If you ask most physicians, PAs, and NPs why they decided to pursue a career in health care, the clichéd and somewhat unwavering response usually includes some variation of “I want to help people.” Although this view is extolled and encouraged, today’s complicated (and at times competitive) practice of medicine has a way of robbing us of that altruism.
What prompted these musings? The other day, the PA program at our university received a letter from a physician group that, for years, has provided us with quality preceptors for our students. The gist of the letter was to inform us that they could no longer take our PA students, because the time spent precepting resulted in reduced productivity and the compensation offered was not enough to offset that loss.
Now, don’t get me wrong, I understand. In today’s “corporate” mentality, productivity makes or breaks a practice. But we have also seen the number of PAs, NPs, and physicians—including alumni of our program—who offer themselves as preceptors dwindle.
Why is this happening, and what can we do about it? With more than 200 PA and 350 NP programs (and counting), the pressure to find and maintain clinical rotation sites and preceptors for thousands of PA and NP students will continue to increase.
We might first consider critical aspects of our “contract” with society—the one that defines our professionalism. Once we take that oath (whether the Hippocratic or another developed by and for our professions), we vow to put patient welfare first. In return for your service to patients, your contribution to the public good, and your assurance of competence and a high level of morality, integrity, accountability, transparency, and objective advice … you will be conferred very significant privileges as a PA or an NP. Those privileges include trust, self-regulation, participation in public policy, funding for what we value in both patient care and medical research, and many personal rewards.
However, there is one other stipulation: The social contract calls for altruistic service. But altruism specifies that one’s deeds benefit the recipient and not necessarily one’s self. The word altruism is derived from Latin through French and refers to “the good of others as the end of moral action.” Auguste Comte, a French philosopher, coined the term. He believed that individuals had a moral obligation to reject self-interest and live for others.1
I am not sure that is possible in today’s society. Can you “altruistically” relinquish your personal interests, your autonomy, and the primary reason for your existence—life, liberty, and the pursuit of happiness? My answer is maybe not. On the other hand, selfishness becomes a virtue when your own happiness is tied to service.
But enough philosophizing. What does this mean for us? A preceptor is one “who teaches, counsels, inspires, serves as a role model, and supports the growth and development of an individual (the novice) for a fixed and limited amount of time, with the specific purpose of socializing the novice into a new role.”2 A preceptor fills three primary roles: nurturer, educator, and mentor. He or she guides and enhances the learning experience of students by providing ideas, information, resources, and feedback.
I would argue that altruism is as important in giving back to our professions as is quality patient care. Think back to your student days (which may be a ways back for some of us). Remember anxiously entering the clinic or hospital on your first day and nervously approaching the front desk to ask for your assigned preceptor, who would play a key role in your transition?
All new professionals acclimate themselves with guidance from preceptors. We all have favorite preceptors and cherished experiences. Our preceptors were dedicated to our success and gladly gave of their time for the betterment of the profession. I am fearful that today’s preceptors do not have the same dedication to students. But please, tell me I am wrong!
Continue for multifactorial barriers >>