (without running for office)
I loved Dave’s final advocacy push because it wasn’t “go become president of your state organization.”
It was:
Care. Know what’s happening. Take one action.
Here are a few simple moves that matter:
- Update your introduction script
“Hi, I’m Tracy Bingaman, your Physician Associate. I’ll be taking care of you today.” - Make sure consult/referral reports come back to you
That’s how systems recognize who is leading the plan. - Ask to be listed publicly
Website, signage, marketing materials—visibility is legitimacy. - Refer to excellent PAs
Professional credibility multiplies when we treat each other like colleagues worth seeking out. - Support your state PA organization
Even one email, one call, one membership renewal—momentum is built by participation.
Final thought: you belong in the room
If you’re reading this and thinking, I’m not qualified to lead or advocate or speak up…
Let me say what I said in the episode:
You are.
And you’ll figure it out.
Someone has to go first.
Someone has to be the PA who asks for the name badge change.
Who says, “Please don’t schedule me as Mary.”
Who requests to be on the website.
Who writes the email when the advocacy alert comes out.
And once one of us does it, it becomes easier for the next.
That’s how professions evolve.
Listen + share
If this episode gave you clarity—or lit a fire—send it to one PA friend who’s tired of being limited by outdated rules.
And if you want more ways to build a career that pays you well and protects your life outside medicine, grab my free Side Gig Guide at: tracybingaman.com/gig.
(And as always—thank you for being here. You’re not “just” anything.)
