Sixteen years ago, Jim Ginter, president of the Wisconsin Academy of Physician Assistants and an ADVANCE author and peer reviewer, received a new kidney and discovered a new path in life. In an article in the Sheboygan Press, Ginter discusses the hereditary kidney disease that left him in need of dialysis at age 30 and the young organ donor who saved his life. The experience inspired Ginter to overcome his distaste for hospitals and pursue a medical career:

Going from a "fainter" to a patient, and now to a physician assistant, has taught me how to see things from each perspective. I can relate better to my patients because I know what they are going through. I had that foley catheter in my bladder, that NG and ET tube down my throat. I waited anxiously for a transplant.

Ginter emphasizes the importance of organ donation and encourages readers to consider becoming an organ donor, particularly during National Physician Assistant Week, Oct. 6-12. In the U.S. less than 30% of eligible citizens are organ donors.

 Link to the full article.

Here at ADVANCE, we’ve been following Ohio PA Earl Morse and his organization, Honor Flight, since its inception in 2005. I'm excited to share this recent feature article in The New York Times about one of Honor Flight’s largest trips yet:

The idea for Honor Flight came from Earl Morse, who was a physician’s assistant at a Veterans Affairs clinic in Springfield, Ohio, when the World War II Memorial opened in 2004.

“I would see my World War II veterans some three, six months later, and I’d ask them if they’d gone to see it,” said Mr. Morse, a veteran of the Air Force and now the president of Honor Flight. “Three hundred of them, and not one of them had been to it. Reality set in. They were never going.”

Link to The New York Times article

Link to previous Honor Flight coverage in ADVANCE

Link to Honor Flight’s Web site

Greg P. Thomas, PA, MPH, AAPA senior vice president for education, membership and resource development, will take part in “Time to Talk CARDIO: Creating A Real Dialogue In the Office,” a Webcast that takes place tomorrow morning at 8 a.m. EST. He will discuss implementation of the program with former surgeon general Richard H. Carmona, MD, MPH, FACS.

Time to Talk CARDIO advisory board members will present the innovative program to various medical societies, government organizations and patient advocacy groups in Washington, D.C. Attendees can learn more about the evidence-based research used to develop the program, the online communication skill-building tool and preview preliminary in-clinic research findings.

To register, click here.

In a move that gets the ball rolling for health care reform, Montana Sen. Max Baucus has released America’s Healthy Future Act of 2009. While the bill is not yet complete, it contains several provisions in favor of physician assistants:

The bill treats physicians, PAs, and NPs very similarly in the new patient models of care, including funding for “physician, nurse practitioner, or physician assistant-led home-based primary care programs with demonstrated expertise in serving high-cost beneficiaries with multiple chronic illnesses and functional disabilities.” The bill recognizes PAs in incentives for chronic care management bonuses in Medicare Advantage; fully integrates PAs in new patient care models; and makes PAs eligible for primary care provider bonuses. Additionally, the bill amends the Medicare statute to allow PAs to order skilled nursing facility care and to provide hospice care for Medicare beneficiaries.

Read more from AAPA here.

California pharmacist Barbara Morris has made her thoughts about physician assistants known in a news release about the ramifications of a primary care physician shortage under a new health care plan. She insinuates that PAs have minimal training, and even goes so far as to use quotations when referring to the PA profession, which leads me to believe she doesn’t think it’s even legitimate.

We already have "barefoot doctors" When you last made an appointment to see your primary care physician did you see the doctor or a "physician assistant"? Before you saw the "physician assistant" you probably saw a "technician" who took your blood pressure, and another "technician" who weighed you and asked some questions.

Democratization of health care has been in the works for a long time. In my profession of pharmacy (well, it's not really a profession anymore -- pharmacists are just shills for the drug companies) it used to be that the pharmacist filled prescriptions. Now, a "certified technician" does that. But the pharmacist is still responsible for errors made by the "certified technician"

Under Obamacare, an unlimited number of "barefoot doctor" types of occupations requiring only minimum training can be created to make up for the shortage of primary care physicians. Too bad for patients, but Obama will be able to gloat that he created jobs.

What do you think about the author’s theories?

Link

An article that originally appeared in the August issue of Contraception argues that increasing the number of PAs, NPs and certified nurse midwives who perform first-trimester abortions could help improve the declining availability of abortion care. The authors note that this is not just as issue of access, but rather an issue of scope of practice.

It is time to acknowledge that PAs, NPs and CNMs [collectively known as advanced practice clinicians (APCs)] are capable and qualified to provide abortion care services, but that current efforts to provide this care are thwarted by both the politics of health care and the politics of abortion. Outdated laws, restrictive regulations, lack of clinical training opportunities, professional turf battles and politically-motivated challenges impede APCs abilities to provide abortion care. APCs, physicians, reproductive health and rights advocates and attorneys must join together to promote the provision of abortion by APCs, thereby protecting both women's access to abortion care and practitioners' rights to provide essential care for their patients.

APCs have a long history of providing comprehensive reproductive health services within primary care and family planning settings. In 2004, APCs saw six times as many women for publicly-funded family planning services as did physicians. Noteworthy is that APCs have been providing abortions in some states since 1973 when abortion was nationally legalized in the United States. There is a growing body of evidence that APCs are safe, efficacious providers of abortion, via both medication and aspiration methods. Studies published in 1986, 2004 and 2006, comparing abortions performed by physicians to abortions performed by NPs and PAs found comparable rates of safety and efficacy.

Despite this evidence, many states have “physician-only” laws which prohibit the performance of abortions by anyone other than licensed physicians. Some of these laws were enacted around the time of Roe v. Wade in 1973 to protect women from unsafe, unlicensed abortion providers. They predate the recognition of APCs role in health care and the development of newer and simpler abortion technologies.

The article also includes a list of strategies to “highlight a few ways for APCs to participate in his/her professional organization and to work with others in bringing the professional voice to scope of practice conversations at the state and national level.”

Link

Over the weekend, the Gwinnett Daily Post published a piece about Georgia PA Larry LaViola, who practiced at Snellville Medical Group for 35 years until his death on August 30. In the article, the author, Susan Gast, crafted a wonderful tribute to her family’s health care provider, and also illustrated what real health care can be.

Here’s a section of the article, but I highly recommend visiting the newspaper to read it in its entirety.

I don't think a day has gone by recently in which I have not heard health care discussed, analyzed or dissected. I—like countless Americans—have listened with interest and mixed feelings.

Just over a week ago, however, my health care died. And I was heartbroken.

His name was Larry LaViola. He was a New Yorker comfortably transplanted and welcomed in the Deep South. He spoke softly, in a smooth, calming cadence - so smooth and calming that if you weren't paying close attention you might miss the pointed ribbing he was shooting your way.

For 35 years, he practiced at Snellville Medical Group and during that time took only two sick days. Officially he was a physician's assistant. But only officially.

To me, to my husband, to my children and to hundreds who live in southern Gwinnett County, he was our family doctor.

Link

A recent story in American Profile magazine highlights the importance of health care providers in rural areas. The author uses a PA to illustrate:

Patrick Armstrong, 52, is a perfect example. Since graduating at age 35 from the University of Iowa's Carver College of Medicine, he has worked as a physician assistant in rural Montana, beginning at Phillips County Hospital in Malta (pop. 2,120). "We wanted to raise our family in a small town," says Armstrong of he and his wife, Kathy, who have three children.

Intermittently, he was the town's only medical provider, giving him broad experience and long days and weeks on the job. After nine years, Armstrong moved 90 miles west to Chinook (pop. 1,386), where he works with a pediatrician and physician assistant at Sweet Medical Center. Once a month, he travels 150 miles to Glasgow, Mont., to work a long weekend at Frances Mahon Deaconess Hospital.

"The rewards," Armstrong says, "are the gratitude of patients. They tell my children, 'Your father saved my life.'"

Link

Morgan Henry, a PA student at the Keck School of Medicine USC Primary Care Physician Assistant Program in California, along with Hawley Almstedt, PhD, has developed a validated research questionnaire to accurately estimate calcium intake.

Their research article, "Validity of a Dietary Calcium Questionnaire Modified to Include Supplement Use in Athletes," was recently published in the Journal of Sports Science and Medicine.

Henry and Almstedt identified limitations in the traditional Rapid Assessment Method (RAM) questionnaire and found a need to expand its scope to include an additional section on dietary supplement intake. Henry’s work demonstrated that the newly developed 42-item LMU RAM questionnaire provides not only a valid estimate of calcium intake, but has a higher degree of clinical accuracy.

Henry’s research was originally presented at the Southwest Chapter American College of Sports Medicine Conference in 2007 where Henry won the 2007 Student Research Award. The Human Performance Laboratory at LMU plans to continue using this questionnaire and it is Henry and Almstedt’s expectation that the LMU RAM will soon be used by nutritionists, dieticians, and medical providers to accurately, reliably, and quickly assess dietary intake of calcium and nutrients important for bone health.

Link to Journal of Sports Science and Medicine article

A PA at Pueblo Community Health Center in Pueblo, Colorado, went missing on Thursday, August 27 at approximately 8:30 a.m.

Susan Halsey, 57, was reported missing by her family after she failed to pick up her daughter from school. Her car was found abandoned at a pharmacy.

Anyone with information about Halsey is asked to call the Pueblo Police Department at 719-553-2502.

Link

**UPDATE** Sept. 2, 2009

Sadly, at approximately 4 p.m. yesterday, Susan Halsey's body was found in a cluster of trees a few blocks from where her car was abandoned. The El Paso County coroner determined that Halsey died of ligature; police say evidence at the scene suggests that she took her own life.

Additional details and a video news report are available here.

Capt. Cory Jenkins, 28, a graduate of Brigham Young University and the physician assistant program at A.T. Still University, was killed on Tuesday in Afghanistan along with three other men when their Striker armored vehicle was hit by an improvised explosive device. According to The Arizona Republic, Jenkins chose to be an Army PA to gain intense experience treating trauma injuries.

"He wanted to be in trauma. He said, 'You can't get any better experience than in the military,'" Stanley Jenkins (Cory's father) recalled Thursday afternoon in front of his home.

Jenkins, from Mesa, Arizona, was the father of a nine-week-old daughter.

Link 

And so the health care reform debate continues... A recent article at Examiner.com champions PAs and NPs as a possible solution to the physician shortage. "Primary physician shortage spurs search for alternatives," by DC public policy examiner Alan Portner, identifies PAs and NPs as the product of "shorter, more intensive, educational subspecialties."

Into this void created by shortages and increasing population may fit relatively new categories of providers with expanded training, but not quite to the level of an M.D. or D.O. These new primary clinical providers are the Physician Assistant and Nurse Practitioner. Both the P.A. and N.P. are educated to the Master's degree level or higher. Their presence may ease the load on remaining primary doctors.

Next time, Portner will answer this question (and the answer should be interesting): What kinds of work can PAs and NPs lift from the shoulders of overburdened doctors? How will your health care access be affected?

Link

In response to an article in USA Today, "Doctor shortage looms as primary care loses its pull," AAPA president Stephen Hanson wrote a letter to the editor explaining what every PA knows and most of the public--and Congress--have yet to understand: PAs can and should be able to fill the gaps in primary care. That letter appeared on the USA Today Web site this morning. Hanson writes:

Doctor shortages threaten the viability of every health care reform option on the table, yet physician assistants (PAs) continue to get short shrift as we debate possible solutions.

Discussions about the cost and time it takes to produce physicians are distracting at a time when solutions should be sought. PAs can provide 80% to 90% of the services offered by physicians, at the same level of care, and are able to enter the medical system much more quickly. PA education programs produce close to 6,000 graduates each year - more than five times the number in family medicine residency programs - building a medical workforce that can help to fill critical gaps in care.

If Congress is serious about its health care goals, we need more PAs to deliver primary care to America. We need legislation that removes barriers to PA care and increases funding for PA education.

Link to Hanson's letter, along with two others, on the USA Today Web site.

Link to the original article.

The Georgia Association of Physician Assistants has announced the winners of the 2009 GAPA Awards. GAPA president Lori Gaylor, PA-C, MPAS, DFAAPA, remarks:

Our award winners have demonstrated high professionalism and dedication to not only GAPA, but to the entire PA profession. I appreciate their hard work, and commend their efforts.

Award recipients are as follows:

Physician Assistant of the Year - Carolanne Redfearn, PA-C

Distinguished Service Award - Jeff Chambers, PA-C, and Coe McGrath, PA-C

Humanitarian of the Year - Terry Mize, PA-C, MMSc

Rural PA of the Year - Mary Alice Phillips, PA-C

Physician/PA Partnership Award - Spencer Wheeler, MD, and Dan Vacala, PA-C, AT-C

Physician of the Year - Jean Sumner, MD

Circle of Honor - Kathy Kemle, PA-C, MS

Brief bios of each of the award winners can be found in the original article, at The Daily Citizen.

Link

A facebook update from Physician Assistant History Center this morning thanked California PA Beth Grivett for donating her recently published book for prospective PA students, So You Want To Be A Physician Assistant, to the PAHx.

The book's foreword, penned by Larry Rosen, PA-C, public relations committee chair of the California Academy of Physician Assistants, describes Grivett's book as a invaluable primer for the PA profession:

In So You Want To Be a Physician Assistant, Beth Grivett has skillfully articulated just about every reason to become a PA…and about every reason not to. Hers is a spot-on, thoughtful, honestly-stripped-of-the-window-dressing look at one of this country’s most sought after and fastest growing professions.

Link