The past few months have been a season of graduations for new NPs and PAs across the country. Recently, I tallied all the graduation ceremonies I have attended since I began my journey in academe some 16 years ago, which came out to about 27 ceremonies—so I have watched more than 4,500 graduates walk across the stage. How exciting that has been!

Last year, I had the opportunity to be a commencement speaker, a daunting responsibility and one that I did not take lightly. I’d like to share my graduation comments with you in this editorial—dedicated to all the new PA and NP grads:

Garry Trudeau, an American cartoonist best known for the Doonesbury comic strip, said, “Commencement speeches were invented largely in the belief that outgoing college students should never be released unto the world until they have been properly sedated.” With that in mind, I will keep my remarks to a minimum. I promise. The educational process has been the subject of a great deal of comment by academics and writers over the past few decades. It has been said that education is an easy target for criticism because its stated aims are often so nobly ambitious that they have little chance of being realized. According to the poet Robert Frost, education is “hanging around until you’ve caught on.”

Your class, like most graduating classes, is unique. You come from all walks of life and all points on the map. As you are poised today on this joyous yet transitional moment, I encourage you to imagine an image of standing on the shoulders of giants. Sir Isaac Newton said, “We are like dwarfs sitting on the shoulders of giants. We see more, and things that are more distant, than they did, not because our sight is superior or because we are taller than they, but because they raise us up, and by their great stature add to ours.”

Whatever image this calls to mind for you, I want to briefly tell you about three important giants. The first is that colleague, family member, or professor who was your mentor. For me, it was Dr. Burton Brasher, a preceptor, mentor, and friend who taught me the importance of sitting with patients and allowing them to be partners in their own care. Integrity and compassion are what he brought to the table as a family doctor in the 1970s and ’80s. I recently had the opportunity to attend his 90th birthday party. Indeed, I had the opportunity to stand on the shoulders of a giant.

The second giant is well known to you. Many examples are seated behind me and perhaps seated behind you now. Who is that person who has equipped you to enter your chosen profession? Who is that person who supported you at home from grade school to grad school? Your faculty, both didactic and clinical, and your family and friends are giants who have given you the opportunity to stand on their shoulders.

The third giant will be born in just a few minutes. That giant, ladies and gentlemen, is you. You now have the opportunity to take your knowledge and skills, your integrity and your compassion, and become a giant in your community. A giant that others can stand on, lean on, rely on, whether they be family members, friends, or students. As John F. Kennedy said, “The torch has been passed to a new generation.” I urge you to take hold of that torch.

The diversity among you has enriched your school, the university as a whole, and each of you individually. While what you brought was diverse, you will all leave with the same credential—a degree setting you apart as a clinician. The degree you will receive today is much more than a piece of paper, much more than initials behind your name.

You have been reminded many times about the expectations that society has for you. Those expectations will only increase as you go forth from today. Your profession has a calling that is devoted to health, healing, caring, and compassion. Society has entrusted its health and well-being to you, and with that trust comes a responsibility that is unmatched in other professions.

While you’ve spent long, sometimes grueling, hours mastering the skills of your new profession, what will make the difference in your success now is what comes from your heart.

Your work will be filled with challenges and opportunities, moments of disappointment, years of joy. Your patients will share their innermost thoughts and life experiences, things they won’t share with anyone else—not parents, not children, not spouses.

Despite the best educational preparation, I expect—and actually hope—you have some trepidation as you prepare to take your first real steps into your chosen profession. I encourage you to remember what that hesitation feels like and never lose sight of it. You must never become complacent. Health care is an ever-changing profession and you must forever be a student for the sake of your patients and your profession.

The uncertainty I’m describing is normal, but I assure you that you have the ability to succeed and we—the giants upon whose shoulders you stand today—are certain you will become some of the best clinicians, no matter where your career takes you.

Today marks the beginning of your new identity. No matter what you choose to do, whether you see patients or take care of athletes, teach students, work in a research laboratory, or draft health policy, being a member of your profession will forever remain a part of your central identity. Over time, it will likely become the most important part of who you are.

And no matter how hard you try to avoid it, you will be recognized. At the grocery store, the church, the barber shop, the hair salon, football games, shopping malls, your children’s school plays, your son or daughter’s athletic event, on the beach—someone will come up to you and say, “That’s Gary Jones, he’s a PA,” or “Let me introduce you to my daughter, Nikita Wells, the nurse practitioner.” There will be no escape. So my advice is, embrace it.

It defines you not just to your patients, but to your family and friends who will consult you first for every health issue, whether it’s in your field of expertise or not. They may not always believe or accept what you tell them, but they will always consult you. Even more, it will define you to society as being someone who is quite distinct, someone who has the highest integrity and someone they can trust.

The diploma you receive today is a symbol of a deep commitment to promoting our expectations of professionalism, humanism, and compassion. From this day forward, it no longer is exclusively or even most often about you. All of your experiences to this moment have raised you up as a giant for your patients, your colleagues, your profession, and everyone you will come into contact with from this day forward.

You must remain committed to maintaining life-long learning skills, to putting the interests of your patients above your own, to striving to treat patients with the highest possible standards, to respecting the values, culture, and dignity of every patient, and to working respectfully with other health professionals to ensure the best care for your patients.

Let me bring my remarks to a close with a few thoughts about the current challenges your professions face today.

Despite the increasing use of diagnostic technologies and advancements in therapeutic abilities, we are witnesses to increasing disparities in the delivery of health care.

Despite spending more on health care than many other developed nations, we have one of the highest percentages of uninsured citizens, leading to increased and preventable diseases.

The threats of medical liability are ever present. Reimbursement isn’t always what we feel it should be.

These challenges lead some to become disillusioned and cynical. Be aware of those pitfalls, and always remember, whether you’re in the emergency department, the urgent care center, the orthopedic clinic, the surgical suite, or an exam room and it’s just you and your patient—yours is a profession of compassion, integrity, and service.

As Alan Kay, an American computer scientist, researcher, and visionary, once said, “The best way to predict the future is to invent it.” Therefore, I ask you to go out and face the challenges head-on and do your part to provide the best quality care to all citizens. America’s health care and that of the world is depending on each of you to make an impact. They are poised to stand on your shoulders to see further and to do more than ever before.

And now for the two words you have been waiting for: In conclusion, let me share with you a quote from my favorite professor—a giant in his own right—Dr. Seuss, who said, “You have brains in your head. You have feet in your shoes. You can steer yourself any direction you choose. You’re on your own. And you know what you know. And you are the one who’ll decide where to go.”

Best wishes and Godspeed.

Feel free to send your comments about this editorial to PAeditor@qhc.com.

The New Giants in Our Professions