Physician assistants (PAs) have partnered with emergency physicians almost since the birth of emergency medicine as a specialty.

ABOVE: Mr. Terry Carlisle today.
LEFT: Mr. Terry Carlisle at his emergency medicine physician assistant residency graduation in 1987.
PHOTOS: Terry Carlisle

Terry Carlisle, PA-C, who has worked for more than 30 years as an emergency medicine physician assistant (EM PA), recently sat down with Chadd K. Kraus, DO, DrPH, a physician in the department of emergency medicine at Geisinger Health System in Danville, Pennsylvania, to discuss his thoughts on the evolution of PAs in emergency medicine. Carlisle is an original member of the Society of Emergency Medicine Physician Assistants (SEMPA), and in 2014, he was recognized as a diplomat of SEMPA for his contributions to emergency medicine. He retired from his career in the emergency department in August. Here are some highlights from their conversation.

CK: What is your background, and how did you become an EM PA?

TC: I started out as an EMT, became a paramedic, and then went to physician assistant school. After I graduated as a PA from Alderson Broaddus University in 1985, I began training in one of the first post-graduate EM training programs specifically designed for PAs at LA County/University of Southern California (USC) in Los Angeles. I completed that program in 1987. While at LA County/USC, I worked with Dr. Gail Anderson, a founding father of emergency medicine, who was the chair of the department of emergency medicine at USC. It was always interesting to hear him talk about emergency medicine and the value he thought PAs could offer to the specialty and to the delivery of emergency care. After my training at LA County/USC, I began my EM PA career, working for five years in the Washington, D.C.–metro area and then for the past 26 years at the University of Missouri-Columbia.

CK: Tell me about your experience and role with SEMPA.

TC: While at LA County in 1986, I wrote a letter to ACEP asking about PA membership. I was told that ACEP was only for physicians so I wasn’t eligible to become member. Around the same time, Arnold Zigman, RN, PA-C, who was the program director of the EM PA residency at LA County, had the idea of creating a professional society for PAs in emergency medicine. In 1990, a group of us met in Los Angeles, and SEMPA was born. It was exciting to be at that first meeting and to be one of the founding members of SEMPA. Over the years, I have been on the Board of Directors of SEMPA and served as Vice President. SEMPA continues to be an excellent professional group for networking, education, and advocacy for EM PAs. Although EM PAs are not eligible for ACEP membership, the relationship between ACEP and SEMPA has always been, and I hope will continue to be, a cooperative, collegial, and productive one.

CK: What do you think has changed since the 1980s and what role do you see EM PAs having in the future?

TC: The acceptance of PAs as important members of the ED team has grown among emergency physicians and among physicians from other specialties. In the clinical setting, more EM PAs are working in the main emergency department and not exclusively in the fast track or urgent care areas of the department. In some facilities, the EM PA plays an active role in trauma and medical resuscitations. As emergency care is found in non-hospital venues, such as satellite or freestanding emergency departments, there might be a role for EM PAs to work in those settings with close collaboration and input from EM attendings at a tertiary facility. Teaching by EM PAs is an area that is vastly overlooked. Many EM PAs have years of experience working in a variety of EM settings and could be utilized as teaching faculty that contribute to the educational missions of EM residency programs as well as EM PA training programs. Finally, there is a great opportunity for EM PAs to take on administrative and leadership roles, such as managers of emergency departments and EMS administrators, and to participate in research endeavors.

CK: There are currently approximately 30 EM PA post-graduate residency/fellowship training programs. Is that going to be the future for PAs in emergency medicine?

TC: As a graduate of one of the first EM PA residencies and as the current program director of an EM PA fellowship for PAs, I have a bias in favor of these training programs. There are many excellent EM PAs out there who have learned on the job. However, as emergency medicine has grown as a specialty, and as EM PA roles continue to evolve, these training programs provide a solid academic foundation in a supervised, clinical environment that gives EM PAs an advantage going into the job market by providing additional focused training in emergency medicine. Additionally, most of these programs are in institutions with EM residencies, giving EM PAs the opportunity to participate in lectures, simulation, journal clubs, and research projects and to gain procedural competencies alongside EM residents, residents who someday will be EM attendings. In the future, I could foresee these programs adopting a standardized curriculum for training EM PAs that could even result in a PA equivalent to EM board certification.