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Power Up for AAPA 2016 with CME, Recert Proposals and Challenge Bowl

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Janette Rodrigues
Janette Rodrigues

The document provides information about the upcoming AAPA Conference in San Antonio, including registration details, CME opportunities, keynote speakers, and a career fair. It highlights over 260 hours of AAPA Category 1 CME credits available, a 70+ employer career fair, networking events, and a 2-day exhibit hall with 250 exhibitors. The conference aims to help attendees refresh skills, recharge their careers, and power up their practices.

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Power Up for AAPA 2016! CME, NCCPA’s Recert Proposal and Challenge Bowl T H E L E A D I N G N E W S R E S O U R C E F O R PA s M AY 2 0 1 6
There’s Still Time to Register! Refresh Your Skills. Recharge Your Career. Power Up Your Practice. Download the AAPA app to plan your schedule & get the latest updates on CME and events. 70+Employers attheAAPA CareerFair san antonio’s 15-mile river walk & alamo NEW! Meet the Expert Sessions pacers for health 5k fun run/walk nationalmedical challengebowl Alumni & networking events 2-Day Exhibit Hall With 250 Exhibitors Student SPARK Sessions 260+ Hours of AAPA Cat. 1 CME CHLM Quality Improvement Symposium “American Sniper” star, PA Kevin Lacz AT OPENING GENERAL SESSION register now at aapaconference.org
ContentsM AY 2 0 1 6 • V O L . 8 , N O . 5 Departments President’s Letter The AAPA House of Delegates to debate and decide policy that affects the PA profession Laws+Legislation Many states are working on PA harmonization acts to clarify scope of practice in all laws affecting PAs Payment Matters A rundown on the members only reimbursement resources on AAPA’s website STAT Washington State adds PAs to state’s mental health code | Scientists confirm severe birth defects tied to Zika virus | PA gymnast headed to Rio Olympics | AAPA past president to serve on advisory board for leading clinical publication Professional Practice How to create a references list that helps you land your next job First Rounds PA students share what they’ve learned about cultural competence and how they’re incorporating it into their practice 6 16 8 11 34 30 Feature Story Equipping PAs for Expanded Opportunities in Healthcare Multiple Pathways, Demonstrating Competence, Flexibility 23 PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 1 
Imagine how you’ll celebrate! A NEW JOB IS CAUSE FOR CELEBRATION, and the PA JobLink can help you get there! • Search over 1,000 jobs – all PA openings • Set job alerts so you don’t miss a thing • Get tips and career advice All in one place! www.PAJobLink.com powered by Health eCareers PAThe CAREER FAIR Connect Meet employers actively hiring PAs Explore Learn about new job opportunities in a relaxed setting Practice Sharpen your “elevator speech” and interview skills Sunday, May 15, 2016 1 p.m. – 3 p.m. Register Here
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© Copyright 2016 by the American Academy of PAs. PA Professional is published monthly and is a registered trademark of AAPA, 2318 Mill Road, Suite 1300, Alexandria, VA 22314-6868. MAGAZINE STAFF PUBLISHER Amy Noecker anoecker@aapa.org EDITOR-IN-CHIEF Janette Rodrigues jrodrigues@aapa.org WRITER/EDITOR Steven Lane slane@aapa.org STAFF WRITER Sarah Sonies ssonies@aapa.org GRAPHIC DESIGNER Joan Dall’Acqua jd@acquagraphics.com CLASSIFIED AND DISPLAY ADVERTISING SALES Tony Manigross 571-319-4508 tmanigross@aapa.org 2318 Mill Road, Suite 1300 Alexandria, VA 22314-6868 PH: 703-836-2272 | FX: 703-684-1924 EM: aapa@aapa.org | WB: aapa.org AAPA BOARD OF DIRECTORS 2015–2016 PRESIDENT AND CHAIR OF THE BOARD Jeffrey A. Katz, PA-C, DFAAPA PRESIDENT-ELECT Josanne K. Pagel, MPAS, PA-C, Karuna RMT®, DFAAPA IMMEDIATE PAST-PRESIDENT John G. McGinnity, MS, PA-C, DFAAPA VICE PRESIDENT AND SPEAKER OF THE HOUSE L. Gail Curtis, MPAS, PA-C, DFAAPA SECRETARY-TREASURER Jonathan E. Sobel, PA-C, MBA, DFAAPA, FAPACVS FIRST VICE SPEAKER David I. Jackson, DHSc, PA-C, DFAAPA SECOND VICE SPEAKER William T. Reynolds, Jr., MPAS, PA-C, DFAAPA DIRECTOR-AT-LARGE Laurie E. Benton, PhD, MPAS, PA-C, RN, DFAAPA DIRECTOR-AT-LARGE Diane M. Bruessow, PA-C, DFAAPA DIRECTOR-AT-LARGE Lauren G. Dobbs, MMS, PA-C DIRECTOR-AT-LARGE Michael C. Doll, MPAS, PA-C, DFAAPA, FAPACVS DIRECTOR-AT-LARGE David E. Mittman, PA, DFAAPA STUDENT DIRECTOR Elizabeth R. Prevou, MPH, MSHS, PA-C CHIEF EXECUTIVE OFFICER Jennifer L. Dorn, MPA V O L 8 | N O 5 | M AY 2 0 1 6 AAPA.ORG PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 4 
PATIENTS FIRST. Cyndy Flores, PA-C Regional Medical Center of San Jose “It’s why we went into medicine, and that’s easily lost. CEP America walks the walk by keeping the patients in focus. CEP America knows how to care for patients across the Acute Care Continuum. Team-based practices are more efficient and effective for great care.” YOUR LIFE. YOUR CAREER. YOUR PARTNERSHIP. To learn more about a career with CEP America visit: go.cep.com/topcareer MPAS Degree Advancement Option Division of Physician Assistant Education Requirements § Graduate of accredited PA program and possess a baccalaureate degree § Current or prior NCCPA certification § Physician/Mentor who agrees to be your preceptor Learn more and apply at: unmc.edu/alliedhealth/padao | 402-559-6673 Program Highlights § Over 30 years of proven success granting master’s degrees to nearly 2000 practicing PAs § 36 semester credit hours of courses including a clinical or education track § Affordable program with no required resident time on the UNMC campus § Graduate in 5 semesters with up to 5 years to complete studies
PRESIDENT’SLETTER The AAPA House of Delegates: Where the Profession’s Policy Is Debated and Decided W ith so much to learn, so many people to meet and so many exciting goings-on at AAPA Conference 2016, it can be easy to forget that conference time is also when some of the most important decisions impacting the PA profession are made. Your elected representatives in the House of Delegates (HOD) have been diligently preparing for the 2016 HOD Meeting and this year they have much to discuss. As an AAPA member, you are represented in the HOD through your state or federal service chapter, your medical specialty, your caucus or the student delegation. The HOD Meeting is your opportunity to have your voice heard as your representatives debate the most relevant and impact- ful issues affecting both the profession and healthcare. Members of the HOD will be considering 54 separate resolutions this year.These resolutions represent a wide range of issues, including the pain management and opioid abuse crisis, PA licensure and the best path forward in addressing the recent NCCPA recertification proposal, PA license portability, guidelines for state regulation of PAs and medical marijuana. One resolution that is particularly important to me focuses on how we can increase the num- ber of preceptors and clinical rotations available to PA stu- dents so we can cultivate the next generation of PA leaders. As a PA, you are a leader and a critical member of the healthcare delivery team. Your voice and your opinion need to be part of the profession’s policy discussion. So as you finish booking your hotel and travel to San Antonio, add an item to your to-do list. Visit the AAPA HOD Governance page and review this year’s resolutions. If there is an item you are passionate about, reach out to your state, federal service, specialty, caucus or student representatives and let them know how you feel. If you have information or data you think is pertinent, send it along. The future of the pro- fession belongs to all of us and your participation will strengthen the foundation on which we will build our future—because, as always, we are stronger together. Jeffrey A. Katz, PA-C, DFAAPA AAPA President and Chair of the Board PA PROFESSIONAL  |  MAY 2016 |  AAPA.ORG | 6 
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LAWS+LEGISLATION Seeking Harmony in State Laws Many States Are Working on PA Harmonization Acts to Clarify Scope of Practice B Y C A R S O N W A L K E R , J D M uch like the profession itself, PA laws and regu- lations have come a long way in the past 50 years. States are improving patient access to healthcare. This includes tearing down barriers standing in the way of PAs delivering this much-needed care. How- ever, while many are advocating for positive changes to PA practice acts, there are still areas of law outside of PA practice acts that are in dire need of improvements, such as provisions on signing for handicap placards, conduct- ing department of transportation physicals, instituting concussion protocols for sporting events and authorizing students to have epi-pens for self-administration at schools. And this list is by no means exhaustive. There are various reasons for this exclusion of PAs from various areas of law. Generally, many of these provisions were either drafted before the PA profession existed or it was just assumed that by including physicians, PAs were also included. However, PAs not being specifically included in a list of providers who can perform certain functions, even though these functions may be well within a PA’s scope of practice, can lead to confusion and unintended outcomes. In order to address these omissions, AAPA has been working with state chapters to introduce legislation called “PA harmonization acts.”The purpose of these acts is to amend those areas of law outside of the PA practice act to accurately reflect a PA’s scope of practice and lessen confusion around what a PA can legally do. These acts can take a few different forms, but they generally serve to amend the various sections of law that may only mention physicians, or physicians and NPs, to include PAs. Numer- ous chapters have been successful in having these harmo- nization acts signed into law. The results not only mean that there is no longer confusion over whether or not PAs can perform a medical function that they are qualified to do, but that when new sections of law and regulations are drafted in the future, legislators and regulators will include PAs because they are already included everywhere else. One recent example of a state that harmonized its laws to include PAs is Oregon. In 2014, Oregon’s governor CARSON WALKER, JD, is an AAPA director of constituent outreach and advocacy. Contact him via email or 571-319-4316. PA PROFESSIONAL  |  MAY 2016 |  AAPA.ORG | 8 
LAWS+LEGISLATION | continued signed SB.1548 into law. The legislation updated 75 areas of Oregon stat- utes to include PAs. The accomplishment was no small feat—the Oregon Society of PAs’Government Affairs Committee spent more than 100 hours analyzing various provisions to determine which were missing PAs. Oregon’s example is just one way to approach harmonization of state laws. Such a heavy lift is not always feasible. Another approach is to pick out the most egregious or impactful omissions in a state’s laws, and draft legislation specifically to address and amend those areas of law that will be the most meaningful to PAs and patients in that state. One state that took this approach was Washington, which recently had a harmonization act (SB. 6445) signed into law that specifically amended the state’s mental health code in 22 places to include PAs. Other states that have been suc- cessful in harmonizing laws are Hawaii and North Dakota. States with active legislation to harmonize laws and regulations in the 2016 legislative session include Illinois and Colorado. Other chapters, including Rhode Island and New Hampshire, are currently in the early stages of reviewing their state laws for the purposes of harmonization in the future. For more information on harmonization acts, or to find out if your state is in the process of harmonizing its laws to include PAs, contact your desig- nated member of AAPA’s constituent organization outreach and advocacy team. Why choose CME Resources’ PANCE/PANRE Review Courses? H Engaged learning environment with audience response technology H Multiple faculty maximizes the course experience H 98% Pass Rate H 100% Money-Back Guarantee** H Most frequently recommended course by Physician Assistants! ** - See website for details Prepare to Excel CMERESOURCES.COM H 5-day program: 43 hours AAPA Cat 1 CME credits H CMExpress 3-day: 26 hours Cat1CME credits Come visit us in Booth 714 “Great course! I’ve used CME Resources for my last three recertifications and it always exceeds my expectations.” – William, Fenton, Michigan For more information or to register go to www.cmeresources.com or call 800-522-3439. 2016 Dates & Locations 5-Day Course Chicago June 6-10 August 1-5 August 24-28 December 5-9 Atlantic City June 20-24 Los Angeles July 20-24 Houston August 14-18 Philadelphia September 12-16 Las Vegas Sept. 27 - Oct. 1 Atlanta October 5-9 Boston October 26-30 Washington D.C. November 9-13 3-Day CMExpress Minneapolis June 11-13 Orlando June 17-19 Charlotte July 15-17 Chicago July 29-31 Las Vegas Sept. 29-Oct. 1 Cleveland November 4-6
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PAYMENTSMATTER Reimbursement Information at Your Fingertips A Guide to Reimbursement Resources on the AAPA Website B Y T R E V O R S I M O N , M P P AAPA offers numerous reimbursement resources to its members, as well as to employers and others interested in PA payment and coverage information. These resources include the for- purchase e-publication“The Essential Guide to PA Reimbursement,”presentations at state and national PA conferences, and the availability of the AAPA reimburse- ment department staff. However, there’s another conve- nient resource that contains a great deal of reimburse- ment information that you may not be aware was readily available: the AAPA website. For those interested in utilizing AAPA’s website to a greater extent, we will highlight many of the reimburse- ment-focused resources available here. Some are available to the general public, while others live behind the web- site’s firewall, for the use of members only. To begin, start at AAPA’s home page. From there, place the cursor over the word Advocacy (top center), which will produce a dropdown menu. To find the AAPA reimburse- ment-related resources, scroll down the list and click on the word Reimbursement (see picture below). This section contains many of the reimbursement resources available from AAPA. It includes links to: TREVOR SIMON, MPP, is AAPA’s assistant director of regulatory policy. Contact him via email or at 571-319-4405. PA PROFESSIONAL  |  MAY 2016 |  AAPA.ORG | 11 
PAYMENT MATTERS | continued ■ Where you can purchase “The Essential Guide to PA Reimbursement,” an extensive explanation of PA policies across various payers and circumstances ■ ICD-10 Preparation Resources: Various pages on the AAPA website pertaining to ICD-10, including pages with general resources, resources by state, resources by specialty and FAQs ■ Reimbursement Basics: An AAPA issue brief that provides an introduc- tion to the issue of PA reimbursement ■ Medicare Reimbursement: A Medicare Resources page with issue briefs on topics such as“incident to,”shared visit billing, use of scribes, PECOS enrollment, Medicare qualifications and coverage of services, preventive services, durable medical equipment, first assisting at surgery, pre-op history and physical examination, home health, diagnostic tests and the EHR incentive program ■ Medicaid Reimbursement: A page with background on the Medicaid program and PA coverage ■ Private Payer Reimbursement: An issue brief on third-party payer policy for PAs ■ Workers’Compensation: A page with background on workers’compen- sation and PA coverage ■ Current Issues: A page containing updates, issue briefs and regulatory comments, as well as an FAQ on the repeal of the sustainable growth rate system ■ Calculating PA Productivity: An issue brief on the measurement of productivity and its relationship with compensation In addition to those resources found on the Reimbursement page, useful reimbursement information can be found under other Advocacy subsec- tions. By clicking on Healthcare Reform, you will be brought to a page with information on the Affordable Care Act (ACA). From here, and using the links now on the left side of the page, you can explore pages that provide background on the law, information on how health reform directly affects PAs, and resources that may be useful in learning more about the ACA. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 12 
PAYMENT MATTERS | continued Finally, another source of information on reimbursement policies can be found by going to Advocacy and then clicking on Federal. Once here, click on Regulatory Advocacy. This will bring you to the same page you were able to access through Reimbursement under the Current Issues link. On this page you will find a list of comment letters submitted to federal agen- cies, such as the Centers for Medicare and Medicaid Services. These letters respond to proposed regulations that affect PAs. In these comment letters, AAPA summarizes relevant sections of the regulations, indicates how the proposed policies affect PAs and makes recommendations to CMS and other federal agencies on ways to attain optimal PA utilization and increase patient access to care. While this article acts as an introduction to the resources available on AAPA’s website, it is not a comprehensive catalog of resources available. To inquire whether AAPA possesses reimbursement-related resources that are not mentioned here, please reach out to the Reimbursement department. Your AAPA Membership Has Benefits! Voluntary Group Short Term and Long Term Disability Insurance 1. New eligible AAPA Fellows who apply within the first 60 days of membership are guaranteed to be accepted! No medical questions or records required! AAPA Fellow members with a date of membership longer than 60 days can still apply, but medical underwriting is required 2. Discounted Premiums- 50% lower than individual disability policies with similar features 3. Short Term disability coverage has no preexisting condition limitation 4. Benefits can be used immediately upon your effective date - guaranteed acceptance applicants do not have to satisfy any time period before filing a claim. Contact us for more details 5. Benefits do not offset individual disability coverage you may have in place Protect your most valuable asset, your paycheck! Protection will replace a portion of your income when a sickness, injury or pregnancy keeps you from working; up to $4,000 per month in Short Term and $8,000 per month in Long Term Benefits. Want to learn more? Visit www.MyPABenefits.com or come talk with us at booth #1207 If you are not covered by a group disability insurance plan, now is the time to consider enrolling in this valuable coverage. If you already have 60% of your earnings covered by a group disability plan through your employer, and would like information on how to increase that benefit to 75-80%, contact Ryan Insurance Strategy Consultants directly at 800-796-0909 ext. 107. "Protecting Your Financial Plans Since 1978"
Proven by more published research than any leading joint supplementL • Shown on a cellular level to inhibit enzymes that breakdown cartilage* • Helps protect articular cartilage* • Gluten-Free • Shown on a cellular level to inhibit enzymes that breakdown cartilage • Helps protect articular cartilage* • Gluten-Free *THESE STATEMENTS HAVE NOT BEEN EVALUATED BY THE FOOD AND DRUG ADMINISTRATION. THIS PRODUCT IS NOT INTENDED TO DIAGNOSE, TREAT, CURE, OR PREVENT ANY DISEASE. L Based in part on data reported by Nielsen through its AOD Service for the Supplement Category for the 52-week period ending 12/26/15, for the U.S. market. Copyright © 2016 Nielsen. Ask about our Patient Programs. Call 1-877-267-2646 or email contactus@nutramaxlabs.com L Based in part on data reported by Nielsen through its AOD Service for the Supplement Category for the 52-week period ending 12/26/15, for the U.S. market. Copyright © 2016 Nielsen. 0 days on HealthProfessionsJobsPlus) UNIVERSITY OF BRIDGEPORT Program Director Physician Assistant Institute The University of Bridgeport (UB), one of Connecticut’s fastest growing universities, invites applications for the Program Director of the Phy- sician Assistant Institute (PAI). The Program Director is a twelve-month position which provides for the overall leadership, administration and management of the PAI program to promote quality education for the students in accordance with the University’s mission and with ARC-PA ac- creditation standards. The University of Bridgeport is an independent and non-sectarian institution well known for its diversity. Founded in 1927 and located in historic New England on the Connecticut shoreline in sight of Long Island Sound’s breathtaking vistas. The campus and region, including the nearby trea- sures of New York City and Boston, provide an unparalleled context for study, professional aspiration, and growth. Students from 80 countries and 45 states make up the global citizenship of the University. To view to full job announcement, see: http://www.bridgeport.edu/job/program-director-physician-assistant-institute/ Qualifications: • If the incumbent is a PA, current NCCPA National Certification and eligibility for CT state licensure; • If the incumbent is a Physician, s/he must hold current licensure as an allopathic or osteopathic physician in Connecticut and must be certified by an ABMS- or AOA-approved specialty board and knowledge about current PA practice standards and the PA role; • A minimum of a Master’s degree, a Doctorate is preferred; • A minimum of six years of clinical experience with at least three years of clinical experience as a practicing PA; if an MD/DO, three years’ expe- rience in clinical setting working with PA; • A minimum of three years of clinical education experience with a minimum of two years in full-time PA education, preferably in a leadership role. The University offers a comprehensive benefits package and competitive salary. Review of applications will begin immediately and continue until the position is filled. Qualified applicants should send a letter of application, resume and contact information for three professional references to: University of Bridgeport Human Resources, Wahlstrom Library, 7th Floor Physician Assistant Institute-Program Director 126 Park Avenue Bridgeport, CT 06604 employment@bridgeport.edu The University of Bridgeport is an Affirmative Action/Equal Opportunity Employer UNIVERSITY OF BRIDGEPORT Program Director Physician Assistant Institute ty of Bridgeport (UB), one of Connecticut’s fastest growing universities, invites ap- the Program Director of the Physician Assistant Institute (PAI). The Program twelve-month position which provides for the overall leadership, administration ment of the PAI program to promote quality education for the students in accordance versity’s mission and with ARC-PA accreditation standards. e full job announcement for position description and requirements: http://www. du/job/program-director-physician-assistant-institute/ ty offers a comprehensive benefits package and competitive salary. Review of ap- ll begin immediately and continue until the position is filled. Qualified applicants a letter of application, resume and contact information for three professional refer- Bridgeport urces, Wahlstrom Library, 7th Floor ssistant Institute-Program Director enue CT 06604 @bridgeport.edu iversity of Bridgeport is an Affirmative Action/Equal Opportunity Employer Advance for NP’s and PA’s Size: 4.5 x 3 Issue: May Due: April 21 by 2pm Cost: $1,794.00 +$149.00 (30 days online) $1,943.00 total w/ web At PAIN, SPINE & REHAB ASSOCIATES we offer a unique opportunity for a driven, self motivated, and hardworking PA. Great work atmosphere. Only 25 min. from D.C. Patient- Centered environment. Exceptional facilities. Hours: M-F 8am-5pm, no weekends, and rare after hours coverage (for phone calls only, shared with physician). 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 Online and Print Versions available  Cost Effective CME  Money Back Guarantee North America’s most widely recognized program for Family Medicine CME and Board Preparation.  Visit www.CoreContent.com  Call 888-343-CORE (2673)  Email mail@CoreContent.com PO Box 30, Bloomfield, CT 06002 Easily manage your procedure competency, in real time, with CMP10C. Coming Soon www.cmp10c.com The most common eating disorder in US adults isn’t just about eating*1-3 The exact cause of binge eating disorder (B.E.D.) is unknown. Research suggests that among potential causes, B.E.D. may have a neurobiological basis.4-12 What is B.E.D.? B.E.D. is defined as recurring episodes† in which a large amount of food is consumed in a relatively short time. Patients feel a lack of control during a binge and marked distress over their eating. Among other symptoms, they typically experience shame and guilt about their bingeing, and may conceal their symptoms even from you.1 To download the patient screener, learn more, and view the full DSM-5® diagnostic criteria, visit BingeEatingDisorder.com/hcp. *Estimated 12-month and lifetime prevalence among an eating disorder–assessed subsample (n=2,980) of the National Comorbidity Survey Replication, a nationally representative face-to-face household survey of English-speaking adults aged ≥18 years.2,3 † Recurrence is defined as, on average, greater than or equal to once weekly for at least 3 months. References: 1. American Psychiatric Association. Binge-eating disorder. In: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013:350-353. 2. Hudson JI, Hiripi E, Pope HG Jr, Kessler RC [published correction appears in Biol Psychiatry. 2012;72(2):164]. Biol Psychiatry. 2007;61(3):348-358. 3. Kessler RC, Berglund PA, Chiu WT, et al. Biol Psychiatry. 2013;73(9):904-914. 4. Balodis IM, Molina ND, Kober H, et al. Obesity (Silver Spring). 2013;21(2):367-377. 5. Schäfer A, Vaitl D, Schienle A. Neuroimage. 2010;50(2):639-643. 6. Woolley JD, Gorno-Tempini ML, Seeley WW, et al. Neurology. 2007;69(14):1424-1433. 7. Schienle A, Schäfer A, Hermann A, Vaitl D. Biol Psychiatry. 2009;65(8):654-661. 8. Davis CA, Levitan RD, Reid C, et al. Obesity (Silver Spring). 2009;17(6):1220-1225. 9. Wang G-J, Geliebter A, Volkow ND, et al. Obesity (Silver Spring). 2011;19(8):1601-1608. 10. Levitan RD, Masellis M, Basile VS, et al. Biol Psychiatry. 2004;56(9):665-669. 11. Naleid AM, Grace MK, Chimukangara  M, Billington CJ, Levine AS. Am J Physiol Regul Integr Comp Physiol. 2007;293(1):R99-R105. 12. Boggiano MM, Chandler PC, Viana JB, Oswald KD, Maldonado CR, Wauford PK. Behav Neurosci. 2005;119(5):1207-1214. Binge eating disorder is a cycle of… Binge. Distress. Repeat.1 DSM-5® is a registered trademark of the American Psychiatric Association. ©2016 Shire US Inc., Lexington, MA 02421 1-800-828-2088 S11684 03/16 S:10.5” T:11”
STAT | Industry News WASHINGTON STATE ADDS PAs TO STATE’S MENTAL HEALTH CODE PAs in Washington state are celebrating Gov. Jay Inslee’s recent signing of SB. 6445 which adds PAs to 22 sections of the state’s mental health code. SB. 6445 becomes effective June 8, 2016. The bill is the product of the successful advocacy efforts of the Washington Academy of PAs (WAPA) and the persistence of WAPA members Suzan Dula, PsyD, PA-C, and Dale Sanderson, PA-C, MPH, and AAPA. Dula and Sanderson contacted their state legislator when the omission of PAs in the state mental health code created obstacles for PAs pro- viding psychiatry services. The bill’s key changes include: • Adding PAs to the definitions of“mental health professional”and“developmental disabilities professional” • Authorizing PAs to sign petitions for specified involuntary detentions • Authorizing PAs to make determinations of incapacity • Adding PAs throughout the Mental Health Advance Directive form Adequacy of and access to mental health ser- vices is a leading concern across the country and AAPA advocates for all states to ensure that PAs are included in state mental health provisions. For more information, contact Keisha Pitts, JD, director of constituent organization outreach and advocacy. Read more here. PA GYMNAST HEADED TO THE RIO OLYMPICS! Houry Gebeshian, PA-C, recently realized a dream deferred when she became the first female gymnast to represent Armenia in the Olympic Games! (She has dual American-Armenian citizenship.) Gebeshian is a 2014 graduate of the Wake Forest University PA program. A standout at gymnastics powerhouse the University of Iowa, she competed as an individual all-arounder in the 2011 NCAA Women’s Gymnastics Championship and she is the 2010 Big10 Conference champion on the balance beam. Read more here. From left to right: state Rep. Joe Schmick; Jeb Shepard of WSMA; state Sen. Randi Becker; Seth Dawson of NAMI-WA; Gov. Jay Inslee; Dale Sanderson, PA-C; Ruth Peterson, legislative assistant to Sen. John Braun, a sponsor of the bill; Suzan Dula, PA-C; Kevin Black, staff counsel to the Washington Senate Human Services and Mental Health Committee; and Kate White Tudor, WAPA’s lobbyist. PA Houry Gebeshian on the balance beam PHOTOBYANHVIÊTCHAU PHOTOCOURTESYOFWAPA PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 16 
STAT | continued AAPA PAST PRESIDENT TO SERVE ON ADVISORY BOARD FOR LEADING CLINICAL PUBLICATION Stephen H. Hanson, MPA, PA-C, DFAAPA, a former AAPA president, has been selected to serve on the editorial advisory board of the leading trade pub- lication Physicians Practice. A regular contributor to the publication, Hanson writes a twice-monthly column on optimizing team-based care and electronic health record (EHR) deployment. His columns are among some of the most widely read and commented on blogs on the Physi- cians Practice website.The publication— widely read among the medical and phy- sician leadership community—made the decision to expand its advisory board to providers across the healthcare landscape to reflect the evolving landscape of today’s medical practice. Hanson, a plastic surgery PA with experience in emergency medicine, urgent care and public health, is the first and only PA to serve on the edito- rial advisory board of Physicians Practice. A PA for more than 35 years, he currently practices medicine in a hospital-based plastic and reconstructive sur- gery practice, in addition to covering a burn unit with his surgeon and business partner M. Brandon Freeman, PhD, MD. As part of the editorial advisory board, Hanson joins a team of physicians and the Physicians Prac- tice editorial staff in helping to shape the content and strategy for the publication. SCIENTISTS CONFIRM SEVERE BIRTH DEFECTS TIED TO ZIKA VIRUS Scientists from the Centers for Disease Control and Prevention (CDC) have concluded, after care- ful review of existing evidence, that Zika virus is a cause of microcephaly and other severe fetal brain defects. In an April report published in the New England Journal of Medicine, the CDC authors describe the rigorous weighing of evidence that led them to their findings. Since its first identification in Brazil in 2015, Zika virus has spread rapidly. While prenatal Zika virus infection was linked to adverse pregnancy and birth outcomes, most notably microcephaly and other serious brain anomalies, exact causation had not yet been established before now. Given the severity of the birth defects, the rapidly spreading virus and the adverse effects on commu- nities, scientists recommend a strategy focused on education and prevention of virus transmission. AIR FORCE PA EARNS AIR FORCE ACHIEVEMENT MEDAL Maj. Kenneth Beadle, U.S. Air Force, DSc, PA-C, (left in photo below), recently received the Air Force Achievement Medal from Brig. Gen. David Julazadeh, com- mander, 455th Air Expeditionary Wing, during a ceremony at Camp Cunningham at Bagram Airfield in Afghanistan. Beadle was among the more than a dozen airmen who earned the recognition for their efforts to recover the wreckage of an F-16 Fighting Falcon that crashed during takeoff in Parwan Province on March 29. A graduate of the Interservice PA Program, Beadle is with the 455th Expeditionary Medical Group, which provides combat medical and combat medical support services to U.S. and coalition forces throughout Afghanistan. PA Stephen Hanson COURTESYOFTHEU.S.DEPARTMENTOFDEFENSE ADOBESTOCK.COM PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 17 
STAT | continued MEDICAID EXPANSIONS IMPROVE HEALTHCARE OUTCOMES FOR LOW- INCOME PATIENTS States that have enacted the Affordable Care Act (ACA) Medicaid expansions are seeing better out- comes in many aspects of healthcare for their low- income residents, suggests a study recently pub- lished in the Annals of Internal Medicine. HEALTH DISPARITIES AND LESBIAN, GAY AND BISEXUAL PATIENTS Lesbian, gay and bisexual patients, especially bisex- ual women, are more likely to encounter barriers to care than their straight counterparts, according to two studies recently published in the American Journal of Public Health. A National Center for Health Statistics study found that healthcare disparities cause gay, lesbian and bisexual patients to suffer more health prob- lems, including highly preventable illnesses such as pneumonia. NEW DIETARY GUIDELINES ISSUED FOR 2015-2020 The U.S. Department of Health and Human Services and the Department of Agriculture have published their latest dietary recommendations. The guide- lines align with previous recommendations, with some differences. Instead of an emphasis on food groups and pairings, the new guidelines empha- size eating habits overall. The guidelines include a newly recommended limit of 10 percent of daily calorie intake coming from added sugars and state that drinking three to five cups of coffee a day is now considered to be part of a healthy eating pat- tern (surely good news for many PAs!). Additionally, the previous 300 milligram restriction on dietary cholesterol has been lifted, in line with many stud- ies showing that dietary cholesterol does not affect blood cholesterol levels. The guidelines for sodium consumption remain at 2,300 milligrams per day for Americans ages 14 and older, but the recom- mendation that certain groups limit their sodium consumption has been eliminated. These recommendations, known by their five- year range for the first time this year, were based on the assumption that there is a link between“poor quality eating patterns and lack of physical activity” and the prevalence of many preventable chronic diseases, such as hypertension, obesity and type 2 diabetes. They were compiled based on a review of 300 studies, in addition to a review of 29,000 public comments. PROMOTING HERPES ZOSTER AWARENESS Herpes zoster strikes nearly 1 million people a year in the United States. One in three adults will get the infection in their lifetime, and anyone who has had chickenpox is at risk of the virus reactivating from its latent state. Yet, most patients know nothing about it or the vaccine that can prevent it. The National Foundation for Infectious Diseases (NFID) wants to change that with a new campaign to raise awareness of herpes zos- ter. Patient information materials include a public service announce- ment about the importance of shingles prevention, an online quiz to help individuals determine if the herpes zoster vaccine is recom- mended for them and a factsheet on shingles myths vs. facts. ADOBESTOCK.COM COURTESYOFNFID PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 18 
STAT | continued HEALTHY EATING AND PREGNANCY The relationship between diet and health plays a pivotal role in the health of mother and baby dur- ing pregnancy. The International Food Information Council Foundation (IFIC) released a new brochure to help providers educate patients about healthful eating during pregnancy. The brochure covers how to eat a balanced diet, eating a variety of foods, healthy weight gain during pregnancy and food safety concerns specific to pregnant women. ESTIMATE OF PHYSICIAN SHORTAGE INCREASED The Association of American Medical Colleges (AAMC) has increased its estimate of the com- ing physician shortage, with projected shortages reaching between 61,700 and 94,700 over the next 10 years and the primary care physician shortage expected to range from 14,900 to 35,600 by 2025. These projections, part of an April AAMC report, are up slightly from recent estimates that the nation would need an additional 46,100 to 90,400 physi- cians by 2025. However, these estimates still fall short of the peak 2010 projections that the United States would be short 130,600 physicians by 2025. This year’s report takes into account the rapid growth of the PA profession and increasing demand for PAs and also updated the supply and demand data and medical school graduate data that were used. Given the unprecedented growth of the PA and NP professions and the projected shortages of primary care providers, the AAMC has recommended continued observation of these professions as the data model evolves and more patients enter the healthcare system. NO DECLINE IN YOUTH TOBACCO USE SINCE 2011 While significant decreases in overall cigarette smoking occurred between 2011 and 2015, tobacco use by middle and high school students has remained unchanged since 2011, according to new data published by the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration’s Center for Tobacco Products. The data from the 2015 National Youth Tobacco Survey show that 4.7 million middle and high school students were current users of a tobacco product in 2015, with current use defined as using tobacco at least once in the past 30 days. Addition- ally, the findings show that e-cigarettes are the most commonly used tobacco product among middle and high school students. NEW TESTS TO ID FOODBORNE ILLNESSES Changes in the tests used to diagnose foodborne illnesses are enabling scientists to identify infec- tions more quickly, but in the longer term these changes could pose challenges to scientists’abil- ity to find outbreaks and monitor progress in preventing foodborne disease, according to a report pub- lished in an April CDC Morbidity and Mortality Weekly Report. These new tests, known as cul- ture-independent diagnostic tests, help providers to quickly diagnose infections—with results available in hours instead of the days needed when using traditional culture methods that require growing bac- teria to determine cause of illness. However, without these bacterial cultures, scien- tists and public health officials are unable to deter- mine the cause of an infection—which limits their ability to monitor outbreaks, check for antibiotic resistance and track trends in foodborne diseases. ADOBESTOCK.COM PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 19 
STAT | continued NEW SCREENING GUIDELINES FOR COPD AND ASPIRIN USE The U.S. Preventive Services Task Force has issued several new recommendations, including final rec- ommendation statements on screening for chronic obstructive pulmonary disease (COPD) and on aspi- rin use for the primary prevention of cardiovascular disease and colorectal cancer. USPSTF recommends against screening for COPD in asymptomatic adults, a grade D recommenda- tion. According to the Task Force, little benefit was found in early detection, and no evidence was found that screening for COPD in adults without respiratory symptoms improved health outcomes. The recommendations further state that clini- cians should be aware of the risk factors for COPD, including current or former exposure to tobacco smoke, educate patients on these risk factors and counsel them not to smoke or to quit. The statement on aspirin use for the primary prevention of cardiovascular disease and colorectal cancer recommends that clinicians with patients between 60 and 69 years old should work with these patients to decide if aspirin use for primary prevention is right for them. According to USPSTF, evidence shows that low-dose aspirin use is most beneficial for people ages 50 to 59. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 20  • CO VISITS TO AAPA HELP BUILD RELATIONSHIPS On February 23, 2016, AAPA hosted former Association of PAs in Cardiology (APAC) president Sondra DePalma, MHS, PA-C, CLS, AACC, at AAPA headquarters in Alexandria, Va. DePalma participated in a full day of strategy and planning meetings with senior leadership and staff from both AAPA and the Acad- emy’s newly created Center for Healthcare Leadership and Management (CHLM). The meetings aimed to identify new collaborative opportunities and ways to improve the practice environments of PAs by leveraging the expertise and experience of PA leaders like De Palma to create specialty-specific approaches to demonstrating PA contributions to a broad range of practice environments.   AAPA and CHLM are committed to working with both current and aspiring PA leaders across the country on the goal of increasing patient access to care through ensuring that PAs are able to consis- tently practice to the fullest extent of their educa- tion and training.  Academy visits like these are an opportunity to build seamless relationships between COs and AAPA and for Academy staff to engage with PA leaders. For more information on ways you can get involved with CHLM or schedule a CO visit, please contact Rick Christiansen, AAPA director of employer development and constituent organiza- tion outreach and advocacy. PA Sondra DePalma, a past president of the Association of PAs in Cardiology, with AAPA staffer Rick Christiansen
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Recommend BayeRaspirin— First for secondary prevention. CV=cardiovascular; MI=myocardial infarction. *Nonfatal MI. References: 1. Antithrombotic Trialists’ (ATT) Collaboration. Lancet. 2009;373:1849-1860. 2. Garcia Rodríguez LA, Cea Soriano L, Hill C, Johansson S. Increased risk of stroke after discontinuation of acetylsalicylic acid: a UK primary care study. Neurology. 2011;76:740-746. 3. Garcia Rodríguez LA, Cea-Soriano L, Martín-Merino E, Johansson S. Discontinuation of low dose aspirin and risk of myocardial infarction: case-control study in UK primary care. BMJ. 2011;343:d4094. Bayer and the Bayer Cross are registered trademarks of Bayer. © 2016 Bayer February 2016 62275-PP-BAY-PREV-US-0539 • Aspirin reduces the risk of recurrent ischemic stroke by 22% and recurrent MI* by 30%1 • Discontinuation of low-dose aspirin can increase the risk of recurrent ischemic stroke by 40%2 and nonfatal MI by 63%3 To order samples and learn more, visit www.bayeraspirinhcp.com First line. First thought. Think Bayer® aspirin first for the secondary prevention of a CV event DARIEN ROWAYTON BANK student.drbank.com/AAPA Got Student Loans?Save $20,000 or more by refining to a lower rate Benefits of Refinancing Include: • No origination fees. No prepayment penalties • Rates start at 2.005% for AAPA Members • Federal, private, undergrad and PA school loans all eligible • Up to 1 year for forbearance is available • Entire process is FREE, from start to finish Loan Type Rate* AAPA Friends and Family Rate*** 5 to 20-year variable** 2.13% - 5.52% 2.005% - 5.395% 5-year fixed 3.50% - 5.75% 3.375% - 5.625% 7-year fixed 4.00% - 6.25% 3.875% - 6.125% 10-year fixed 4.50% - 6.50% 4.375% - 6.375% 15-year fixed 5.00% - 6.75% 4.875% - 6.625% 20-year fixed 5.25% - 7.00% 5.125% - 6.875% *Assumes a 0.25% discount for making automated payments from a DRB checking account **Variable rates are calculated by adding a margin to 3-Month LIBOR ***Displayed rates reflect a 0.125% rate discount which is available to all friends and family of the AAPA Apply Now! student.drbank.com/AAPA
FEATURE STORY More than fifty resolutions have been submitted to this year’s House of Delegates, including several related to NCCPA’s PANRE proposal, one relating to AAPA supporting full practice respon­ sibility—the concept that PAs should have the right to define their scope of practice and take responsi­bility for their clinical decisions—and another to the accreditation of postgraduate clinical training programs. AAPA members can access all the resolutions on the HOD page. The resolutions related to the NCCPA PANRE proposal can be found on the AAPA News Center page— scroll down to "Submitted HOD Resolutions Regarding the Proposed Model." EQUIPPING PAS FOR EXPANDED OPPORTUNITIES IN HEALTHCAREBY STEVEN LANE, MA, MPP MANY FACTORS, INCLUDING CONSUMER EMPOWERMENT AND A HEIGHTENED FOCUS ON HEALTHCARE QUALITY AND PATIENT SAFETY are raising the level of scrutiny on how providers develop and demonstrate clinical competency. The PA profession itself has been changing as well, with the percentage of PAs practicing in non–primary care specialties rising steadily over the past two decades. Nearly three-quarters of PAs now say that their primary area of practice is in a specialty other than primary care, which the National Commission on Certification of Physician Assistants cites as one of the reasons it has proposed a new recertification model that would include a proctored, closed-book exam in a specialty area—a proposal that has engendered lively debate among PAs around the country and that will be among the most discussed issues at the upcoming House of Delegates meeting at AAPA Conference 2016 in San Antonio this month. With the introduction of NCCPA’s voluntary certificate of added qualifications (CAQ) program several years ago, many PAs expressed concern that a CAQ in a specialty area would eventually become mandatory, imposed by either employers or state regulatory bodies. Many believe that the credentialing and privileging processes of hospitals and health systems, as well as private provider practices, are sufficient to demonstrate PA competence in a specialty. In recent years, there has also been discussion about the appropriate role of clinical postgraduate training and even about the creation of a PA clinical doctoral degree. An AAPA task force has just released a report on a possible accreditation model for postgraduate training programs. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 23 
CLINICAL DOCTORATE? RECERTIFICATION? RESIDENCY? CAQ? The issue of how to maintain multiple pathways to demonstrate PAs’ clinical competency is one of the six key issues facing the profession that is being addressed in AAPA’s 2016-2020 Strategic Plan. (This story is the sev- enth in PA Professional’s ongoing series of strategic plan–related articles; you can read the other six in the PA Pro archives.) AAPA President Jeffrey A. Katz, PA-C, DFAAPA, frames the issue like this: “PAs have always been able to adapt to changing healthcare needs because of the multiple pathways available to us to develop and demon- strate our competencies. We must collectively ensure that pathways for demonstrating our skills do not become restricted to any single require- ment. Simultaneously, we must acknowledge the reality that demonstrat- ing competencies is best addressed at the practice level.” PA Professional spoke to a number of PA leaders and managers for their perspectives on these questions. Recertification and Maintaining Flexibility The overriding concern of most PAs on this issue is to maintain the profes- sion’s well-known clinical flexibility, which has allowed PAs to move quickly to where the need is in the healthcare system or even within their current workplace. Roughly half of all PAs change the specialty area in which they primarily practice at least once in their careers, according to the 2015 AAPA National Survey, and many change specialties multiple times. The AAPA Board of Directors and HOD, and many AAPA members, are concerned that the proposed new NCCPA recertification model threatens this flexibility. The proposed model would require all PAs to select a spe- cialty area in which to be examined, in a secure, proctored timed format, in addition to the generalist portion of the recertification process, which would assess core medical knowledge through a series of take-home exams over the 10-year recertification cycle. NCCPA has said it expects to offer between nine and 11 specialty area exams, including an exam in family medicine. Under the original NCCPA proposal process, PAs who achieve a high enough score on the specialty exam and also elect to satisfy other requirements, including CME hours and a minimum time spent working in the specialty, would be eligible for a CAQ. Under the proposal, acquiring a CAQ would be voluntary, but some PAs fear that it could even- tually become a de facto requirement; especially in hospitals or health systems where the PA practice FEATURE STORY, continued Jeffrey A. Katz PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 24 
INTERVENTIONAL RADIOLOGY, CONTINUED model is not well understood, administrators may be looking for easy ways to have employees demonstrate competence, or hospital system lawyers may want to require it in order to mitigate concerns about potential liabil- ity in adverse outcome cases. Of equal concern is the CAQ becoming a requirement by payers or state licensing authorities. “Our concern is to ensure that NCCPA’s proposed specialty exam requirements do not become a de facto requirement for specialty practice or employment,”says Katz. Clinical Postgraduate PA Training Programs Another pathway for demonstration of clinical competency and advanced training in the clinical setting is through a PA clinical postgraduate pro- gram (sometimes called a“residency”). These have been around since the 1980s, but relatively few PAs have gone through them. Today there are about 60 known programs, typically 12-18 months in length and graduat- ing two to six fellows a year. The AAPA Task Force on Accreditation of Post- graduate Training Programs recently completed its review of available evidence on postgraduate training programs for PAs and determined that “the development of an efficient, PA-led, national model for accreditation, continuous quality improvement, and reporting on outcomes is needed.” The task force described key elements and considerations for an optimal national model. Accreditation of postgraduate programs requires a degree of flexibility because the programs are so different from each other, according to task force chair Reamer Bushardt, PharmD, PA-C, DFAAPA.“The purposes of these programs vary widely,”he says,“and we don’t really know what is working well because we have very limited outcome data. But there is a desire to have an accreditation or national recognition process; some insti- tutions would like to have a way to establish their credibility.” The task force’s paper,“Accreditation and Implications of Clinical Post- graduate PA Training Programs,”has been submitted to the HOD for approval as policy. If approved, the paper would replace an earlier position paper that had cautioned against development of a postgraduate accredi- tation process. From the Director’s Office PAs who oversee other PAs in large health systems are strong advocates for maintaining the practice flexibility of their PA workforce, and for the hospi- tal or health system’s ability to train PAs and assess their competence in their own way. This is in accord with AAPA’s position that“competency is best assessed at the practice level.” FEATURE STORY, continued Reamer Bushardt POSTGRADUATE TRAINING CLINICAL EXPERIENCE TRAINING COURSES AND CAREER RESOURCES ADVANCED CERTIFICATIONS PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 25 
“I think it is dangerous if we go down the path that our NP colleagues have taken—once you have become specialized in pediatrics you cannot treat other patients,”says Todd Pickard, PA-C, director of PA practice at MD Anderson Center, who oversees nearly 300 PAs.“Creating pathways where we narrowly define our competency really inhibits our ability to practice in multiple specialties. And nobody in my institution, or others that I know of, says that PAs are incompetent because they don’t have specialty certification.” Laurie Benton, PhD, MPAS, PA-C, DFAAPA, a PA administrator at Baylor, Scott & White Health in Temple, Tex., agrees.“If you go into a new area of practice that requires new training, let hospitals and specialty staff be the ones to train you. We have onboarding and training procedures for that specialty. We can take the responsibility.” Benton, a member of the AAPA Board of Directors, also advocates for a distinction between knowledge, which can be assessed on an exam, and competence, which cannot.“You can have someone that is very book smart but you put them in a life or death situation and they might not react well,”she says.“They may not feel comfortable inserting a chest tube or clamping a bleeding artery. I feel it should be left to the specialty team and the physician to determine that the person is trained. I need to see it for myself, not trust a piece of paper.” PAs in management also make a key distinction between“a certificate” and“certification.” “I do advocate for recognition of PAs who have served in a specialty for all of their careers,”says Josanne Pagel, MPAS, PA-C, Karuna®RMT, DFAAPA, executive director of PA services at the Cleveland Clinic, and also AAPA president-elect.“Those PAs should have that certificate, but it should not be a certification. That was the original intent of the CAQ, to recognize the knowledge of those PAs.” “When I think of certification, I think of an accrediting body that has public responsibility,”says Pickard.“Certification from NCCPA is required to practice. But a certificate just shows that you have completed additional training and have additional skills, like doing 25 hours of ACLS.” ‘Psychiatry Is a Bit Different’ One specialty area where the CAQ may be closest to becoming a de facto requirement is psychiatry.“Psychiatry is a bit different,”says Tracy Keizer, PA-C, director of the PA/NP postgraduate fellowship program in psychiatry at Regions Hospital in St. Paul, Minn.“NPs have a specific degree that they can get in psych. So we do have quite a bit of competition with them because of that certification. This is a reality with employers and payers.” “There has been a lot of push for the CAQ at our institution,”adds Keizer. “I am not one to promote it because it does limit our flexibility, but our administration has said it is the goal.” “All it takes is a perception,”says Pagel.“If you have one leader at a prac- tice who perceives that NPs are certified so PAs must be certified, that can immediately stop the hiring of PAs. I have seen it in psychiatry; it is reality.” James Cannon, PA-C, DHA, MBA, DFAAPA, a former chair of NCCPA and a leader of the Association of PAs in Psychiatry, says he has seen multiple cases of PAs being shut out of job opportunities and reimbursement in that specialty, prior to the creation of the psychiatry CAQ. “The market- place in mental health makes psychiatry truly the most unique specialty,” Cannon says.“We are competing against psychologists, psychiatric NPs, clinical counselors—all with formal qualifications in mental health. An emphasis should be placed on first amending those state laws that cur- rently do not define PAs as mental health providers.”Cannon, who has earned the CAQ in psychiatry, considers the proposed CAQ program a FEATURE STORY, continued Todd Pickard Laurie Benton Josanne Pagel PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 26 
FEATURE STORY, continued “kind of portfolio, a way to organize one’s experience, CME, physician attestation, and medical knowledge.” Preserving Multiple Pathways It remains to be seen whether other specialties will follow in the first tentative steps toward requiring a CAQ for practice that seem to have been taken in psychiatry. And some perspective is necessary. At present, the number of PAs who have earned a CAQ is approximately 1,000, less than 1 percent of the more than 108,500 PAs in clinical practice today. “With a reported 45,000 open PA jobs, why would any prudent employer limit their applicant pool to such a narrow universe by making the CAQ a requirement?”asks Tricia Marriott, PA-C, MPAS, DFAAPA, MJ Health Law, principal advisor with AAPA’s Center for Healthcare Leader- ship and Management, who speaks regularly to health system adminis- trators around the country.“We know that only about 100 of the 12,000 PAs in orthopaedics have obtained a CAQ, and there is no evidence that the PA with a CAQ would be a better candidate for a sports medicine practice than one with 15 years of experience in sports medicine and no CAQ.” AAPA is working proactively to ensure that CAQs, or other formal attestations of specialty training, do not become de facto requirements and limit the ability of PAs to switch specialties and of the profession to move to where the demand is greatest. “We are not against the CAQ, but we want to ensure that there are many pathways for PAs to demonstrate competence and expertise, and that these are well understood by employers, credentialing bodies, reg- ulators, and payers,”says Katz.“It is well documented that provider com- petency is best established at the practice level.” STEVEN LANE, MA, MPP is senior strategic writer for AAPA and an editor of PA Professional. Contact him via email or 571-319-4364. Tracy Keizer James Cannon Tricia Marriott NCCPA.NET PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 27 
Sunday, May 15, 2016 | 12:00–12:45 PM (Lunch will be served) Hemisfair 2 at the Henry B. Gonzalez Convention Center This program is not affiliated with AAPA Conference. Considerations for Pain Management with OTCAnalgesics A PA Perspective Please join Dayne Alonso, MMS, PA-C, at this year’s AAPA Conference for a presentation on over-the-counter (OTC) analgesics. This engaging, case-based presentation will provide an overview of how pain affects patient quality of life and will discuss options for managing pain with OTC analgesics. Ms Alonso will also highlight considerations when making OTC analgesic recommendations and reinforce the importance of educating patients about appropriate use of recommended products. Ms Alonso is the chief physician assistant in oncology/hematology at Advanced Medical Specialties in Miami; a member of the Board of Trustees at Rocky Vista University in Parker, Colorado; and chair of the Legislative & Governmental Affairs Committee of the Florida Academy of Physician Assistants (FAPA), for which she has served as president. A member of the Pi Alpha Honor Society at Nova Southeastern University, Ms Alonso has been recognized as a FAPA Humanitarian Physician Assistant of the Year and was nominated for the AAPA Outstanding PA of the Year Award. Featuring Dayne Alonso, MMS, PA-C Program Director of the PA Program at Miami Dade College in Miami, Florida Please also visit McNeil Consumer Healthcare at Booth 931 throughout the AAPA Conference. Program sponsored by: © Johnson & Johnson Consumer Inc. 2016 Explore challenging orthopaedic topics with expert faculty – and earn up to 28.25 AAPA Category 1 CME credits at the same time! Learn about injuries to the spine, shoulder, elbow, wrist, hand, hip, knee, ankle and foot with interactive sessions. Attend breakout sessions on MRI case studies, fracture management and physical exam techniques. Make sure to save your spot at the popular hands-on Splinting and Casting Workshop! AAPA members save extra. Register today! aapa.org/galaxy
Our work at the AAPA Center for Healthcare Leadership and Management (CHLM) is to ensure PA interests are represented with employers and to cultivate PA leaders. We work with employers and you to move the PA profession forward. WE ADVISE EMPLOYERS on best practices to maximize provider utilization and retain top talent. Employers rely on us as the expert on PA reimbursement and billing, scope of practice, regulatory compliance, and credentialing and privileging. When PAs are able to practice at their highest level, patient care is at its best. And that’s something we can all support. WE BUILD PA LEADERS with innovative training events to equip you to lead your team, your committee, your workplace and your profession. We want to help you grow as a leader both personally and professionally, because we know that as each PA becomes stronger, so does the profession. Learn more about how CHLM is working for you every day. chlm.org You advocate for patients. We advocate for you. We are CHLM.
PROFESSIONALPRACTICE Cultivate Your Network Employment References: Tips and Techniques B Y J E N N I F E R A N N E H O H M A N C reating your references list is an essential part of the job search that can also help you cultivate your professional network and prepare you for inter- views. Your list, comprising people with whom you’ve worked closely and who can attest to your skills, is a great way to review your accomplishments and look at your practice to date through the eyes of your clinical partners. I suggest creating a reference list document that matches the font and overall style of your CV and cover letter and keeping it to one page. List your strongest and most recent references first and include their contract information and their professional relationship with you as well as how long you’ve known each other. Choose people with whom you’ve worked closely and can speak knowl- edgably (and positively!) about your work, accomplish- ments and character. It’s key that you reach out to each reference and confirm their willingness to be contacted. You might also review some highlights of your work together and ask them what they consider to be your strongest points. Share an updated copy of your CV and some information about your current career goals. Ask them about their preferred method of contact by employers with whom you’ll be putting them in touch. JENNIFER ANNE HOHMAN is the founder and principal of PA Career Coach, a service dedicated to helping PAs create rewarding, healthy and patient-centered careers. Contact her via email. PA PROFESSIONAL  |  MAY 2016 |  AAPA.ORG | 30 
PROFESSIONAL PRACTICE | continued The assessments of physicians you partnered with are probably of greatest interest to prospective employers, but you might also include contact information for a few other individuals who can attest to your skills and great qualities. For recent graduates, these people might include pro- fessors/preceptors, established clinicians, other PAs and even a patient you’ve treated. To cultivate your references and keep them a thriving resource, keep your professional network active by staying in touch with former col- leagues and bosses. A current relationship will improve the odds of a posi- tive and pertinent response to a referral request. It’s also a great idea to share an updated version of your resume with them as well as information about the job you are applying to. Help them to be advocates for you! Be sure to express your thanks for the time and effort they share to ben- efit your career (a thank you note is a good place to start; an invitation to coffee, if feasible, is a nice gesture and will nurture your network) and keep your references in the loop—let them know where your job search landed you. How many references to provide? Three to six is a good number for most positions. When to share their information is also important: Rather than sharing your reference list with an employer with your cover letter and CV, wait until your interview to share the list. This gives you an oppor- tunity to inform your references about the employer and some specifics of the position. In summary, references are an aspect of the job search that highlight the quality of your working relationships. Everyone encounters some problem- atic ones as part of being a PA along with the great ones—and a negative referral need not be a career disaster. (More on that in PA Professional’s June-July issue.) Keeping your professional network alive is a key to career growth and this truth is never more apparent than during the job search. Build on your relationships to help land your next position, and help respected colleagues by doing the same for them! PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 31 
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first rounds  |  A special section for and by PA students This edition of First Rounds (FR) was produced by FR Editor Paul Gonzales, PA-S2, University of Texas Southwestern Medical Center in Dallas, and FR Assistant Editor Mia McDonald, PA-S1, Jefferson College of Health Sciences in Roanoke, Va. Tuk’s traditional Thai blessing ceremony before she was cremated. Sometimes the Guidelines Are Meant to Be Broken BY STEPHANIE GOMOLKA, PA-S1 My mother-in-law, Vilavun, grew up in a small city on the Gulf of Thailand named Chon Buri, meaning “City of Water.” She had no running water, slept under mosquito nets with her five sisters and endured water snakes and roaches invading the home during monsoon season. She was poorly educated and attended school only when she wasn’t tending to her father’s shop and rice mill. In the 1960s, Tuk, as she was nicknamed, moved to New Zealand, where she enrolled in secretary school, met her soulmate and found a good paying job. With $150 to their name, she and her new partner boarded a plane for New York to start a family. Despite being a New Yorker for 40 years before her death, Tuk remained in many ways a rural town Thai girl with beliefs that matched her upbringing. Tuk had always been apprehensive about heed- ing the advice of American doctors. Where she grew up people used herbal remedies and prayed to their Buddhist ancestors for healing and answers. She was taken aback that when she went to doctors for a simple cold she was invari- ably prescribed an antibiotic. This ultimately led to her distrust in American doctors as she felt that they did not listen to her concerns and just gave her an antibiotic for every ailment. Tuk felt that her perceived education level and cultural beliefs prevented her from receiving the care that she needed and deserved. A turning point occurred for Tuk in the 90s when a friend gave her a copy of “Prevention.” It was then that she felt confirmed in her belief that Western doctors were killing their patients with antibiotics. She turned to supplements and herbal remedies to take care of her own health. She became fixated on natural medicine. In 2005, Tuk began to feel sharp back pains, which she treated naturally with supplements, and in 2007, she was diagnosed with stage 4 lung cancer. Tuk felt she was too frail to begin chemo- therapy and decided to have the tumor removed via cyberknife. One year later Tuk was told she had less than a year left and began treating her- self with natural remedies, much to her cancer team’s disapproval. It was even difficult for our PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 34 
first rounds  |  continued Tuk and Pad with family at their traditional Thai wedding ceremony in New York City. Left to right: Krisana Suthiwongs, Pad Gajajiva, Vilavun“Tuk”Gajajiva,Tao Tangnavarad, Khanitha Tangnavarad. Tuk spending time with the author and her grandson, Kieran, in the summer of 2011. STEFANIE GOMOLKA, PA-S1, attends the Shenandoah University PA program and is a member of the class of 2017. family to watch her refuse treatment. No one really took the time to understand where she was coming from. However, the one year she was given turned into two, and then three, before the cancer eventually took her life. Tuk remained emotionally strong up to her last day. I never realized the impact Tuk had had on me until my first job interview four years ago at Craig Hospital in Denver. They asked about any cultural experiences I had had in my life, and of course Tuk’s story immedi- ately came to mind. After I told the story, the inter- viewer asked if I believed Tuk was able to extend her life because of culture and “alternative” beliefs about medicine. It was the first time I had truly removed my familial bias from the situation and thought objectively about it. After thinking for what felt like an eternity, I looked her straight in the eye and said, “Probably.” She looked me in the eye and said, “Definitely.” Now, in the midst of a rigorous PA program, I con- stantly remind myself of Tuk and her struggle with Western medicine. Studying guidelines, medications, flowcharts and treatment preferences, I can’t help but sometimes think that these will not apply to every patient I will work with. Culturally competent medi- cine should be tailored to the individual. Even if we don’t completely understand a patient’s culture, it is our job to get to know them and understand why they make the decisions they do. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 35 
first rounds  |  continued Sheila Hautbois, PA-S1, with Rachel Carlson, director of the Shenandoah University PA program Outside the Box BY SHEILA HAUTBOIS, MPH, CHES, PA-S1 When most of us consider cultural compe- tence, we think of various ethnicities and heritages. One culture we might not consider is the deaf community who use American Sign Lan- guage (ASL) to communicate. Compared to hear- ing people, individuals who are deaf have poorer health. In fact, patients who were deaf before age 3 are less likely to see a healthcare provider than other adults. Shenandoah University PA students recently had an opportunity to interview patients of differ- ent cultures. One such patient was deaf and had a medical ASL interpreter with her. Although being provided with an interpreter is a legal right, this does not always happen in the U.S. The reality is that both patient and provider truly need an inter- preter to ensure that good understanding occurs on both sides. From our interview with a deaf patient and her feedback afterward, we learned many things. Properly setting up our room is vital to commu- nication. The room should be well lit, and we should not stand in front of a window or an area of glare. If we stand to the side and create a tri- angle with the patient and the interpreter, the patient must then choose between watching the interpreter and looking at us. This not only slows down interpretation, but also causes the patient to make awkward neck movements. By standing right next to the interpreter, we can make com- munication easier for a deaf patient. Eye contact is very important, as is keeping our mouth visible in case a patient reads lips to enhance communication. If we need to wear a surgical mask while communicating with a deaf patient, it should be see-through when possible. If more than one provider will be in the room, we should explain why and gain the patient’s consent. Even though an interpreter is present, we should use “I” and “you,” speaking directly to our patients. We need to be mindful of who we are interviewing; routine questions such as “Have you had any hoarseness?” would not apply to patients who do not speak. Short sentences at a moderate pace with pauses between sentences are ideal. Providing information in a simple manner helps with patient comprehension and also allows for easier interpretation. Giving subject cues in advance of details helps the patient understand what we will discuss next. Because ASL does not follow English syntax, many deaf high school grad- uates only read English at a fourth- or fifth-grade level. Patient handouts should therefore be very easy to understand. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 36 
first rounds  |  continued SHEILA HAUTBOIS, PA-S1, attends the Shenandoah University PA program and is a member of the class of 2017. One such patient was deaf and had a medical ASL interpreter with her. Although being provided with an interpreter is a legal right, this does not always happen in the U.S. The reality is that both patient and provider truly need an interpreter to ensure that good understanding occurs on both sides. Asking deaf patients open-ended questions is vital. Yes-and-no questions will not tell us if we have been understood. If a patient is having trou- ble understanding something, we should explain it differently. We can enhance communication with gestures and facial expressions. Drawing a picture or writing things down might also help. We should explain what we are going to do and why, prior to any physical contact during our exam. Visual aids and hands-on demonstrations can be helpful when teaching a skill or discussing how to take medications. All of us can continue to grow in cultural compe- tence. In our workplace, we can offer online appointment booking and patient communication via email or health portals. We should never make assumptions. Every patient is different, just as every individual is unique. One patient at a time, we can help make healthcare a more positive experience for the deaf community. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 37 
first rounds  |  continued When You Can’t Speak, Listen BY RYAN HUNTON, PA-S2 Ihumbly admit that, despite six years invested in my Spanish language education, as of March 2016, I cannot speak conversational Spanish. This added another layer of cultural separation in my clinical work during our PA program’s recent med- ical trip to Piedras Negras, Mexico. Throughout the week, I was heavily dependent on the various assigned interpreters. In working with interpret- ers, I became aware of the possibility of inconsis- tency and misinterpretation of medical words. I inevitably vowed to reprioritize learning Spanish, especially medical Spanish. Still, despite this in- ability to communicate directly with the patient, I was determined to maximize the patient-provider relationship. And in the end, I found that speaking the same language is not as crucial to this rela- tionship as one might suppose. Take, for example, the 67-year-old man who entered our makeshift church-clinic in a town called Nava with no particular complaint, perhaps seeking reassurance. When I asked him the col- loquial “What brings you in today?” he expressed concern about his blood sugar level, which was mildly elevated, and I could see in his eyes and face that his concern was profound. As I began going through the routine of asking various questions (through the interpreter) about recent symptoms and past medical history, he respectfully asked me to slow down. My collabo- rating physician had previously told me, “Many of these people are constantly being pushed aside by society. This is their chance to be seen and heard.” So when this gentleman asked me to slow down, I did. And I listened. It became clear that he, like many who came into our clinics throughout the week, had not primarily come for a pharma- ceutical; rather, he came for an honest assess- ment and care. He seemed grateful for my For me, just as the history and physical exam are the essential elements of understanding the patient’s medical problem, these nonverbal aspects of communication became the essential elements of building trust and relationship. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 38 
first rounds  |  continued attention, and I was grateful for the reminder that sometimes patients need acknowledgement more than anything else. With each patient, as I explained each step in my physical examination and treatment plan, I paid extra attention to the nonverbal aspects of con- versation: the introductions, the “mucho gusto,” the eye contact despite my speaking words they did not understand, the returned eye contact despite my not understanding the words they were speaking, the shaking of hands, the smile, the farewell. These aspects of the patient encoun- ter are often skimmed over or neglected when one speaks the same language as the patient. For me, just as the history and physical exam are the essential elements of understanding the patient’s medical problem, these nonverbal aspects of communication became the essential elements of building trust and relationship. And they remain essential elements of building trust and relation- ships as I see patients back in Kentucky. RYAN HUNTON, PA-S2, attends the University of Kentucky PA program and is a member of the class of 2017. Ryan Hunton performs a physical exam on an infant. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 39 
first rounds  |  continued Milk, Honey and Beyond BY BELEN LAQUI-RAMOS, PA-S2 Growing up in the Philippines, our family al- ways valued whatever was served on the table despite its simplicity and meagerness. My mother always made sure my brother and I had a cup of freshly brewed Barako coffee over steamed rice for breakfast. A sprinkle of cane sugar made everything magically delicious. At lunchtime, I couldn’t wait to show off a piece of fried mack- erel atop white rice with salty fish sauce and ka- lamansi, a small citrus fruit something like a lime. My mother wrapped them delicately with banana leaves. My days were simple, yet fun-filled—I would even say perfect. After graduation from high school, my family supported my decision to become a preschool teacher, but after five years, there was a call from far away. This call was quite hard to ignore and led me to a teaching job in Texas. For those who have been teachers in the U.S. public schools, you are probably familiar with the lunch lines in the cafeteria. The students grabbed and hastily devoured their food with their thoughts only on recess and enjoying 10 minutes of freedom out- side. Some students took their food trays and immediately swerved to dispose of their food directly into the trash bins. I thought, “Wait, I am missing something here?” Goodbye milk, banana, fideo, enchiladas and broccoli! Coming from a developing country, I was tempted to save that good food! As a result, I talked to my students daily about the importance of conserving food, valuing what they have and limiting the consump- tion of cheese- and jalapeno-smothered chips. But I soon realized that making poor nutritional choices and wasting food is not a trivial problem or mere hormonal craving; it is part of their cul- ture and tradition. Soon there was another call, even harder to ignore this time. Instead of the wastefulness of preschoolers, now I saw middle school students with lunches packed by mom or grandma full of spicy nacho chips and 500 mL of soda. I took a deep breath and thought, “This is an epidemic!” These were words I would later hear from not one but almost all of my future preceptors. While shadowing a pediatric PA, I noticed several patients were not only obese, but also had bor- derline hypertriglyceridemia and diabetes mellitus Members of the class of 2016 after performing community service in health and patient education. Left to right: Ayana Gates, Courtney Brice, Megan Castillo, Nathaniel Garcia, Delmer Robinson, Cassandra Trevino, Benny Lopez, Claudia Pena, Peter Maldonado, Lin Yang, Belen Ramos. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 40 
first rounds  |  continued BELEN LAQUI-RAMOS, PA-S2, attends the University of Texas, Rio Grande Valley (Pan American) PA program and is a member of the class of 2016. type 2 at the young age of 14. My decision was made. Since then, I have equipped myself with the medical knowledge and skills to educate our population about eating healthier, while still enjoying the culture and tradition of being Asian or Hispanic down in the Rio Grande Valley. I love Mexican fajitas, menudo and carne guisada. I always crave Filipino dishes, such as dried and salted fish, pancit, lumpia and unripe mangoes with salted shrimp paste. And these popular cul- tural meals can be enjoyed, but in moderation. Educating patients is my next calling, which I am ready to fulfill soon as a PA. Growing up with barely enough to eat, my fam- ily often told stories of the U.S. being the land of milk and honey. To me, heaps of food repre- sented status and symbolized prosperity. Food was celebration, family bonding and being home. After moving to the U.S., where food scarcity is not a day-to-day concern for most people, I have learned that food does not hold the same mean- ing for most Americans as it does for me. For me, living in and enjoying the land of milk and honey does not mean eating all you can as long as you can, but remembering the basic premise that food is for strength, nourishment and life. Belen Laqui-Ramos (second from left) with her husband, Naesar, and (left to right) daughters Pauline, Patrisha and Meleri. Belen’s food fusion for breakfast, lunch, snacks and dinner. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 41 
first rounds  |  continued To the Border and Back BY SUSAN M. OGDEN, PA-S2 In February, I had the opportunity to travel to the U.S.-Mexico border for my capstone rotation. The month I spent in the Lower Rio Grande Val- ley provided me with firsthand knowledge of the importance of cultural competence. Although my journal is full of impressions and observations there are a few key components to my experienc- es that affect PAs. In the Rio Grande Valley, farming and ranching are the mainstays of life. The workweek consists of six or seven long days for meager wages. The more family members who can work, the better it is for the family. Often, this means children leave school during their middle-school years to work, and their long-term educational goals are sacri- ficed for family need. Formal education may end at ages 12–14 for some young people here. In South Texas, many of the residents only speak Spanish. I took French as my foreign lan- guage in high school because I grew up three hours from Canada. Not having a background in Spanish set up a considerable language barrier, and I found myself initially needing a translator for my history and physical exams during this rotation. But over the next four weeks, my out- look changed from dreading the next conversa- tion to accepting the challenge of being an effective communicator in a new language. There is also a literacy barrier; many residents are illiterate in both English and Spanish or have a basic reading level in Spanish only. We learned in didactic year that providers need to assess literacy as part of the assessment of patients, and living here has given me new ideas on how to address this issue. Written instructions for medications can lead to a high rate of noncompliance; how- ever, pictographs can be found for almost any medical condition and will yield better outcomes. Although it takes time to create or copy these in clinic, I believe it is worth it. While here, I have seen the importance of close family bonds in the Latino culture. Children are raised with a commitment to care for the matri- arch and patriarch of the family until their last days. Decisions are made as a family unit. Now I understand why I have walked into very crowded hospital and exam rooms, at any time of day or night, to take a patient history. The living conditions for most Rio Grande Valley residents are drastically different from those in San Antonio. Some colonias (neighborhoods) do not have indoor plumbing, public transportation or paved roads; other areas lack sidewalks and streetlights. Health challenges abound: lack of UT Health Science Center at San Antonio PA students with dialysis patients PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 42 
first rounds  |  continued outdoor play and exercise, greater risk of disease and injuries, water contamination and inability to obtain basic services. Remember Maslow’s hierar- chy of needs? A hungry family does not make choices about healthy food or preventive care— the immediate goal is to feed all the mouths around the table. In the same way, someone who has performed manual labor for the whole week may not have the energy to get medications refilled or make sure well-child exams are scheduled. In summary, living in a different culture has motivated me to be a better provider. I will be examining each patient’s barriers to health and my own treatment plan more closely. Did I com- municate so the patient could understand? Did I overcome language and literacy barriers? Have I educated family members? Have I taken the patient’s occupational, social and environmental histories accurately? Is what I am recommending to the patient feasible given their environment? I hope to be able to answer “yes” to all those ques- tions in my PA career. SUSAN OGDEN, PA-S2, attends The University of Texas Health Science Center at San Antonio, PA program and is a member of the class of 2016. Susan Ogden at Sacred Heart Church in McAllen, Texas. Farm workers in the Rio Grande Valley. Farming is the primary occupation of most residents. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 43 
first rounds  |  continued Facts and Figures: ■ Program: University of Kentucky ■ Location: Lexington, KY ■ Degree: Master of Science ■ Year of Establishment: 1973 ■ Program Director: Scott Black, MD ■ Number of Applicants: 340 ■ Number of Applicants Interviewed: 120 ■ Number of Applicants Accepted: 56; 40 in Lexington and 16 in Morehead ■ Length of Program: 30 months; 18 didactic and 12 clinical ■ PANCE Pass Rate (class of 2015): 94% PA Program Spotlight: University of Kentucky BY RYAN HUNTON, PA-S2 Inever foresaw becoming so actively involved in PA organizations when I started my training as a PA student at the University of Kentucky (UK) in January 2015. In the first few days I was simply trying to learn how to handle a scalpel without hurting myself and how to adjust to the great tide of information that was sweeping over me. Over time, I learned about the various opportunities to become involved as a PA student, and it is through the mentorship, support and community I have experienced firsthand at UK that I have been able to serve in leadership roles with both AAPA and the Physician Assistant Education Association. I initially chose to complete my PA education at UK because of its rich tradition in medical and health science education. The UK PA Studies pro- gram was established in 1973, just eight years after the profession’s debut; it is among nine dis- ciplines in the College of Health Sciences (CHS), which celebrates its 50th anniversary this year. Both UK CHS and the PA program are near UK Chandler Hospital, and these three entities collec- tively provide a great source of clinical, didactic and inter-professional education for students. The PA program also partners with Norton Healthcare in Louisville, through which it provides a clinical rotation scholarship. This $5,000 scholarship is provided to 10 students who will complete most of their rotations in Louisville through Norton Healthcare hospitals and clinics. Other clinical sites are provided throughout the state through the Area Health Education Center. In 1996, the program was extended to include a distant learning site at Morehead State University, designed for students who intend to work in rural communities. One of the strengths of the UK PA program is its focus on the history and physical exam as the foundation of clinical medicine, which is especially helpful in regions where certain diag- nostic or medical imaging tools are unavailable. The program requires students to complete rural clinical rotations as part of its mission to “prepare and encourage graduates to practice in rural and underserved communities.” Through UK PA fac- ulty member Dr. William Grimes, students also gain clinical experience in their didactic year by PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 44 
first rounds  |  continued The University of Kentucky 2015 White Coat Ceremony for PA students volunteering at New Hope Clinic in Owingsville, Ky., a free medical clinic which has served the rural community since 2000. Aside from its focus on rural medicine, the UK PA program offers several international opportu- nities, including regular clinical rotations in Kenya, Swaziland and England, and clinical training in Ecuador and Mexico. One of my classmates, Amy Hehre, and her husband Robert recently pur- chased an 11,000 square-foot building in Kenya which will soon become a healthcare facility for terminally ill orphans. In a recent article, she expressed appreciation for the UK PA program’s focus on hands-on knowledge and clinical experi- ence even before the standard clinical year. Much of the program’s international outreach comes through clinical coordinators David Fahringer, MSPH, PA-C, and Dr. Somu Chatterjee, as well as through faculty member Sam Powdrill, PA-C, who has served in international medical missions work as an ophthalmology PA for more than 20 years. Outside the classroom, UK PA students serve the local community through organizations like the Jordan Light Foundation, Shriners Hospital for Children, Helping Hands and Upward Bound, and through various schools, programs and commu- nity events. Each year, students attend a legisla- tive day in Kentucky’s capital, Frankfort, to advocate for pertinent PA-related legislation. The day is sponsored by our state PA chapter, KAPA. Students and alumni of the UK PA program take a leading role among the Kentucky PA community to continue the conversation with legislators about the PA profession and how PAs serve as part of medical teams to address Kentucky’s healthcare needs. RYAN HUNTON, PA-S2, attends the University of Kentucky PA program and is a member of the class of 2017. UNIVERSITYOFKENTUCKYPAPROGRAM PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 45 

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Power Up for AAPA 2016 with CME, Recert Proposals and Challenge Bowl

  • 1. Power Up for AAPA 2016! CME, NCCPA’s Recert Proposal and Challenge Bowl T H E L E A D I N G N E W S R E S O U R C E F O R PA s M AY 2 0 1 6
  • 2. There’s Still Time to Register! Refresh Your Skills. Recharge Your Career. Power Up Your Practice. Download the AAPA app to plan your schedule & get the latest updates on CME and events. 70+Employers attheAAPA CareerFair san antonio’s 15-mile river walk & alamo NEW! Meet the Expert Sessions pacers for health 5k fun run/walk nationalmedical challengebowl Alumni & networking events 2-Day Exhibit Hall With 250 Exhibitors Student SPARK Sessions 260+ Hours of AAPA Cat. 1 CME CHLM Quality Improvement Symposium “American Sniper” star, PA Kevin Lacz AT OPENING GENERAL SESSION register now at aapaconference.org
  • 3. ContentsM AY 2 0 1 6 • V O L . 8 , N O . 5 Departments President’s Letter The AAPA House of Delegates to debate and decide policy that affects the PA profession Laws+Legislation Many states are working on PA harmonization acts to clarify scope of practice in all laws affecting PAs Payment Matters A rundown on the members only reimbursement resources on AAPA’s website STAT Washington State adds PAs to state’s mental health code | Scientists confirm severe birth defects tied to Zika virus | PA gymnast headed to Rio Olympics | AAPA past president to serve on advisory board for leading clinical publication Professional Practice How to create a references list that helps you land your next job First Rounds PA students share what they’ve learned about cultural competence and how they’re incorporating it into their practice 6 16 8 11 34 30 Feature Story Equipping PAs for Expanded Opportunities in Healthcare Multiple Pathways, Demonstrating Competence, Flexibility 23 PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 1 
  • 4. Imagine how you’ll celebrate! A NEW JOB IS CAUSE FOR CELEBRATION, and the PA JobLink can help you get there! • Search over 1,000 jobs – all PA openings • Set job alerts so you don’t miss a thing • Get tips and career advice All in one place! www.PAJobLink.com powered by Health eCareers PAThe CAREER FAIR Connect Meet employers actively hiring PAs Explore Learn about new job opportunities in a relaxed setting Practice Sharpen your “elevator speech” and interview skills Sunday, May 15, 2016 1 p.m. – 3 p.m. Register Here
  • 5. PA NewGraduate® is the country’s top-rated professional liability insurance solution designed to save PAs THOUSANDS OF DOLLARS as they start their healthcare careers! One of the most important things a PA can do as they join America’s healthcare workforce is to make certain that their individual liability insurance is secure. Whether you, your physician or medical practice pays for your coverage, there is NO SMARTER CHOICE than CM&F’s PA NewGraduate® . This unique Claims-Made conversion policy converts to Occurrence in Year Six with FREE tail coverage. No matter what your medical specialty, this policy offers the vital protection you need at tremendous savings compared to the average, national malpractice insurance competitor. By having your own PA NewGraduate® policy, your new employer will respect your respon- sible planning; and if they are reimbursing you for your coverage - they’ll be VERY PLEASED that you chose so prudently! Apply Today! www.PANewGraduate.com Attention Graduating PAs Starting Your Career With Quality Liability Coverage Is VITAL - For Both You AND Your New Employer. COVERAGES PA NewGraduate® Professional Liability $1,000,000 License Defense $25,000/$100,000 HIPAA Defense $25,000 Deposition Defense $10,000 First Aid $15,000 Loss Of Earnings $2,500 Per Day Good Samaritan Included Biomedical Defense $10,000 Assault Upon You $25,000 Medical Payments $25,000/$100,000 PA NewGraduate® First Year Premium ONLY $300.00 99 Hudson Street, 12th Fl., New York, NY 10013-2815 Tel: 1-800-221-4904 Fax: 646-390-5163 Email: info@cmfgroup.com VISA/MasterCard PA NewGraduate® First Year Premium ONLY $300.00 Year 1 Premium: $300 Year 2 Premium: $750 Year 3 Premium: $2,500
  • 6. © Copyright 2016 by the American Academy of PAs. PA Professional is published monthly and is a registered trademark of AAPA, 2318 Mill Road, Suite 1300, Alexandria, VA 22314-6868. MAGAZINE STAFF PUBLISHER Amy Noecker anoecker@aapa.org EDITOR-IN-CHIEF Janette Rodrigues jrodrigues@aapa.org WRITER/EDITOR Steven Lane slane@aapa.org STAFF WRITER Sarah Sonies ssonies@aapa.org GRAPHIC DESIGNER Joan Dall’Acqua jd@acquagraphics.com CLASSIFIED AND DISPLAY ADVERTISING SALES Tony Manigross 571-319-4508 tmanigross@aapa.org 2318 Mill Road, Suite 1300 Alexandria, VA 22314-6868 PH: 703-836-2272 | FX: 703-684-1924 EM: aapa@aapa.org | WB: aapa.org AAPA BOARD OF DIRECTORS 2015–2016 PRESIDENT AND CHAIR OF THE BOARD Jeffrey A. Katz, PA-C, DFAAPA PRESIDENT-ELECT Josanne K. Pagel, MPAS, PA-C, Karuna RMT®, DFAAPA IMMEDIATE PAST-PRESIDENT John G. McGinnity, MS, PA-C, DFAAPA VICE PRESIDENT AND SPEAKER OF THE HOUSE L. Gail Curtis, MPAS, PA-C, DFAAPA SECRETARY-TREASURER Jonathan E. Sobel, PA-C, MBA, DFAAPA, FAPACVS FIRST VICE SPEAKER David I. Jackson, DHSc, PA-C, DFAAPA SECOND VICE SPEAKER William T. Reynolds, Jr., MPAS, PA-C, DFAAPA DIRECTOR-AT-LARGE Laurie E. Benton, PhD, MPAS, PA-C, RN, DFAAPA DIRECTOR-AT-LARGE Diane M. Bruessow, PA-C, DFAAPA DIRECTOR-AT-LARGE Lauren G. Dobbs, MMS, PA-C DIRECTOR-AT-LARGE Michael C. Doll, MPAS, PA-C, DFAAPA, FAPACVS DIRECTOR-AT-LARGE David E. Mittman, PA, DFAAPA STUDENT DIRECTOR Elizabeth R. Prevou, MPH, MSHS, PA-C CHIEF EXECUTIVE OFFICER Jennifer L. Dorn, MPA V O L 8 | N O 5 | M AY 2 0 1 6 AAPA.ORG PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 4 
  • 7. PATIENTS FIRST. Cyndy Flores, PA-C Regional Medical Center of San Jose “It’s why we went into medicine, and that’s easily lost. CEP America walks the walk by keeping the patients in focus. CEP America knows how to care for patients across the Acute Care Continuum. Team-based practices are more efficient and effective for great care.” YOUR LIFE. YOUR CAREER. YOUR PARTNERSHIP. To learn more about a career with CEP America visit: go.cep.com/topcareer MPAS Degree Advancement Option Division of Physician Assistant Education Requirements § Graduate of accredited PA program and possess a baccalaureate degree § Current or prior NCCPA certification § Physician/Mentor who agrees to be your preceptor Learn more and apply at: unmc.edu/alliedhealth/padao | 402-559-6673 Program Highlights § Over 30 years of proven success granting master’s degrees to nearly 2000 practicing PAs § 36 semester credit hours of courses including a clinical or education track § Affordable program with no required resident time on the UNMC campus § Graduate in 5 semesters with up to 5 years to complete studies
  • 8. PRESIDENT’SLETTER The AAPA House of Delegates: Where the Profession’s Policy Is Debated and Decided W ith so much to learn, so many people to meet and so many exciting goings-on at AAPA Conference 2016, it can be easy to forget that conference time is also when some of the most important decisions impacting the PA profession are made. Your elected representatives in the House of Delegates (HOD) have been diligently preparing for the 2016 HOD Meeting and this year they have much to discuss. As an AAPA member, you are represented in the HOD through your state or federal service chapter, your medical specialty, your caucus or the student delegation. The HOD Meeting is your opportunity to have your voice heard as your representatives debate the most relevant and impact- ful issues affecting both the profession and healthcare. Members of the HOD will be considering 54 separate resolutions this year.These resolutions represent a wide range of issues, including the pain management and opioid abuse crisis, PA licensure and the best path forward in addressing the recent NCCPA recertification proposal, PA license portability, guidelines for state regulation of PAs and medical marijuana. One resolution that is particularly important to me focuses on how we can increase the num- ber of preceptors and clinical rotations available to PA stu- dents so we can cultivate the next generation of PA leaders. As a PA, you are a leader and a critical member of the healthcare delivery team. Your voice and your opinion need to be part of the profession’s policy discussion. So as you finish booking your hotel and travel to San Antonio, add an item to your to-do list. Visit the AAPA HOD Governance page and review this year’s resolutions. If there is an item you are passionate about, reach out to your state, federal service, specialty, caucus or student representatives and let them know how you feel. If you have information or data you think is pertinent, send it along. The future of the pro- fession belongs to all of us and your participation will strengthen the foundation on which we will build our future—because, as always, we are stronger together. Jeffrey A. Katz, PA-C, DFAAPA AAPA President and Chair of the Board PA PROFESSIONAL  |  MAY 2016 |  AAPA.ORG | 6 
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  • 10. LAWS+LEGISLATION Seeking Harmony in State Laws Many States Are Working on PA Harmonization Acts to Clarify Scope of Practice B Y C A R S O N W A L K E R , J D M uch like the profession itself, PA laws and regu- lations have come a long way in the past 50 years. States are improving patient access to healthcare. This includes tearing down barriers standing in the way of PAs delivering this much-needed care. How- ever, while many are advocating for positive changes to PA practice acts, there are still areas of law outside of PA practice acts that are in dire need of improvements, such as provisions on signing for handicap placards, conduct- ing department of transportation physicals, instituting concussion protocols for sporting events and authorizing students to have epi-pens for self-administration at schools. And this list is by no means exhaustive. There are various reasons for this exclusion of PAs from various areas of law. Generally, many of these provisions were either drafted before the PA profession existed or it was just assumed that by including physicians, PAs were also included. However, PAs not being specifically included in a list of providers who can perform certain functions, even though these functions may be well within a PA’s scope of practice, can lead to confusion and unintended outcomes. In order to address these omissions, AAPA has been working with state chapters to introduce legislation called “PA harmonization acts.”The purpose of these acts is to amend those areas of law outside of the PA practice act to accurately reflect a PA’s scope of practice and lessen confusion around what a PA can legally do. These acts can take a few different forms, but they generally serve to amend the various sections of law that may only mention physicians, or physicians and NPs, to include PAs. Numer- ous chapters have been successful in having these harmo- nization acts signed into law. The results not only mean that there is no longer confusion over whether or not PAs can perform a medical function that they are qualified to do, but that when new sections of law and regulations are drafted in the future, legislators and regulators will include PAs because they are already included everywhere else. One recent example of a state that harmonized its laws to include PAs is Oregon. In 2014, Oregon’s governor CARSON WALKER, JD, is an AAPA director of constituent outreach and advocacy. Contact him via email or 571-319-4316. PA PROFESSIONAL  |  MAY 2016 |  AAPA.ORG | 8 
  • 11. LAWS+LEGISLATION | continued signed SB.1548 into law. The legislation updated 75 areas of Oregon stat- utes to include PAs. The accomplishment was no small feat—the Oregon Society of PAs’Government Affairs Committee spent more than 100 hours analyzing various provisions to determine which were missing PAs. Oregon’s example is just one way to approach harmonization of state laws. Such a heavy lift is not always feasible. Another approach is to pick out the most egregious or impactful omissions in a state’s laws, and draft legislation specifically to address and amend those areas of law that will be the most meaningful to PAs and patients in that state. One state that took this approach was Washington, which recently had a harmonization act (SB. 6445) signed into law that specifically amended the state’s mental health code in 22 places to include PAs. Other states that have been suc- cessful in harmonizing laws are Hawaii and North Dakota. States with active legislation to harmonize laws and regulations in the 2016 legislative session include Illinois and Colorado. Other chapters, including Rhode Island and New Hampshire, are currently in the early stages of reviewing their state laws for the purposes of harmonization in the future. For more information on harmonization acts, or to find out if your state is in the process of harmonizing its laws to include PAs, contact your desig- nated member of AAPA’s constituent organization outreach and advocacy team. Why choose CME Resources’ PANCE/PANRE Review Courses? H Engaged learning environment with audience response technology H Multiple faculty maximizes the course experience H 98% Pass Rate H 100% Money-Back Guarantee** H Most frequently recommended course by Physician Assistants! ** - See website for details Prepare to Excel CMERESOURCES.COM H 5-day program: 43 hours AAPA Cat 1 CME credits H CMExpress 3-day: 26 hours Cat1CME credits Come visit us in Booth 714 “Great course! I’ve used CME Resources for my last three recertifications and it always exceeds my expectations.” – William, Fenton, Michigan For more information or to register go to www.cmeresources.com or call 800-522-3439. 2016 Dates & Locations 5-Day Course Chicago June 6-10 August 1-5 August 24-28 December 5-9 Atlantic City June 20-24 Los Angeles July 20-24 Houston August 14-18 Philadelphia September 12-16 Las Vegas Sept. 27 - Oct. 1 Atlanta October 5-9 Boston October 26-30 Washington D.C. November 9-13 3-Day CMExpress Minneapolis June 11-13 Orlando June 17-19 Charlotte July 15-17 Chicago July 29-31 Las Vegas Sept. 29-Oct. 1 Cleveland November 4-6
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  • 13. PAYMENTSMATTER Reimbursement Information at Your Fingertips A Guide to Reimbursement Resources on the AAPA Website B Y T R E V O R S I M O N , M P P AAPA offers numerous reimbursement resources to its members, as well as to employers and others interested in PA payment and coverage information. These resources include the for- purchase e-publication“The Essential Guide to PA Reimbursement,”presentations at state and national PA conferences, and the availability of the AAPA reimburse- ment department staff. However, there’s another conve- nient resource that contains a great deal of reimburse- ment information that you may not be aware was readily available: the AAPA website. For those interested in utilizing AAPA’s website to a greater extent, we will highlight many of the reimburse- ment-focused resources available here. Some are available to the general public, while others live behind the web- site’s firewall, for the use of members only. To begin, start at AAPA’s home page. From there, place the cursor over the word Advocacy (top center), which will produce a dropdown menu. To find the AAPA reimburse- ment-related resources, scroll down the list and click on the word Reimbursement (see picture below). This section contains many of the reimbursement resources available from AAPA. It includes links to: TREVOR SIMON, MPP, is AAPA’s assistant director of regulatory policy. Contact him via email or at 571-319-4405. PA PROFESSIONAL  |  MAY 2016 |  AAPA.ORG | 11 
  • 14. PAYMENT MATTERS | continued ■ Where you can purchase “The Essential Guide to PA Reimbursement,” an extensive explanation of PA policies across various payers and circumstances ■ ICD-10 Preparation Resources: Various pages on the AAPA website pertaining to ICD-10, including pages with general resources, resources by state, resources by specialty and FAQs ■ Reimbursement Basics: An AAPA issue brief that provides an introduc- tion to the issue of PA reimbursement ■ Medicare Reimbursement: A Medicare Resources page with issue briefs on topics such as“incident to,”shared visit billing, use of scribes, PECOS enrollment, Medicare qualifications and coverage of services, preventive services, durable medical equipment, first assisting at surgery, pre-op history and physical examination, home health, diagnostic tests and the EHR incentive program ■ Medicaid Reimbursement: A page with background on the Medicaid program and PA coverage ■ Private Payer Reimbursement: An issue brief on third-party payer policy for PAs ■ Workers’Compensation: A page with background on workers’compen- sation and PA coverage ■ Current Issues: A page containing updates, issue briefs and regulatory comments, as well as an FAQ on the repeal of the sustainable growth rate system ■ Calculating PA Productivity: An issue brief on the measurement of productivity and its relationship with compensation In addition to those resources found on the Reimbursement page, useful reimbursement information can be found under other Advocacy subsec- tions. By clicking on Healthcare Reform, you will be brought to a page with information on the Affordable Care Act (ACA). From here, and using the links now on the left side of the page, you can explore pages that provide background on the law, information on how health reform directly affects PAs, and resources that may be useful in learning more about the ACA. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 12 
  • 15. PAYMENT MATTERS | continued Finally, another source of information on reimbursement policies can be found by going to Advocacy and then clicking on Federal. Once here, click on Regulatory Advocacy. This will bring you to the same page you were able to access through Reimbursement under the Current Issues link. On this page you will find a list of comment letters submitted to federal agen- cies, such as the Centers for Medicare and Medicaid Services. These letters respond to proposed regulations that affect PAs. In these comment letters, AAPA summarizes relevant sections of the regulations, indicates how the proposed policies affect PAs and makes recommendations to CMS and other federal agencies on ways to attain optimal PA utilization and increase patient access to care. While this article acts as an introduction to the resources available on AAPA’s website, it is not a comprehensive catalog of resources available. To inquire whether AAPA possesses reimbursement-related resources that are not mentioned here, please reach out to the Reimbursement department. Your AAPA Membership Has Benefits! Voluntary Group Short Term and Long Term Disability Insurance 1. New eligible AAPA Fellows who apply within the first 60 days of membership are guaranteed to be accepted! No medical questions or records required! AAPA Fellow members with a date of membership longer than 60 days can still apply, but medical underwriting is required 2. Discounted Premiums- 50% lower than individual disability policies with similar features 3. Short Term disability coverage has no preexisting condition limitation 4. Benefits can be used immediately upon your effective date - guaranteed acceptance applicants do not have to satisfy any time period before filing a claim. Contact us for more details 5. Benefits do not offset individual disability coverage you may have in place Protect your most valuable asset, your paycheck! Protection will replace a portion of your income when a sickness, injury or pregnancy keeps you from working; up to $4,000 per month in Short Term and $8,000 per month in Long Term Benefits. Want to learn more? Visit www.MyPABenefits.com or come talk with us at booth #1207 If you are not covered by a group disability insurance plan, now is the time to consider enrolling in this valuable coverage. If you already have 60% of your earnings covered by a group disability plan through your employer, and would like information on how to increase that benefit to 75-80%, contact Ryan Insurance Strategy Consultants directly at 800-796-0909 ext. 107. "Protecting Your Financial Plans Since 1978"
  • 16. Proven by more published research than any leading joint supplementL • Shown on a cellular level to inhibit enzymes that breakdown cartilage* • Helps protect articular cartilage* • Gluten-Free • Shown on a cellular level to inhibit enzymes that breakdown cartilage • Helps protect articular cartilage* • Gluten-Free *THESE STATEMENTS HAVE NOT BEEN EVALUATED BY THE FOOD AND DRUG ADMINISTRATION. THIS PRODUCT IS NOT INTENDED TO DIAGNOSE, TREAT, CURE, OR PREVENT ANY DISEASE. L Based in part on data reported by Nielsen through its AOD Service for the Supplement Category for the 52-week period ending 12/26/15, for the U.S. market. Copyright © 2016 Nielsen. Ask about our Patient Programs. Call 1-877-267-2646 or email contactus@nutramaxlabs.com L Based in part on data reported by Nielsen through its AOD Service for the Supplement Category for the 52-week period ending 12/26/15, for the U.S. market. Copyright © 2016 Nielsen. 0 days on HealthProfessionsJobsPlus) UNIVERSITY OF BRIDGEPORT Program Director Physician Assistant Institute The University of Bridgeport (UB), one of Connecticut’s fastest growing universities, invites applications for the Program Director of the Phy- sician Assistant Institute (PAI). The Program Director is a twelve-month position which provides for the overall leadership, administration and management of the PAI program to promote quality education for the students in accordance with the University’s mission and with ARC-PA ac- creditation standards. The University of Bridgeport is an independent and non-sectarian institution well known for its diversity. Founded in 1927 and located in historic New England on the Connecticut shoreline in sight of Long Island Sound’s breathtaking vistas. The campus and region, including the nearby trea- sures of New York City and Boston, provide an unparalleled context for study, professional aspiration, and growth. Students from 80 countries and 45 states make up the global citizenship of the University. To view to full job announcement, see: http://www.bridgeport.edu/job/program-director-physician-assistant-institute/ Qualifications: • If the incumbent is a PA, current NCCPA National Certification and eligibility for CT state licensure; • If the incumbent is a Physician, s/he must hold current licensure as an allopathic or osteopathic physician in Connecticut and must be certified by an ABMS- or AOA-approved specialty board and knowledge about current PA practice standards and the PA role; • A minimum of a Master’s degree, a Doctorate is preferred; • A minimum of six years of clinical experience with at least three years of clinical experience as a practicing PA; if an MD/DO, three years’ expe- rience in clinical setting working with PA; • A minimum of three years of clinical education experience with a minimum of two years in full-time PA education, preferably in a leadership role. The University offers a comprehensive benefits package and competitive salary. Review of applications will begin immediately and continue until the position is filled. Qualified applicants should send a letter of application, resume and contact information for three professional references to: University of Bridgeport Human Resources, Wahlstrom Library, 7th Floor Physician Assistant Institute-Program Director 126 Park Avenue Bridgeport, CT 06604 employment@bridgeport.edu The University of Bridgeport is an Affirmative Action/Equal Opportunity Employer UNIVERSITY OF BRIDGEPORT Program Director Physician Assistant Institute ty of Bridgeport (UB), one of Connecticut’s fastest growing universities, invites ap- the Program Director of the Physician Assistant Institute (PAI). 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  • 17.  Online and Print Versions available  Cost Effective CME  Money Back Guarantee North America’s most widely recognized program for Family Medicine CME and Board Preparation.  Visit www.CoreContent.com  Call 888-343-CORE (2673)  Email mail@CoreContent.com PO Box 30, Bloomfield, CT 06002 Easily manage your procedure competency, in real time, with CMP10C. Coming Soon www.cmp10c.com The most common eating disorder in US adults isn’t just about eating*1-3 The exact cause of binge eating disorder (B.E.D.) is unknown. Research suggests that among potential causes, B.E.D. may have a neurobiological basis.4-12 What is B.E.D.? B.E.D. is defined as recurring episodes† in which a large amount of food is consumed in a relatively short time. Patients feel a lack of control during a binge and marked distress over their eating. Among other symptoms, they typically experience shame and guilt about their bingeing, and may conceal their symptoms even from you.1 To download the patient screener, learn more, and view the full DSM-5® diagnostic criteria, visit BingeEatingDisorder.com/hcp. *Estimated 12-month and lifetime prevalence among an eating disorder–assessed subsample (n=2,980) of the National Comorbidity Survey Replication, a nationally representative face-to-face household survey of English-speaking adults aged ≥18 years.2,3 † Recurrence is defined as, on average, greater than or equal to once weekly for at least 3 months. References: 1. American Psychiatric Association. Binge-eating disorder. In: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013:350-353. 2. Hudson JI, Hiripi E, Pope HG Jr, Kessler RC [published correction appears in Biol Psychiatry. 2012;72(2):164]. Biol Psychiatry. 2007;61(3):348-358. 3. Kessler RC, Berglund PA, Chiu WT, et al. Biol Psychiatry. 2013;73(9):904-914. 4. Balodis IM, Molina ND, Kober H, et al. Obesity (Silver Spring). 2013;21(2):367-377. 5. Schäfer A, Vaitl D, Schienle A. Neuroimage. 2010;50(2):639-643. 6. Woolley JD, Gorno-Tempini ML, Seeley WW, et al. Neurology. 2007;69(14):1424-1433. 7. Schienle A, Schäfer A, Hermann A, Vaitl D. Biol Psychiatry. 2009;65(8):654-661. 8. Davis CA, Levitan RD, Reid C, et al. Obesity (Silver Spring). 2009;17(6):1220-1225. 9. Wang G-J, Geliebter A, Volkow ND, et al. Obesity (Silver Spring). 2011;19(8):1601-1608. 10. Levitan RD, Masellis M, Basile VS, et al. Biol Psychiatry. 2004;56(9):665-669. 11. Naleid AM, Grace MK, Chimukangara  M, Billington CJ, Levine AS. Am J Physiol Regul Integr Comp Physiol. 2007;293(1):R99-R105. 12. Boggiano MM, Chandler PC, Viana JB, Oswald KD, Maldonado CR, Wauford PK. Behav Neurosci. 2005;119(5):1207-1214. Binge eating disorder is a cycle of… Binge. Distress. Repeat.1 DSM-5® is a registered trademark of the American Psychiatric Association. ©2016 Shire US Inc., Lexington, MA 02421 1-800-828-2088 S11684 03/16 S:10.5” T:11”
  • 18. STAT | Industry News WASHINGTON STATE ADDS PAs TO STATE’S MENTAL HEALTH CODE PAs in Washington state are celebrating Gov. Jay Inslee’s recent signing of SB. 6445 which adds PAs to 22 sections of the state’s mental health code. SB. 6445 becomes effective June 8, 2016. The bill is the product of the successful advocacy efforts of the Washington Academy of PAs (WAPA) and the persistence of WAPA members Suzan Dula, PsyD, PA-C, and Dale Sanderson, PA-C, MPH, and AAPA. Dula and Sanderson contacted their state legislator when the omission of PAs in the state mental health code created obstacles for PAs pro- viding psychiatry services. The bill’s key changes include: • Adding PAs to the definitions of“mental health professional”and“developmental disabilities professional” • Authorizing PAs to sign petitions for specified involuntary detentions • Authorizing PAs to make determinations of incapacity • Adding PAs throughout the Mental Health Advance Directive form Adequacy of and access to mental health ser- vices is a leading concern across the country and AAPA advocates for all states to ensure that PAs are included in state mental health provisions. For more information, contact Keisha Pitts, JD, director of constituent organization outreach and advocacy. Read more here. PA GYMNAST HEADED TO THE RIO OLYMPICS! Houry Gebeshian, PA-C, recently realized a dream deferred when she became the first female gymnast to represent Armenia in the Olympic Games! (She has dual American-Armenian citizenship.) Gebeshian is a 2014 graduate of the Wake Forest University PA program. A standout at gymnastics powerhouse the University of Iowa, she competed as an individual all-arounder in the 2011 NCAA Women’s Gymnastics Championship and she is the 2010 Big10 Conference champion on the balance beam. Read more here. From left to right: state Rep. Joe Schmick; Jeb Shepard of WSMA; state Sen. Randi Becker; Seth Dawson of NAMI-WA; Gov. Jay Inslee; Dale Sanderson, PA-C; Ruth Peterson, legislative assistant to Sen. John Braun, a sponsor of the bill; Suzan Dula, PA-C; Kevin Black, staff counsel to the Washington Senate Human Services and Mental Health Committee; and Kate White Tudor, WAPA’s lobbyist. PA Houry Gebeshian on the balance beam PHOTOBYANHVIÊTCHAU PHOTOCOURTESYOFWAPA PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 16 
  • 19. STAT | continued AAPA PAST PRESIDENT TO SERVE ON ADVISORY BOARD FOR LEADING CLINICAL PUBLICATION Stephen H. Hanson, MPA, PA-C, DFAAPA, a former AAPA president, has been selected to serve on the editorial advisory board of the leading trade pub- lication Physicians Practice. A regular contributor to the publication, Hanson writes a twice-monthly column on optimizing team-based care and electronic health record (EHR) deployment. His columns are among some of the most widely read and commented on blogs on the Physi- cians Practice website.The publication— widely read among the medical and phy- sician leadership community—made the decision to expand its advisory board to providers across the healthcare landscape to reflect the evolving landscape of today’s medical practice. Hanson, a plastic surgery PA with experience in emergency medicine, urgent care and public health, is the first and only PA to serve on the edito- rial advisory board of Physicians Practice. A PA for more than 35 years, he currently practices medicine in a hospital-based plastic and reconstructive sur- gery practice, in addition to covering a burn unit with his surgeon and business partner M. Brandon Freeman, PhD, MD. As part of the editorial advisory board, Hanson joins a team of physicians and the Physicians Prac- tice editorial staff in helping to shape the content and strategy for the publication. SCIENTISTS CONFIRM SEVERE BIRTH DEFECTS TIED TO ZIKA VIRUS Scientists from the Centers for Disease Control and Prevention (CDC) have concluded, after care- ful review of existing evidence, that Zika virus is a cause of microcephaly and other severe fetal brain defects. In an April report published in the New England Journal of Medicine, the CDC authors describe the rigorous weighing of evidence that led them to their findings. Since its first identification in Brazil in 2015, Zika virus has spread rapidly. While prenatal Zika virus infection was linked to adverse pregnancy and birth outcomes, most notably microcephaly and other serious brain anomalies, exact causation had not yet been established before now. Given the severity of the birth defects, the rapidly spreading virus and the adverse effects on commu- nities, scientists recommend a strategy focused on education and prevention of virus transmission. AIR FORCE PA EARNS AIR FORCE ACHIEVEMENT MEDAL Maj. Kenneth Beadle, U.S. Air Force, DSc, PA-C, (left in photo below), recently received the Air Force Achievement Medal from Brig. Gen. David Julazadeh, com- mander, 455th Air Expeditionary Wing, during a ceremony at Camp Cunningham at Bagram Airfield in Afghanistan. Beadle was among the more than a dozen airmen who earned the recognition for their efforts to recover the wreckage of an F-16 Fighting Falcon that crashed during takeoff in Parwan Province on March 29. A graduate of the Interservice PA Program, Beadle is with the 455th Expeditionary Medical Group, which provides combat medical and combat medical support services to U.S. and coalition forces throughout Afghanistan. PA Stephen Hanson COURTESYOFTHEU.S.DEPARTMENTOFDEFENSE ADOBESTOCK.COM PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 17 
  • 20. STAT | continued MEDICAID EXPANSIONS IMPROVE HEALTHCARE OUTCOMES FOR LOW- INCOME PATIENTS States that have enacted the Affordable Care Act (ACA) Medicaid expansions are seeing better out- comes in many aspects of healthcare for their low- income residents, suggests a study recently pub- lished in the Annals of Internal Medicine. HEALTH DISPARITIES AND LESBIAN, GAY AND BISEXUAL PATIENTS Lesbian, gay and bisexual patients, especially bisex- ual women, are more likely to encounter barriers to care than their straight counterparts, according to two studies recently published in the American Journal of Public Health. A National Center for Health Statistics study found that healthcare disparities cause gay, lesbian and bisexual patients to suffer more health prob- lems, including highly preventable illnesses such as pneumonia. NEW DIETARY GUIDELINES ISSUED FOR 2015-2020 The U.S. Department of Health and Human Services and the Department of Agriculture have published their latest dietary recommendations. The guide- lines align with previous recommendations, with some differences. Instead of an emphasis on food groups and pairings, the new guidelines empha- size eating habits overall. The guidelines include a newly recommended limit of 10 percent of daily calorie intake coming from added sugars and state that drinking three to five cups of coffee a day is now considered to be part of a healthy eating pat- tern (surely good news for many PAs!). Additionally, the previous 300 milligram restriction on dietary cholesterol has been lifted, in line with many stud- ies showing that dietary cholesterol does not affect blood cholesterol levels. The guidelines for sodium consumption remain at 2,300 milligrams per day for Americans ages 14 and older, but the recom- mendation that certain groups limit their sodium consumption has been eliminated. These recommendations, known by their five- year range for the first time this year, were based on the assumption that there is a link between“poor quality eating patterns and lack of physical activity” and the prevalence of many preventable chronic diseases, such as hypertension, obesity and type 2 diabetes. They were compiled based on a review of 300 studies, in addition to a review of 29,000 public comments. PROMOTING HERPES ZOSTER AWARENESS Herpes zoster strikes nearly 1 million people a year in the United States. One in three adults will get the infection in their lifetime, and anyone who has had chickenpox is at risk of the virus reactivating from its latent state. Yet, most patients know nothing about it or the vaccine that can prevent it. The National Foundation for Infectious Diseases (NFID) wants to change that with a new campaign to raise awareness of herpes zos- ter. Patient information materials include a public service announce- ment about the importance of shingles prevention, an online quiz to help individuals determine if the herpes zoster vaccine is recom- mended for them and a factsheet on shingles myths vs. facts. ADOBESTOCK.COM COURTESYOFNFID PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 18 
  • 21. STAT | continued HEALTHY EATING AND PREGNANCY The relationship between diet and health plays a pivotal role in the health of mother and baby dur- ing pregnancy. The International Food Information Council Foundation (IFIC) released a new brochure to help providers educate patients about healthful eating during pregnancy. The brochure covers how to eat a balanced diet, eating a variety of foods, healthy weight gain during pregnancy and food safety concerns specific to pregnant women. ESTIMATE OF PHYSICIAN SHORTAGE INCREASED The Association of American Medical Colleges (AAMC) has increased its estimate of the com- ing physician shortage, with projected shortages reaching between 61,700 and 94,700 over the next 10 years and the primary care physician shortage expected to range from 14,900 to 35,600 by 2025. These projections, part of an April AAMC report, are up slightly from recent estimates that the nation would need an additional 46,100 to 90,400 physi- cians by 2025. However, these estimates still fall short of the peak 2010 projections that the United States would be short 130,600 physicians by 2025. This year’s report takes into account the rapid growth of the PA profession and increasing demand for PAs and also updated the supply and demand data and medical school graduate data that were used. Given the unprecedented growth of the PA and NP professions and the projected shortages of primary care providers, the AAMC has recommended continued observation of these professions as the data model evolves and more patients enter the healthcare system. NO DECLINE IN YOUTH TOBACCO USE SINCE 2011 While significant decreases in overall cigarette smoking occurred between 2011 and 2015, tobacco use by middle and high school students has remained unchanged since 2011, according to new data published by the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration’s Center for Tobacco Products. The data from the 2015 National Youth Tobacco Survey show that 4.7 million middle and high school students were current users of a tobacco product in 2015, with current use defined as using tobacco at least once in the past 30 days. Addition- ally, the findings show that e-cigarettes are the most commonly used tobacco product among middle and high school students. NEW TESTS TO ID FOODBORNE ILLNESSES Changes in the tests used to diagnose foodborne illnesses are enabling scientists to identify infec- tions more quickly, but in the longer term these changes could pose challenges to scientists’abil- ity to find outbreaks and monitor progress in preventing foodborne disease, according to a report pub- lished in an April CDC Morbidity and Mortality Weekly Report. These new tests, known as cul- ture-independent diagnostic tests, help providers to quickly diagnose infections—with results available in hours instead of the days needed when using traditional culture methods that require growing bac- teria to determine cause of illness. However, without these bacterial cultures, scien- tists and public health officials are unable to deter- mine the cause of an infection—which limits their ability to monitor outbreaks, check for antibiotic resistance and track trends in foodborne diseases. ADOBESTOCK.COM PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 19 
  • 22. STAT | continued NEW SCREENING GUIDELINES FOR COPD AND ASPIRIN USE The U.S. Preventive Services Task Force has issued several new recommendations, including final rec- ommendation statements on screening for chronic obstructive pulmonary disease (COPD) and on aspi- rin use for the primary prevention of cardiovascular disease and colorectal cancer. USPSTF recommends against screening for COPD in asymptomatic adults, a grade D recommenda- tion. According to the Task Force, little benefit was found in early detection, and no evidence was found that screening for COPD in adults without respiratory symptoms improved health outcomes. The recommendations further state that clini- cians should be aware of the risk factors for COPD, including current or former exposure to tobacco smoke, educate patients on these risk factors and counsel them not to smoke or to quit. The statement on aspirin use for the primary prevention of cardiovascular disease and colorectal cancer recommends that clinicians with patients between 60 and 69 years old should work with these patients to decide if aspirin use for primary prevention is right for them. According to USPSTF, evidence shows that low-dose aspirin use is most beneficial for people ages 50 to 59. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 20  • CO VISITS TO AAPA HELP BUILD RELATIONSHIPS On February 23, 2016, AAPA hosted former Association of PAs in Cardiology (APAC) president Sondra DePalma, MHS, PA-C, CLS, AACC, at AAPA headquarters in Alexandria, Va. DePalma participated in a full day of strategy and planning meetings with senior leadership and staff from both AAPA and the Acad- emy’s newly created Center for Healthcare Leadership and Management (CHLM). The meetings aimed to identify new collaborative opportunities and ways to improve the practice environments of PAs by leveraging the expertise and experience of PA leaders like De Palma to create specialty-specific approaches to demonstrating PA contributions to a broad range of practice environments.   AAPA and CHLM are committed to working with both current and aspiring PA leaders across the country on the goal of increasing patient access to care through ensuring that PAs are able to consis- tently practice to the fullest extent of their educa- tion and training.  Academy visits like these are an opportunity to build seamless relationships between COs and AAPA and for Academy staff to engage with PA leaders. For more information on ways you can get involved with CHLM or schedule a CO visit, please contact Rick Christiansen, AAPA director of employer development and constituent organiza- tion outreach and advocacy. PA Sondra DePalma, a past president of the Association of PAs in Cardiology, with AAPA staffer Rick Christiansen
  • 23. The BankAmericard Cash Rewards™ credit card for American Academy of Physician Assistants Get more cash back for the things you buy most. Plus, a $100 cash rewards bonus offer. 1% 2% 3% cash back on purchases everywhere, every time cash back at grocery stores cash back on gas To apply for a credit card, visit newcardonline.com and enter Priority Code VACN5C. Carry the only card that helps support American Academy of Physician Assistants • $100 cash rewards bonus if you make at least $500 in purchases in the first 90 days* • Earn rewards automatically • No expiration on rewards • No rotating categories For information about the rates, fees, other costs and benefits associated with the use of this Rewards card, or to apply, go to the website listed above or write to P.O. Box 15020, Wilmington, DE 19850. *You will qualify for $100 bonus cash rewards if you use your new credit card account to make any combination of Purchase transactions totaling at least $500 (exclusive of any fees, returns and adjustments) that post to your account within 90 days of the account open date. Limit one (1) bonus cash rewards offer per new account. This one-time promotion is limited to new customers opening an account in response to this offer. Other advertised promotional bonus cash rewards offers can vary from this promotion and may not be substituted. Allow 8-12 weeks from qualifying for the bonus cash rewards to post to your rewards balance. ▼ The 2% cash back on grocery store purchases and 3% cash back on gas purchases applies to the first $1,500 in combined purchases in these categories each quarter. After that the base 1% earn rate applies to those purchases. By opening and/or using these products from Bank of America, you’ll be providing valuable financial support to American Academy of Physician Assistants. This credit card program is issued and administered by Bank of America, N.A. Visa and Visa Signature are registered trademarks of Visa International Service Association, and are used by the issuer pursuant to license from Visa U.S.A. Inc. BankAmericard Cash Rewards is a trademark and Bank of America and the Bank of America logo are registered trademarks of Bank�of�America�Corporation. ©2016 Bank of America Corporation ARPH45XW-05132015 AD-06-15-0544 $100cash rewards bonus offer* Grocery store and gas bonus rewards apply to the first $1,500 in combined purchases in these categories each quarter.▼ $350 PA Students $425 Physician Assistants “I really loved this course, happy to have a more condensed view of the PANCE. The review was very entertaining, knowledgable and a great study environment. Worth the money! “ Sara Mow, PA-C – Primary Care www.CertMedEd.com 100%Guarantee or your money back! 3-Day PANCE / PANRE Board Review & CME $50 Discount See Inside 2016 3-day & 5-day Conferences Our 5-day CHICAGO Course Conference early registration is NOW decreased to ONLY $500 (never pay over $800 again!) and includes: ♥ 50hoursofCategory1CME ♥ Over 20 hour of Pharmacology ♥ Large printed binder of slides ♥ 12-lead EKG course (other charge extra for this) ♥ Workshops in Radigology, Laboratory Medicine , Alternative Medicnine, and Criticial Care Medicine April 15-17 Orlando, FL April 18-20 Seattle, WA May 6-8 Chicago, IL May 9-11 State College, PA June 17-19 Alexandria, WA July 25-27 Harrogate, TN Aug 15-17 Wilkes-Barre, PA Aug 19-21 Syracuse, NY Sept 9-11 Atlanta, GA Sept 9-11 Denver, CO Sept 10-14 Chicago, IL Oct 24-26 Nashville, TN Nov 14-16 Cleveland, OH Dec 3-5 Las Vegas, NV Dec 5-7 Philadelphia, PA
  • 24. Recommend BayeRaspirin— First for secondary prevention. CV=cardiovascular; MI=myocardial infarction. *Nonfatal MI. References: 1. Antithrombotic Trialists’ (ATT) Collaboration. Lancet. 2009;373:1849-1860. 2. Garcia Rodríguez LA, Cea Soriano L, Hill C, Johansson S. Increased risk of stroke after discontinuation of acetylsalicylic acid: a UK primary care study. Neurology. 2011;76:740-746. 3. Garcia Rodríguez LA, Cea-Soriano L, Martín-Merino E, Johansson S. Discontinuation of low dose aspirin and risk of myocardial infarction: case-control study in UK primary care. BMJ. 2011;343:d4094. Bayer and the Bayer Cross are registered trademarks of Bayer. © 2016 Bayer February 2016 62275-PP-BAY-PREV-US-0539 • Aspirin reduces the risk of recurrent ischemic stroke by 22% and recurrent MI* by 30%1 • Discontinuation of low-dose aspirin can increase the risk of recurrent ischemic stroke by 40%2 and nonfatal MI by 63%3 To order samples and learn more, visit www.bayeraspirinhcp.com First line. First thought. Think Bayer® aspirin first for the secondary prevention of a CV event DARIEN ROWAYTON BANK student.drbank.com/AAPA Got Student Loans?Save $20,000 or more by refining to a lower rate Benefits of Refinancing Include: • No origination fees. No prepayment penalties • Rates start at 2.005% for AAPA Members • Federal, private, undergrad and PA school loans all eligible • Up to 1 year for forbearance is available • Entire process is FREE, from start to finish Loan Type Rate* AAPA Friends and Family Rate*** 5 to 20-year variable** 2.13% - 5.52% 2.005% - 5.395% 5-year fixed 3.50% - 5.75% 3.375% - 5.625% 7-year fixed 4.00% - 6.25% 3.875% - 6.125% 10-year fixed 4.50% - 6.50% 4.375% - 6.375% 15-year fixed 5.00% - 6.75% 4.875% - 6.625% 20-year fixed 5.25% - 7.00% 5.125% - 6.875% *Assumes a 0.25% discount for making automated payments from a DRB checking account **Variable rates are calculated by adding a margin to 3-Month LIBOR ***Displayed rates reflect a 0.125% rate discount which is available to all friends and family of the AAPA Apply Now! student.drbank.com/AAPA
  • 25. FEATURE STORY More than fifty resolutions have been submitted to this year’s House of Delegates, including several related to NCCPA’s PANRE proposal, one relating to AAPA supporting full practice respon­ sibility—the concept that PAs should have the right to define their scope of practice and take responsi­bility for their clinical decisions—and another to the accreditation of postgraduate clinical training programs. AAPA members can access all the resolutions on the HOD page. The resolutions related to the NCCPA PANRE proposal can be found on the AAPA News Center page— scroll down to "Submitted HOD Resolutions Regarding the Proposed Model." EQUIPPING PAS FOR EXPANDED OPPORTUNITIES IN HEALTHCAREBY STEVEN LANE, MA, MPP MANY FACTORS, INCLUDING CONSUMER EMPOWERMENT AND A HEIGHTENED FOCUS ON HEALTHCARE QUALITY AND PATIENT SAFETY are raising the level of scrutiny on how providers develop and demonstrate clinical competency. The PA profession itself has been changing as well, with the percentage of PAs practicing in non–primary care specialties rising steadily over the past two decades. Nearly three-quarters of PAs now say that their primary area of practice is in a specialty other than primary care, which the National Commission on Certification of Physician Assistants cites as one of the reasons it has proposed a new recertification model that would include a proctored, closed-book exam in a specialty area—a proposal that has engendered lively debate among PAs around the country and that will be among the most discussed issues at the upcoming House of Delegates meeting at AAPA Conference 2016 in San Antonio this month. With the introduction of NCCPA’s voluntary certificate of added qualifications (CAQ) program several years ago, many PAs expressed concern that a CAQ in a specialty area would eventually become mandatory, imposed by either employers or state regulatory bodies. Many believe that the credentialing and privileging processes of hospitals and health systems, as well as private provider practices, are sufficient to demonstrate PA competence in a specialty. In recent years, there has also been discussion about the appropriate role of clinical postgraduate training and even about the creation of a PA clinical doctoral degree. An AAPA task force has just released a report on a possible accreditation model for postgraduate training programs. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 23 
  • 26. CLINICAL DOCTORATE? RECERTIFICATION? RESIDENCY? CAQ? The issue of how to maintain multiple pathways to demonstrate PAs’ clinical competency is one of the six key issues facing the profession that is being addressed in AAPA’s 2016-2020 Strategic Plan. (This story is the sev- enth in PA Professional’s ongoing series of strategic plan–related articles; you can read the other six in the PA Pro archives.) AAPA President Jeffrey A. Katz, PA-C, DFAAPA, frames the issue like this: “PAs have always been able to adapt to changing healthcare needs because of the multiple pathways available to us to develop and demon- strate our competencies. We must collectively ensure that pathways for demonstrating our skills do not become restricted to any single require- ment. Simultaneously, we must acknowledge the reality that demonstrat- ing competencies is best addressed at the practice level.” PA Professional spoke to a number of PA leaders and managers for their perspectives on these questions. Recertification and Maintaining Flexibility The overriding concern of most PAs on this issue is to maintain the profes- sion’s well-known clinical flexibility, which has allowed PAs to move quickly to where the need is in the healthcare system or even within their current workplace. Roughly half of all PAs change the specialty area in which they primarily practice at least once in their careers, according to the 2015 AAPA National Survey, and many change specialties multiple times. The AAPA Board of Directors and HOD, and many AAPA members, are concerned that the proposed new NCCPA recertification model threatens this flexibility. The proposed model would require all PAs to select a spe- cialty area in which to be examined, in a secure, proctored timed format, in addition to the generalist portion of the recertification process, which would assess core medical knowledge through a series of take-home exams over the 10-year recertification cycle. NCCPA has said it expects to offer between nine and 11 specialty area exams, including an exam in family medicine. Under the original NCCPA proposal process, PAs who achieve a high enough score on the specialty exam and also elect to satisfy other requirements, including CME hours and a minimum time spent working in the specialty, would be eligible for a CAQ. Under the proposal, acquiring a CAQ would be voluntary, but some PAs fear that it could even- tually become a de facto requirement; especially in hospitals or health systems where the PA practice FEATURE STORY, continued Jeffrey A. Katz PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 24 
  • 27. INTERVENTIONAL RADIOLOGY, CONTINUED model is not well understood, administrators may be looking for easy ways to have employees demonstrate competence, or hospital system lawyers may want to require it in order to mitigate concerns about potential liabil- ity in adverse outcome cases. Of equal concern is the CAQ becoming a requirement by payers or state licensing authorities. “Our concern is to ensure that NCCPA’s proposed specialty exam requirements do not become a de facto requirement for specialty practice or employment,”says Katz. Clinical Postgraduate PA Training Programs Another pathway for demonstration of clinical competency and advanced training in the clinical setting is through a PA clinical postgraduate pro- gram (sometimes called a“residency”). These have been around since the 1980s, but relatively few PAs have gone through them. Today there are about 60 known programs, typically 12-18 months in length and graduat- ing two to six fellows a year. The AAPA Task Force on Accreditation of Post- graduate Training Programs recently completed its review of available evidence on postgraduate training programs for PAs and determined that “the development of an efficient, PA-led, national model for accreditation, continuous quality improvement, and reporting on outcomes is needed.” The task force described key elements and considerations for an optimal national model. Accreditation of postgraduate programs requires a degree of flexibility because the programs are so different from each other, according to task force chair Reamer Bushardt, PharmD, PA-C, DFAAPA.“The purposes of these programs vary widely,”he says,“and we don’t really know what is working well because we have very limited outcome data. But there is a desire to have an accreditation or national recognition process; some insti- tutions would like to have a way to establish their credibility.” The task force’s paper,“Accreditation and Implications of Clinical Post- graduate PA Training Programs,”has been submitted to the HOD for approval as policy. If approved, the paper would replace an earlier position paper that had cautioned against development of a postgraduate accredi- tation process. From the Director’s Office PAs who oversee other PAs in large health systems are strong advocates for maintaining the practice flexibility of their PA workforce, and for the hospi- tal or health system’s ability to train PAs and assess their competence in their own way. This is in accord with AAPA’s position that“competency is best assessed at the practice level.” FEATURE STORY, continued Reamer Bushardt POSTGRADUATE TRAINING CLINICAL EXPERIENCE TRAINING COURSES AND CAREER RESOURCES ADVANCED CERTIFICATIONS PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 25 
  • 28. “I think it is dangerous if we go down the path that our NP colleagues have taken—once you have become specialized in pediatrics you cannot treat other patients,”says Todd Pickard, PA-C, director of PA practice at MD Anderson Center, who oversees nearly 300 PAs.“Creating pathways where we narrowly define our competency really inhibits our ability to practice in multiple specialties. And nobody in my institution, or others that I know of, says that PAs are incompetent because they don’t have specialty certification.” Laurie Benton, PhD, MPAS, PA-C, DFAAPA, a PA administrator at Baylor, Scott & White Health in Temple, Tex., agrees.“If you go into a new area of practice that requires new training, let hospitals and specialty staff be the ones to train you. We have onboarding and training procedures for that specialty. We can take the responsibility.” Benton, a member of the AAPA Board of Directors, also advocates for a distinction between knowledge, which can be assessed on an exam, and competence, which cannot.“You can have someone that is very book smart but you put them in a life or death situation and they might not react well,”she says.“They may not feel comfortable inserting a chest tube or clamping a bleeding artery. I feel it should be left to the specialty team and the physician to determine that the person is trained. I need to see it for myself, not trust a piece of paper.” PAs in management also make a key distinction between“a certificate” and“certification.” “I do advocate for recognition of PAs who have served in a specialty for all of their careers,”says Josanne Pagel, MPAS, PA-C, Karuna®RMT, DFAAPA, executive director of PA services at the Cleveland Clinic, and also AAPA president-elect.“Those PAs should have that certificate, but it should not be a certification. That was the original intent of the CAQ, to recognize the knowledge of those PAs.” “When I think of certification, I think of an accrediting body that has public responsibility,”says Pickard.“Certification from NCCPA is required to practice. But a certificate just shows that you have completed additional training and have additional skills, like doing 25 hours of ACLS.” ‘Psychiatry Is a Bit Different’ One specialty area where the CAQ may be closest to becoming a de facto requirement is psychiatry.“Psychiatry is a bit different,”says Tracy Keizer, PA-C, director of the PA/NP postgraduate fellowship program in psychiatry at Regions Hospital in St. Paul, Minn.“NPs have a specific degree that they can get in psych. So we do have quite a bit of competition with them because of that certification. This is a reality with employers and payers.” “There has been a lot of push for the CAQ at our institution,”adds Keizer. “I am not one to promote it because it does limit our flexibility, but our administration has said it is the goal.” “All it takes is a perception,”says Pagel.“If you have one leader at a prac- tice who perceives that NPs are certified so PAs must be certified, that can immediately stop the hiring of PAs. I have seen it in psychiatry; it is reality.” James Cannon, PA-C, DHA, MBA, DFAAPA, a former chair of NCCPA and a leader of the Association of PAs in Psychiatry, says he has seen multiple cases of PAs being shut out of job opportunities and reimbursement in that specialty, prior to the creation of the psychiatry CAQ. “The market- place in mental health makes psychiatry truly the most unique specialty,” Cannon says.“We are competing against psychologists, psychiatric NPs, clinical counselors—all with formal qualifications in mental health. An emphasis should be placed on first amending those state laws that cur- rently do not define PAs as mental health providers.”Cannon, who has earned the CAQ in psychiatry, considers the proposed CAQ program a FEATURE STORY, continued Todd Pickard Laurie Benton Josanne Pagel PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 26 
  • 29. FEATURE STORY, continued “kind of portfolio, a way to organize one’s experience, CME, physician attestation, and medical knowledge.” Preserving Multiple Pathways It remains to be seen whether other specialties will follow in the first tentative steps toward requiring a CAQ for practice that seem to have been taken in psychiatry. And some perspective is necessary. At present, the number of PAs who have earned a CAQ is approximately 1,000, less than 1 percent of the more than 108,500 PAs in clinical practice today. “With a reported 45,000 open PA jobs, why would any prudent employer limit their applicant pool to such a narrow universe by making the CAQ a requirement?”asks Tricia Marriott, PA-C, MPAS, DFAAPA, MJ Health Law, principal advisor with AAPA’s Center for Healthcare Leader- ship and Management, who speaks regularly to health system adminis- trators around the country.“We know that only about 100 of the 12,000 PAs in orthopaedics have obtained a CAQ, and there is no evidence that the PA with a CAQ would be a better candidate for a sports medicine practice than one with 15 years of experience in sports medicine and no CAQ.” AAPA is working proactively to ensure that CAQs, or other formal attestations of specialty training, do not become de facto requirements and limit the ability of PAs to switch specialties and of the profession to move to where the demand is greatest. “We are not against the CAQ, but we want to ensure that there are many pathways for PAs to demonstrate competence and expertise, and that these are well understood by employers, credentialing bodies, reg- ulators, and payers,”says Katz.“It is well documented that provider com- petency is best established at the practice level.” STEVEN LANE, MA, MPP is senior strategic writer for AAPA and an editor of PA Professional. Contact him via email or 571-319-4364. Tracy Keizer James Cannon Tricia Marriott NCCPA.NET PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 27 
  • 30. Sunday, May 15, 2016 | 12:00–12:45 PM (Lunch will be served) Hemisfair 2 at the Henry B. Gonzalez Convention Center This program is not affiliated with AAPA Conference. Considerations for Pain Management with OTCAnalgesics A PA Perspective Please join Dayne Alonso, MMS, PA-C, at this year’s AAPA Conference for a presentation on over-the-counter (OTC) analgesics. This engaging, case-based presentation will provide an overview of how pain affects patient quality of life and will discuss options for managing pain with OTC analgesics. Ms Alonso will also highlight considerations when making OTC analgesic recommendations and reinforce the importance of educating patients about appropriate use of recommended products. Ms Alonso is the chief physician assistant in oncology/hematology at Advanced Medical Specialties in Miami; a member of the Board of Trustees at Rocky Vista University in Parker, Colorado; and chair of the Legislative & Governmental Affairs Committee of the Florida Academy of Physician Assistants (FAPA), for which she has served as president. A member of the Pi Alpha Honor Society at Nova Southeastern University, Ms Alonso has been recognized as a FAPA Humanitarian Physician Assistant of the Year and was nominated for the AAPA Outstanding PA of the Year Award. Featuring Dayne Alonso, MMS, PA-C Program Director of the PA Program at Miami Dade College in Miami, Florida Please also visit McNeil Consumer Healthcare at Booth 931 throughout the AAPA Conference. Program sponsored by: © Johnson & Johnson Consumer Inc. 2016 Explore challenging orthopaedic topics with expert faculty – and earn up to 28.25 AAPA Category 1 CME credits at the same time! Learn about injuries to the spine, shoulder, elbow, wrist, hand, hip, knee, ankle and foot with interactive sessions. Attend breakout sessions on MRI case studies, fracture management and physical exam techniques. Make sure to save your spot at the popular hands-on Splinting and Casting Workshop! AAPA members save extra. Register today! aapa.org/galaxy
  • 31. Our work at the AAPA Center for Healthcare Leadership and Management (CHLM) is to ensure PA interests are represented with employers and to cultivate PA leaders. We work with employers and you to move the PA profession forward. WE ADVISE EMPLOYERS on best practices to maximize provider utilization and retain top talent. Employers rely on us as the expert on PA reimbursement and billing, scope of practice, regulatory compliance, and credentialing and privileging. When PAs are able to practice at their highest level, patient care is at its best. And that’s something we can all support. WE BUILD PA LEADERS with innovative training events to equip you to lead your team, your committee, your workplace and your profession. We want to help you grow as a leader both personally and professionally, because we know that as each PA becomes stronger, so does the profession. Learn more about how CHLM is working for you every day. chlm.org You advocate for patients. We advocate for you. We are CHLM.
  • 32. PROFESSIONALPRACTICE Cultivate Your Network Employment References: Tips and Techniques B Y J E N N I F E R A N N E H O H M A N C reating your references list is an essential part of the job search that can also help you cultivate your professional network and prepare you for inter- views. Your list, comprising people with whom you’ve worked closely and who can attest to your skills, is a great way to review your accomplishments and look at your practice to date through the eyes of your clinical partners. I suggest creating a reference list document that matches the font and overall style of your CV and cover letter and keeping it to one page. List your strongest and most recent references first and include their contract information and their professional relationship with you as well as how long you’ve known each other. Choose people with whom you’ve worked closely and can speak knowl- edgably (and positively!) about your work, accomplish- ments and character. It’s key that you reach out to each reference and confirm their willingness to be contacted. You might also review some highlights of your work together and ask them what they consider to be your strongest points. Share an updated copy of your CV and some information about your current career goals. Ask them about their preferred method of contact by employers with whom you’ll be putting them in touch. JENNIFER ANNE HOHMAN is the founder and principal of PA Career Coach, a service dedicated to helping PAs create rewarding, healthy and patient-centered careers. Contact her via email. PA PROFESSIONAL  |  MAY 2016 |  AAPA.ORG | 30 
  • 33. PROFESSIONAL PRACTICE | continued The assessments of physicians you partnered with are probably of greatest interest to prospective employers, but you might also include contact information for a few other individuals who can attest to your skills and great qualities. For recent graduates, these people might include pro- fessors/preceptors, established clinicians, other PAs and even a patient you’ve treated. To cultivate your references and keep them a thriving resource, keep your professional network active by staying in touch with former col- leagues and bosses. A current relationship will improve the odds of a posi- tive and pertinent response to a referral request. It’s also a great idea to share an updated version of your resume with them as well as information about the job you are applying to. Help them to be advocates for you! Be sure to express your thanks for the time and effort they share to ben- efit your career (a thank you note is a good place to start; an invitation to coffee, if feasible, is a nice gesture and will nurture your network) and keep your references in the loop—let them know where your job search landed you. How many references to provide? Three to six is a good number for most positions. When to share their information is also important: Rather than sharing your reference list with an employer with your cover letter and CV, wait until your interview to share the list. This gives you an oppor- tunity to inform your references about the employer and some specifics of the position. In summary, references are an aspect of the job search that highlight the quality of your working relationships. Everyone encounters some problem- atic ones as part of being a PA along with the great ones—and a negative referral need not be a career disaster. (More on that in PA Professional’s June-July issue.) Keeping your professional network alive is a key to career growth and this truth is never more apparent than during the job search. Build on your relationships to help land your next position, and help respected colleagues by doing the same for them! PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 31 
  • 34. Whether you’re in the halls of a hospital, the office or the subway, there’s one place you can find CME to keep you clinically current. Explore all Learning Central has to offer – more than 400 activities, including Self-Assessment and Performance Improvement CME (PI-CME) plus JAAPA post-tests. Many activities are free or discounted to members. The Latest Featured CME like Online Orthopaedic CME PANCE/PANRE Prep with trusted resources like AAPA PANCE/PANRE Review PI-CME with activities like Intralign Health’s Surgical Safety Time Out Self-Assessment CME with interactive eCase Challenges LEARN HERE aapa.org/LearningCentral Learning Central. Connect learning with life.
  • 35. FUNdraiser Benefitting Your PA Foundation Thank You to Our AAPA 2016 Event Sponsors!
  • 36. first rounds  |  A special section for and by PA students This edition of First Rounds (FR) was produced by FR Editor Paul Gonzales, PA-S2, University of Texas Southwestern Medical Center in Dallas, and FR Assistant Editor Mia McDonald, PA-S1, Jefferson College of Health Sciences in Roanoke, Va. Tuk’s traditional Thai blessing ceremony before she was cremated. Sometimes the Guidelines Are Meant to Be Broken BY STEPHANIE GOMOLKA, PA-S1 My mother-in-law, Vilavun, grew up in a small city on the Gulf of Thailand named Chon Buri, meaning “City of Water.” She had no running water, slept under mosquito nets with her five sisters and endured water snakes and roaches invading the home during monsoon season. She was poorly educated and attended school only when she wasn’t tending to her father’s shop and rice mill. In the 1960s, Tuk, as she was nicknamed, moved to New Zealand, where she enrolled in secretary school, met her soulmate and found a good paying job. With $150 to their name, she and her new partner boarded a plane for New York to start a family. Despite being a New Yorker for 40 years before her death, Tuk remained in many ways a rural town Thai girl with beliefs that matched her upbringing. Tuk had always been apprehensive about heed- ing the advice of American doctors. Where she grew up people used herbal remedies and prayed to their Buddhist ancestors for healing and answers. She was taken aback that when she went to doctors for a simple cold she was invari- ably prescribed an antibiotic. This ultimately led to her distrust in American doctors as she felt that they did not listen to her concerns and just gave her an antibiotic for every ailment. Tuk felt that her perceived education level and cultural beliefs prevented her from receiving the care that she needed and deserved. A turning point occurred for Tuk in the 90s when a friend gave her a copy of “Prevention.” It was then that she felt confirmed in her belief that Western doctors were killing their patients with antibiotics. She turned to supplements and herbal remedies to take care of her own health. She became fixated on natural medicine. In 2005, Tuk began to feel sharp back pains, which she treated naturally with supplements, and in 2007, she was diagnosed with stage 4 lung cancer. Tuk felt she was too frail to begin chemo- therapy and decided to have the tumor removed via cyberknife. One year later Tuk was told she had less than a year left and began treating her- self with natural remedies, much to her cancer team’s disapproval. It was even difficult for our PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 34 
  • 37. first rounds  |  continued Tuk and Pad with family at their traditional Thai wedding ceremony in New York City. Left to right: Krisana Suthiwongs, Pad Gajajiva, Vilavun“Tuk”Gajajiva,Tao Tangnavarad, Khanitha Tangnavarad. Tuk spending time with the author and her grandson, Kieran, in the summer of 2011. STEFANIE GOMOLKA, PA-S1, attends the Shenandoah University PA program and is a member of the class of 2017. family to watch her refuse treatment. No one really took the time to understand where she was coming from. However, the one year she was given turned into two, and then three, before the cancer eventually took her life. Tuk remained emotionally strong up to her last day. I never realized the impact Tuk had had on me until my first job interview four years ago at Craig Hospital in Denver. They asked about any cultural experiences I had had in my life, and of course Tuk’s story immedi- ately came to mind. After I told the story, the inter- viewer asked if I believed Tuk was able to extend her life because of culture and “alternative” beliefs about medicine. It was the first time I had truly removed my familial bias from the situation and thought objectively about it. After thinking for what felt like an eternity, I looked her straight in the eye and said, “Probably.” She looked me in the eye and said, “Definitely.” Now, in the midst of a rigorous PA program, I con- stantly remind myself of Tuk and her struggle with Western medicine. Studying guidelines, medications, flowcharts and treatment preferences, I can’t help but sometimes think that these will not apply to every patient I will work with. Culturally competent medi- cine should be tailored to the individual. Even if we don’t completely understand a patient’s culture, it is our job to get to know them and understand why they make the decisions they do. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 35 
  • 38. first rounds  |  continued Sheila Hautbois, PA-S1, with Rachel Carlson, director of the Shenandoah University PA program Outside the Box BY SHEILA HAUTBOIS, MPH, CHES, PA-S1 When most of us consider cultural compe- tence, we think of various ethnicities and heritages. One culture we might not consider is the deaf community who use American Sign Lan- guage (ASL) to communicate. Compared to hear- ing people, individuals who are deaf have poorer health. In fact, patients who were deaf before age 3 are less likely to see a healthcare provider than other adults. Shenandoah University PA students recently had an opportunity to interview patients of differ- ent cultures. One such patient was deaf and had a medical ASL interpreter with her. Although being provided with an interpreter is a legal right, this does not always happen in the U.S. The reality is that both patient and provider truly need an inter- preter to ensure that good understanding occurs on both sides. From our interview with a deaf patient and her feedback afterward, we learned many things. Properly setting up our room is vital to commu- nication. The room should be well lit, and we should not stand in front of a window or an area of glare. If we stand to the side and create a tri- angle with the patient and the interpreter, the patient must then choose between watching the interpreter and looking at us. This not only slows down interpretation, but also causes the patient to make awkward neck movements. By standing right next to the interpreter, we can make com- munication easier for a deaf patient. Eye contact is very important, as is keeping our mouth visible in case a patient reads lips to enhance communication. If we need to wear a surgical mask while communicating with a deaf patient, it should be see-through when possible. If more than one provider will be in the room, we should explain why and gain the patient’s consent. Even though an interpreter is present, we should use “I” and “you,” speaking directly to our patients. We need to be mindful of who we are interviewing; routine questions such as “Have you had any hoarseness?” would not apply to patients who do not speak. Short sentences at a moderate pace with pauses between sentences are ideal. Providing information in a simple manner helps with patient comprehension and also allows for easier interpretation. Giving subject cues in advance of details helps the patient understand what we will discuss next. Because ASL does not follow English syntax, many deaf high school grad- uates only read English at a fourth- or fifth-grade level. Patient handouts should therefore be very easy to understand. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 36 
  • 39. first rounds  |  continued SHEILA HAUTBOIS, PA-S1, attends the Shenandoah University PA program and is a member of the class of 2017. One such patient was deaf and had a medical ASL interpreter with her. Although being provided with an interpreter is a legal right, this does not always happen in the U.S. The reality is that both patient and provider truly need an interpreter to ensure that good understanding occurs on both sides. Asking deaf patients open-ended questions is vital. Yes-and-no questions will not tell us if we have been understood. If a patient is having trou- ble understanding something, we should explain it differently. We can enhance communication with gestures and facial expressions. Drawing a picture or writing things down might also help. We should explain what we are going to do and why, prior to any physical contact during our exam. Visual aids and hands-on demonstrations can be helpful when teaching a skill or discussing how to take medications. All of us can continue to grow in cultural compe- tence. In our workplace, we can offer online appointment booking and patient communication via email or health portals. We should never make assumptions. Every patient is different, just as every individual is unique. One patient at a time, we can help make healthcare a more positive experience for the deaf community. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 37 
  • 40. first rounds  |  continued When You Can’t Speak, Listen BY RYAN HUNTON, PA-S2 Ihumbly admit that, despite six years invested in my Spanish language education, as of March 2016, I cannot speak conversational Spanish. This added another layer of cultural separation in my clinical work during our PA program’s recent med- ical trip to Piedras Negras, Mexico. Throughout the week, I was heavily dependent on the various assigned interpreters. In working with interpret- ers, I became aware of the possibility of inconsis- tency and misinterpretation of medical words. I inevitably vowed to reprioritize learning Spanish, especially medical Spanish. Still, despite this in- ability to communicate directly with the patient, I was determined to maximize the patient-provider relationship. And in the end, I found that speaking the same language is not as crucial to this rela- tionship as one might suppose. Take, for example, the 67-year-old man who entered our makeshift church-clinic in a town called Nava with no particular complaint, perhaps seeking reassurance. When I asked him the col- loquial “What brings you in today?” he expressed concern about his blood sugar level, which was mildly elevated, and I could see in his eyes and face that his concern was profound. As I began going through the routine of asking various questions (through the interpreter) about recent symptoms and past medical history, he respectfully asked me to slow down. My collabo- rating physician had previously told me, “Many of these people are constantly being pushed aside by society. This is their chance to be seen and heard.” So when this gentleman asked me to slow down, I did. And I listened. It became clear that he, like many who came into our clinics throughout the week, had not primarily come for a pharma- ceutical; rather, he came for an honest assess- ment and care. He seemed grateful for my For me, just as the history and physical exam are the essential elements of understanding the patient’s medical problem, these nonverbal aspects of communication became the essential elements of building trust and relationship. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 38 
  • 41. first rounds  |  continued attention, and I was grateful for the reminder that sometimes patients need acknowledgement more than anything else. With each patient, as I explained each step in my physical examination and treatment plan, I paid extra attention to the nonverbal aspects of con- versation: the introductions, the “mucho gusto,” the eye contact despite my speaking words they did not understand, the returned eye contact despite my not understanding the words they were speaking, the shaking of hands, the smile, the farewell. These aspects of the patient encoun- ter are often skimmed over or neglected when one speaks the same language as the patient. For me, just as the history and physical exam are the essential elements of understanding the patient’s medical problem, these nonverbal aspects of communication became the essential elements of building trust and relationship. And they remain essential elements of building trust and relation- ships as I see patients back in Kentucky. RYAN HUNTON, PA-S2, attends the University of Kentucky PA program and is a member of the class of 2017. Ryan Hunton performs a physical exam on an infant. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 39 
  • 42. first rounds  |  continued Milk, Honey and Beyond BY BELEN LAQUI-RAMOS, PA-S2 Growing up in the Philippines, our family al- ways valued whatever was served on the table despite its simplicity and meagerness. My mother always made sure my brother and I had a cup of freshly brewed Barako coffee over steamed rice for breakfast. A sprinkle of cane sugar made everything magically delicious. At lunchtime, I couldn’t wait to show off a piece of fried mack- erel atop white rice with salty fish sauce and ka- lamansi, a small citrus fruit something like a lime. My mother wrapped them delicately with banana leaves. My days were simple, yet fun-filled—I would even say perfect. After graduation from high school, my family supported my decision to become a preschool teacher, but after five years, there was a call from far away. This call was quite hard to ignore and led me to a teaching job in Texas. For those who have been teachers in the U.S. public schools, you are probably familiar with the lunch lines in the cafeteria. The students grabbed and hastily devoured their food with their thoughts only on recess and enjoying 10 minutes of freedom out- side. Some students took their food trays and immediately swerved to dispose of their food directly into the trash bins. I thought, “Wait, I am missing something here?” Goodbye milk, banana, fideo, enchiladas and broccoli! Coming from a developing country, I was tempted to save that good food! As a result, I talked to my students daily about the importance of conserving food, valuing what they have and limiting the consump- tion of cheese- and jalapeno-smothered chips. But I soon realized that making poor nutritional choices and wasting food is not a trivial problem or mere hormonal craving; it is part of their cul- ture and tradition. Soon there was another call, even harder to ignore this time. Instead of the wastefulness of preschoolers, now I saw middle school students with lunches packed by mom or grandma full of spicy nacho chips and 500 mL of soda. I took a deep breath and thought, “This is an epidemic!” These were words I would later hear from not one but almost all of my future preceptors. While shadowing a pediatric PA, I noticed several patients were not only obese, but also had bor- derline hypertriglyceridemia and diabetes mellitus Members of the class of 2016 after performing community service in health and patient education. Left to right: Ayana Gates, Courtney Brice, Megan Castillo, Nathaniel Garcia, Delmer Robinson, Cassandra Trevino, Benny Lopez, Claudia Pena, Peter Maldonado, Lin Yang, Belen Ramos. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 40 
  • 43. first rounds  |  continued BELEN LAQUI-RAMOS, PA-S2, attends the University of Texas, Rio Grande Valley (Pan American) PA program and is a member of the class of 2016. type 2 at the young age of 14. My decision was made. Since then, I have equipped myself with the medical knowledge and skills to educate our population about eating healthier, while still enjoying the culture and tradition of being Asian or Hispanic down in the Rio Grande Valley. I love Mexican fajitas, menudo and carne guisada. I always crave Filipino dishes, such as dried and salted fish, pancit, lumpia and unripe mangoes with salted shrimp paste. And these popular cul- tural meals can be enjoyed, but in moderation. Educating patients is my next calling, which I am ready to fulfill soon as a PA. Growing up with barely enough to eat, my fam- ily often told stories of the U.S. being the land of milk and honey. To me, heaps of food repre- sented status and symbolized prosperity. Food was celebration, family bonding and being home. After moving to the U.S., where food scarcity is not a day-to-day concern for most people, I have learned that food does not hold the same mean- ing for most Americans as it does for me. For me, living in and enjoying the land of milk and honey does not mean eating all you can as long as you can, but remembering the basic premise that food is for strength, nourishment and life. Belen Laqui-Ramos (second from left) with her husband, Naesar, and (left to right) daughters Pauline, Patrisha and Meleri. Belen’s food fusion for breakfast, lunch, snacks and dinner. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 41 
  • 44. first rounds  |  continued To the Border and Back BY SUSAN M. OGDEN, PA-S2 In February, I had the opportunity to travel to the U.S.-Mexico border for my capstone rotation. The month I spent in the Lower Rio Grande Val- ley provided me with firsthand knowledge of the importance of cultural competence. Although my journal is full of impressions and observations there are a few key components to my experienc- es that affect PAs. In the Rio Grande Valley, farming and ranching are the mainstays of life. The workweek consists of six or seven long days for meager wages. The more family members who can work, the better it is for the family. Often, this means children leave school during their middle-school years to work, and their long-term educational goals are sacri- ficed for family need. Formal education may end at ages 12–14 for some young people here. In South Texas, many of the residents only speak Spanish. I took French as my foreign lan- guage in high school because I grew up three hours from Canada. Not having a background in Spanish set up a considerable language barrier, and I found myself initially needing a translator for my history and physical exams during this rotation. But over the next four weeks, my out- look changed from dreading the next conversa- tion to accepting the challenge of being an effective communicator in a new language. There is also a literacy barrier; many residents are illiterate in both English and Spanish or have a basic reading level in Spanish only. We learned in didactic year that providers need to assess literacy as part of the assessment of patients, and living here has given me new ideas on how to address this issue. Written instructions for medications can lead to a high rate of noncompliance; how- ever, pictographs can be found for almost any medical condition and will yield better outcomes. Although it takes time to create or copy these in clinic, I believe it is worth it. While here, I have seen the importance of close family bonds in the Latino culture. Children are raised with a commitment to care for the matri- arch and patriarch of the family until their last days. Decisions are made as a family unit. Now I understand why I have walked into very crowded hospital and exam rooms, at any time of day or night, to take a patient history. The living conditions for most Rio Grande Valley residents are drastically different from those in San Antonio. Some colonias (neighborhoods) do not have indoor plumbing, public transportation or paved roads; other areas lack sidewalks and streetlights. Health challenges abound: lack of UT Health Science Center at San Antonio PA students with dialysis patients PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 42 
  • 45. first rounds  |  continued outdoor play and exercise, greater risk of disease and injuries, water contamination and inability to obtain basic services. Remember Maslow’s hierar- chy of needs? A hungry family does not make choices about healthy food or preventive care— the immediate goal is to feed all the mouths around the table. In the same way, someone who has performed manual labor for the whole week may not have the energy to get medications refilled or make sure well-child exams are scheduled. In summary, living in a different culture has motivated me to be a better provider. I will be examining each patient’s barriers to health and my own treatment plan more closely. Did I com- municate so the patient could understand? Did I overcome language and literacy barriers? Have I educated family members? Have I taken the patient’s occupational, social and environmental histories accurately? Is what I am recommending to the patient feasible given their environment? I hope to be able to answer “yes” to all those ques- tions in my PA career. SUSAN OGDEN, PA-S2, attends The University of Texas Health Science Center at San Antonio, PA program and is a member of the class of 2016. Susan Ogden at Sacred Heart Church in McAllen, Texas. Farm workers in the Rio Grande Valley. Farming is the primary occupation of most residents. PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 43 
  • 46. first rounds  |  continued Facts and Figures: ■ Program: University of Kentucky ■ Location: Lexington, KY ■ Degree: Master of Science ■ Year of Establishment: 1973 ■ Program Director: Scott Black, MD ■ Number of Applicants: 340 ■ Number of Applicants Interviewed: 120 ■ Number of Applicants Accepted: 56; 40 in Lexington and 16 in Morehead ■ Length of Program: 30 months; 18 didactic and 12 clinical ■ PANCE Pass Rate (class of 2015): 94% PA Program Spotlight: University of Kentucky BY RYAN HUNTON, PA-S2 Inever foresaw becoming so actively involved in PA organizations when I started my training as a PA student at the University of Kentucky (UK) in January 2015. In the first few days I was simply trying to learn how to handle a scalpel without hurting myself and how to adjust to the great tide of information that was sweeping over me. Over time, I learned about the various opportunities to become involved as a PA student, and it is through the mentorship, support and community I have experienced firsthand at UK that I have been able to serve in leadership roles with both AAPA and the Physician Assistant Education Association. I initially chose to complete my PA education at UK because of its rich tradition in medical and health science education. The UK PA Studies pro- gram was established in 1973, just eight years after the profession’s debut; it is among nine dis- ciplines in the College of Health Sciences (CHS), which celebrates its 50th anniversary this year. Both UK CHS and the PA program are near UK Chandler Hospital, and these three entities collec- tively provide a great source of clinical, didactic and inter-professional education for students. The PA program also partners with Norton Healthcare in Louisville, through which it provides a clinical rotation scholarship. This $5,000 scholarship is provided to 10 students who will complete most of their rotations in Louisville through Norton Healthcare hospitals and clinics. Other clinical sites are provided throughout the state through the Area Health Education Center. In 1996, the program was extended to include a distant learning site at Morehead State University, designed for students who intend to work in rural communities. One of the strengths of the UK PA program is its focus on the history and physical exam as the foundation of clinical medicine, which is especially helpful in regions where certain diag- nostic or medical imaging tools are unavailable. The program requires students to complete rural clinical rotations as part of its mission to “prepare and encourage graduates to practice in rural and underserved communities.” Through UK PA fac- ulty member Dr. William Grimes, students also gain clinical experience in their didactic year by PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 44 
  • 47. first rounds  |  continued The University of Kentucky 2015 White Coat Ceremony for PA students volunteering at New Hope Clinic in Owingsville, Ky., a free medical clinic which has served the rural community since 2000. Aside from its focus on rural medicine, the UK PA program offers several international opportu- nities, including regular clinical rotations in Kenya, Swaziland and England, and clinical training in Ecuador and Mexico. One of my classmates, Amy Hehre, and her husband Robert recently pur- chased an 11,000 square-foot building in Kenya which will soon become a healthcare facility for terminally ill orphans. In a recent article, she expressed appreciation for the UK PA program’s focus on hands-on knowledge and clinical experi- ence even before the standard clinical year. Much of the program’s international outreach comes through clinical coordinators David Fahringer, MSPH, PA-C, and Dr. Somu Chatterjee, as well as through faculty member Sam Powdrill, PA-C, who has served in international medical missions work as an ophthalmology PA for more than 20 years. Outside the classroom, UK PA students serve the local community through organizations like the Jordan Light Foundation, Shriners Hospital for Children, Helping Hands and Upward Bound, and through various schools, programs and commu- nity events. Each year, students attend a legisla- tive day in Kentucky’s capital, Frankfort, to advocate for pertinent PA-related legislation. The day is sponsored by our state PA chapter, KAPA. Students and alumni of the UK PA program take a leading role among the Kentucky PA community to continue the conversation with legislators about the PA profession and how PAs serve as part of medical teams to address Kentucky’s healthcare needs. RYAN HUNTON, PA-S2, attends the University of Kentucky PA program and is a member of the class of 2017. UNIVERSITYOFKENTUCKYPAPROGRAM PA PROFESSIONAL  |  MAY 2016  |  AAPA.ORG | 45