Left to right: OC Patrick Roberts, Class 1-15; OC Karin Sommers, Class 2-15; OC Aaron Spera, Class 1-15; Mr. Vincent "Vince" Tenorio; CW3 Salvador Thorn, Class 1-15; 1LT Richard Ahlstrom, Class 3-14; MAJ Militza Rivera-Cortes, IPAP Phase 2 Clinical C...
Retired Chief Warrant Officer Vincent Tenorio holds a certain bragging right that very few Army PAs have; he was in Physician's Assistant (PA) Program Class No. 1, FY 1972. A man of short stature but gargantuan heart, Vince is one of the few remaining pioneers of our profession that remain. When I first met Vince, I was aware he was regarded by my peers as the best PA to learn from in the Emergency Department, but I had no idea of his history. I only began learning about his history from things other people would tell me about him. That's just who Vince is, though, as he feels no need to impress upon you his resume. You would never know what I'm about to tell you unless you heard it from someone else, or read about it in this article.
As I get to know Vince, it quickly becomes apparent that he loves to learn. Starting his military career as a medic in the Vietnam era, he obtained training as a laboratory technician, 91C (LPN equivalent), and dialysis technician. When an educational opportunity arose, Vince seized it. His devotion to learning lead him to apply to the first ever Physician Assistant class in 1972. The inaugural class was an extremely competitive cohort, with over 40 people from his hospital alone applying. In fact, so many people applied that a pretest was administered to limit the amount of applications. After passing the pretest, Vince attended the selection process in San Antonio, TX.
On day one, they were given a series of written tests. You have a brick. List all of the different ways you can use this brick. So he did. He also did the same for a piece of string. When asked to stand in front of a panel of colonels from varying specialties to answer questions, he did so.
"Why do you seem so nervous?" They asked.
"Because my wife is due any day now, Sir." He answered.
Despite his nerves and despite his pregnant wife waiting at home, Vince confidently told the board that he wanted the responsibility of forming and representing this new profession. After enduring a grueling two day selection process that Vince describes as stressful and abstract, he was sent back home, arriving on the day of his child's birth. A little over two months later, Vince would find out he was selected to attend the first ever Army PA class.
Needless to say, being the first class came with its own unique sets of challenges. Without any previous foundation to base their class progress on, the program was marked with a high attrition rate and tremendous amounts of stress. Some people couldn't handle the academic rigor, some took to alcohol to cope, and others voluntarily removed themselves from the program. Despite this, Vince was determined to make it through the school. Failure was not an option for Vince.
"How did you do in PA school?" I asked him.
"I came into the school with the mindset that if they wanted to get rid of me, they'd have to sweep up my daggone finger nails off the floor first."
As I listened to his experiences in PA school, a thought crept into my mind. Despite 43 years separating our time in PA school, our experiences were not too different. Multiple tests throughout the week, drinking through the proverbial fire hose, long nights of studying, and little time for your family. What I find most incredible, however, is that while I attended PA school, I knew what a PA was and that my hard work would culminate in a rewarding career. In contrast, Vince and many of his classmates had little idea of what a PA was. The world had little idea what a PA was. The nascent profession was still an enigma to most of the medical community. Despite this, he invested his time and effort to completing this school without a clear reward. Would I have been so willing to make such an investment with such a nebulous outcome?
After finishing PA school, Vince was assigned to the 25th Infantry Division in Hawaii. The Division Surgeon had little idea what to do with these new PAs. They started by taking the place of doctors supporting various units on their training events and field exercises. Soon, the Division Surgeon was taking requests from battalion commanders demanding PAs over doctors. In many ways, PAs were preferred due to their prior military experience and skill sets they acquired as enlisted Soldiers. This eventually resulted in PAs being assigned directly to battalions, as opposed to hospitals and clinics. It was the work of Vince and his peers that established the role of PAs on the front lines. Their dedication and pioneering spirit solidified the role for the military PA that has endured for 43 years. Had these first few not been successful, where would the profession within the military be today? Such an impact cannot be overstated.
After serving as a military PA at multiple duty stations, Vince was ready to stay in one place and retired at the rank of Chief Warrant Officer 3. Serving as a civilian PA in Hawaii, Vince recognized a lack of formal professional organization on the island and became involved in uniting civilian PAs through the Hawaii Academy of Physician Assistants. At the time of his arrival to Hawaii, PAs were certified but not licensed at the state level. Recognizing that this was restricting PAs, Vince was instrumental in changing state policy and enabling PAs to become licensed. Licensure allowed PAs to prescribe Schedule III-V substances. Vince would continue this progress by forming a PA advisory committee to the Hawaii Medical Board, where issues important to PAs could be heard at the state legislature. As the Medical Board Representative, Vince helped pass legislation allowing PAs to prescribe Schedule II controlled substances and increasing the PA to MD ratio from 2:1 to 4:1. He is currently petitioning for changes in the medical record review procedures for PAs. Passage of this proposition would decrease the volume and burden of PA medical records review required by overseeing doctors.
When he's not busy seeing patients and representing the PA community at the state legislature, Vince works with both military and civilian PA students. Vince currently mentors military PAs in the Tripler Emergency Department and helps organize civilian PA clinical rotations on Hawaii. Even after retiring from a career in public service, Vince has continued to be a role-model and mentor to both military and civilian PAs.
It's a busy Saturday morning at Liliha Bakery in Honolulu, Hawaii. As I interview Vince over some eggs and pancakes, I realize something. I realize why he is so valued as a mentor and a professional. He brought me someplace I have never been before, and tells me about a host of other places to take my family while I am living on island. He tells me how to get involved in the local community. He tells me about the importance of being involved in the future of the profession by being involved in organizing PAs. He tells me his recipe for success with patients.
"Listen to your patient. Don't dismiss them. Be unbiased, take your emotions out of it and just listen."
That's just who Vince is, without even thinking about it, he wants to make you better. He wants to make the PA profession better, as a whole. He is always subconsciously teaching his students. He is always thinking of other people first.
Of all the advice bestowed upon me throughout my military career, the advice that resonates most with me goes something like this: no matter where you are, identify someone you admire, someone that gets it, and do your best to be as much like them as you can. At the time, I'm not sure I truly understood that advice. I think I am starting to understand it now. I want to be like Vincent Tenorio. Lifelong student, consummate professional, caring provider, humble man, and most importantly, mentor.
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