Antonia C. Novello, M.D., M.P.H., Dr.Ph., the first woman and first Hispanic to become surgeon general, offered congratulations and counseling and posed challenges to the 34 graduates of the Physician Associate Program at their Commencement in September.

“It has been said by the sociologist Robert Bellah that your work as a professional defines you as a human being,” said Novello, now the health commissioner for New York state. “First there is a job, where the goal is simply earning a living and supporting your family. Then there is a career, where you trace your progress through appointments and achievements. Then there is a calling, the ideal blending of activity and character that makes work inseparable from life. I hope you are not just looking for a job. I hope you are not just building a career. I hope you are looking for a calling.”

The first of the challenges facing the new graduates, said Novello, is an increasingly diverse society, one that is aging, comes from all over the world and speaks a multitude of languages. Health care providers, she said, must understand all aspects of their patients’ lives. “Patients don’t care how much you know until they know how much you care.”

Access to health care was the second challenge she cited, pointing out that 45 million people in this country lack health insurance. “Don’t treat poor people as second-class citizens just because they may not have the same economic or educational advantages that you enjoy.” Again citing the diversity of the patient population and the 14 million Americans who lack proficiency in English, she said, “Medical training has to address the biases that we bring to medical school.”

Domestic violence is another challenge. “Health care professionals will fail 95 percent of the time to identify victims of domestic violence,” she said.

The final, and most important, challenge, she said, is professionalism. “Can we health care professionals maintain the traditional humanistic qualities of medicine in an increasingly corporate structure?” she asked. “I think we can. To do that, take care of people. Become a voice for the disenfranchised. Use your voice. Have the courage to put patients first.”