Preparing PAs to Lead in Diabetes Care

Preparing PAs to Become
Leaders in Diabetes Management
November Is National Diabetes Month
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
N O V E M B E R 2 0 1 6

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Inside
C O V E R S T O R Y
Preparing PAs to Become Leaders
in Diabetes Management
F E AT U R E S T O R Y
U.S. Coast Guard PAs Aboard
the Eagle
Providing Healthcare and Leadership on the
High Seas
16
21
Departments
Laws + Legislation
NCQA proposes new medical home
measures and PA advisor protects clinician
and patient interest
STAT
CDC and Pew release joint statement,
signed by AAPA, on antibiotic stewardship
| CMS releases final rule on MACRA | Sena-
tors know America needs PAs to help fight
opioid addiction epidemic | New study may
have broader implications for PA utilization
in hospital settings across all service lines
Professional Practice
Making a good transition to a new
specialty or practice setting using the
2016 AAPA Salary Report
One on One
Catching up with PA Randall L. Owen
who went from NASA to a Harvard
Medical School fellowship
10
6
32
28
ContentsN O V E M B E R 2 0 1 6 • V O L . 8 , N O . 1 0
AAPA’s Navigating Healthcare
Look for AAPA’s Navigating Healthcare icon to read
stories on the Affordable Care Act and the
broader changes impacting PAs in this rapidly
changing healthcare environment.
Visit us at aapa.org to see what else we
are doing for you. PA PROFESSIONAL | NOVEMBER 2016 | AAPA.ORG | 1

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© Copyright 2016 by the American Academy of PAs. PA Professional is published monthly and is a registered trademark
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AAPA BOARD OF DIRECTORS 2016–2017
Josanne K. Pagel, MPAS, PA-C, Karuna®RMT, DFAAPA
PRESIDENT AND CHAIR OF THE BOARD
L. Gail Curtis, MPAS, PA-C, DFAAPA
PRESIDENT-ELECT
Jeffrey A. Katz, PA-C, DFAAPA
IMMEDIATE PAST PRESIDENT
David I. Jackson, DHSc, PA-C, DFAAPA
VICE PRESIDENT AND SPEAKER OF THE HOUSE
Jonathan E. Sobel, PA-C, MBA, DFAAPA, FAPACVS
SECRETARY-TREASURER
William T. Reynolds, Jr., MPAS, PA-C, DFAAPA
DIRECTOR / FIRST VICE SPEAKER OF THE HOUSE
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DIRECTOR / SECOND VICE SPEAKER OF THE HOUSE
Laurie E. Benton, PhD, MPAS, PA-C, RN, DFAAPA
DIRECTOR-AT-LARGE
Diane M. Bruessow, MPAS, PA-C, DFAAPA
DIRECTOR-AT-LARGE
Lauren G. Dobbs, MMS, PA-C
DIRECTOR-AT-LARGE
David E. Mittman, PA, DFAAPA
DIRECTOR-AT-LARGE
Beth R. Smolko, MMS, PA-C
DIRECTOR-AT-LARGE
Joseph Sutherland, MS, PA-C
STUDENT DIRECTOR
Jennifer L. Dorn, MPA
CHIEF EXECUTIVE OFFICER
V O L 8 | N O 1 0 | N O V E M B E R 2 0 1 6
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PA PROFESSIONAL | NOVEMBER 2016 | AAPA.ORG | 3

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LAWS+LEGISLATION
NCQA Proposes New Medical
Home Measures
PA Advisor Protects Clinician and Patient Interests
B Y E L L E N R AT H F O N
P
rimary care practices seeking medical home recog-
nition from the National Committee for Quality
Assurance (NCQA) in 2017 will experience a stream-
lined process that is less burdensome for front-line
clinicians.
In early 2015, NCQA announced plans to redesign its
patient-centered medical home (PCMH) recognition
approach, which has been in place since 2008. Since that
year, AAPA has influenced improvements in recognition
standards that have enabled full participation of PAs in
NCQA-recognized medical homes. For instance, NCQA has
shifted from physician-centric language to inclusive lan-
guage, such as“clinician,”and clarified that PAs can lead a
medical home. The draft redesign continues to recognize
full engagement of PAs. It includes a new standard that
requires the practice to have“a designated clinician
leader”who supports the PCMH model.
ELLEN RATHFON is AAPA’s
director of professional advocacy.
Contact her via email or
517-319-4347.

LAWS+LEGISLATION | continued
PA Presence on PCMH Advisory Group
A few months after announcing its redesign plan, NCQA appointed a com-
mittee of advisors that includes PA Leslie Milteer, who has practiced family
medicine for the past 14 years. AAPA nominated Milteer because of her
experience in policy development, preventive care guideline authorship
and family medicine.
“Advisory panel members serve as content experts on what will bring
meaningful change to team-based, patient-centered care,”Milteer said.
“We provide input to NCQA staff on changes they are considering, as well
as some changes they may not have identified without our experience as
providers. The redesign shows growth in healthcare policy by trying to find
the most meaningful changes that will have direct impact on patient care
and reduce the administrative burden. The NCQA is also aligning the PCMH
data collection requirements with other national programs to reduce
administrative demands,”she noted.
“The diversity of the 24-member advisory group ensures that all team
member perspectives are considered in the updated standards,”said Milt-
eer, who is faculty for the St. Catherine University Master of PA Studies
program and practices with Multicare Associates, a state-certified patient-
centered healthcare home practice.
NCQA Proposes Significant Streamlining
NCQA wants“to strengthen the link between recognition and practice
performance,”said Michael S. Barr, NCQA executive vice president, Quality
Measurement and Research Group.“We want to better support practices
and reduce unnecessary work. We want to encourage more investment
in health information technology to support PCMH recognition, and we

LAWS+LEGISLATION | continued
want to align PCMH activities with reporting requirements for other
organizations.”
NCQA heard from stakeholders that the current process
■ Is too difficult for small practices
■ Focuses on process instead of performance
■ Requires too much documentation
■ Provides too little contact with a real person at NCQA
■ Provides too little education and guidance
■ Neglects opportunities for data acquisition
■ Allows momentum to decline within the practice during the lengthy
three-year period before renewal
■ Generates uncertainty that all practices are accomplishing what they
claim
■ Requires the use of two separate, complicated tools
The draft standards propose:
1. Engaging practices in an annual“check-in”to maintain recognition,
rather than submitting documentation every three years for renewal
2. Reducing the documentation burden by using information generated in
the course of patient care to support alignment with the standards and
by communicating online
3. Offering more education and guidance to practices undergoing the
transformation process
4. Reducing the provider reporting burden by aligning with other national
reporting requirements
Many Parallels to Current PCMH Standards
The update separates recognition requirements into six categories, similar
to those in current standards. Categories include team-based care and
practice organization, knowing and managing patients, patient-centered
access and continuity, care management and support, care coordination
and care transitions, and performance measurement and quality
improvement.
Each category includes“core standards”and“additional criteria.”Core
standards are considered necessary to demonstrate practice transforma-
tion.“Additional criteria”include important characteristics, but practices
can select those that best suit the patients and communities they serve.
Advisory Efforts Winding Down
The redesign is scheduled for release in March 2017.“I’m excited to see the
positive changes in the final guidelines,”Milteer said.“I have been honored
to represent the dedicated PAs working in primary care settings in this role.
The new guidelines should help practices improve care delivery by
enhancing the team based care that PAs have always excelled at, for the
benefit of our patients.”

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STAT | Industry News
CDC AND PEW RELEASE JOINT STATEMENT ON IMPORTANCE OF OUTPATIENT
ANTIBIOTIC STEWARDSHIP
The CDC and The Pew Charitable Trusts in October released a Joint Statement on the Importance of Out-
patient Antibiotic Stewardship. The joint statement is the coordinated effort of 11 national organizations,
including AAPA, to expand antibiotic stewardship to combat the potential public health threat posed by
antibiotic-resistant pathogens.
The need for an established goal for outpatient antibiotic stewardship originated from a paper published
in the Journal of the American Medical Association, which measured the rates of outpatient oral antibiotic
prescribing by age and diagnosis in U.S. healthcare practices and emergency departments. The Pew Chari-
table Trusts and the CDC also released“Antibiotic Use in Outpatient Settings,”a report that evaluated cur-
rent antibiotic use in the U.S. The report found that 30 percent or about 47 million antibiotic prescriptions
in the U.S. each year are unnecessary.
In 2015, the White House set the goal of reducing inappropriate antibiotic use by 50 percent within the
next five years. Sustained, coordinated efforts from healthcare providers, state and local health agencies,
and key stakeholders are needed to help reach this goal.
CMS RELEASES FINAL RULE ON MACRA
The CMS in October released its highly anticipated final rule on
the Medicare Access and CHIP Reauthorization Act (MACRA), also
known as the Quality Payments Program (QPP). The 2,398-page
rule provides details and information on the framework surround-
ing the Medicare program’s shift to value-based payment models.
The rule also provides specific performance and reporting require-
ments for PAs, physicians and nurse practitioners.
Highlights of the final rule include:
• Details on various options for participation in the first year of the
QPP from full participation to a limited submission of reporting
information to“test”the ability of a health professional to meet
the requirements
• An expansion in the number of potential patient care deliv-
ery models that will qualify as Advanced Alternative Payment
Models
• A reduction in the reporting requirements necessary in meeting
qualification metrics for Advancing Care Information (formerly
meaningful use) and Clinical Practice Improvement.
AAPA was disappointed by the lack of CMS responsiveness to our
request to develop a methodology to increase transparency and
provide the ability to track individual medical services performed
by PAs that are billed under the name of the physician. However,
despite the fact that this is a“final”rule, CMS is allowing for a com-
ment period and AAPA will continue to urge CMS to find a solution
to our concern.
AAPA staff will provide a more comprehensive review of the rule
soon and encourages PAs to visit CMS’QPP website and the Acad-
emy’s MACRA web page for additional information.
ADOBESTOCK.COM

STAT | continued
PA PAC – THANKS AND GIVING
As we approach the end of the year, a big thank
you to the 690 PAs and AAPA staff members who
have contributed to PA PAC, the Academy’s political
action committee. The only PAC in the U.S. focused
on representing PAs on Capitol Hill, PA PAC is
$8,000 away from its year-end goal. Will you help
us reach our goal? It is critically important that we
begin 2017 with a robust PAC, poised to build new
relationships and support our congressional cham-
pions. Amplify your voice on Capitol Hill—learn
more and donate today.
SENATORS KNOW AMERICA NEEDS
PAs TO HELP FIGHT OPIOID
ADDICTION EPIDEMIC
AAPA attended the Substance Abuse and Mental
Health Services Administration’s (SAMHSA) public
meeting in October in Newark, N.J., to solicit feed-
back from stakeholders regarding the educational
requirement stipulated in the Comprehensive
Addiction and Recovery Act (CARA) (Pub.L. 114-
198) for PAs and nurse practitioners (NPs) to pre-
scribe buprenorphine for the treatment of opioid
addiction.
At the meeting, representatives of the American
Society of Addiction Medicine, American Associa-
tion of Nurse Practitioners and AAPA all stressed
that adult learners need flexibility and many
options to meet the educational requirement.
AAPA emphasized that the law provides HHS
Secretary Sylvia Mathews Burwell with flexibility,
which she should use, particularly for PAs who
already have experience in addiction medicine. The
organizations also talked about the need to not
make requirements so onerous that they serve as
barriers to PAs and NPs providing addiction treat-
ment. Consumer representatives at the meeting
stressed the need to expand treatment opportuni-
ties as soon as possible.
AAPA is pleased that U.S. Sens. Rob Portman
(R-OH) and Kelly Ayotte (R-NH) in October urged
SAMHSA to expedite the release of the regulations,
particularly those related to educational require-
ments for PAs and NPs. Read more here.
NEW STUDY MAY HAVE BROADER
IMPLICATIONS FOR PA UTILIZATION
IN HOSPITALS
In an article recently published in the Journal of
Clinical Outcomes Management, Johns Hopkins
researchers found that an expanded PA hospitalist
staffing model at a community hospital provided
similar outcomes and a lower cost of care than a
conventional one. Researchers did a retrospective
study comparing two hospitalist groups at a 384-
bed community hospital in Annapolis, Md. One
group had an expanded PA staffing model, with
three physicians and three PAs. The other group
had a“conventional”staffing model, with nine phy-
sicians and two PAs.
Between January 2012 and June 2013, research-
ers examined the in-hospital mortality, cost of care,
readmission, length of stay and consultant use.
Between the two groups, there was no statistically
significant difference for in-hospital mortality, read-
mission, length of stay, or consultant use. Cost of
care was less in the expanded PA group. In conclu-
sion, an expanding PA staff modeling can yield a
similar level of care at a lower cost.
AAPA sees this as an important study that has
broader implications for PA utilization in a hospital
setting across all service lines.
BEING A PA MAKES FORBES’ LIST OF “MOST
MEANINGFUL JOBS THAT PAY WELL”
Forbes recently ranked the PA profession as the 15th most meaningful job
that also pays well. To measure a sense of purpose combined with annual
pay, Forbes gathered compensation data from PayScale and surveyed
workers in 482 jobs from the Occupational Information Network (O*NET).
Although, they were paid the lowest, people found the most meaning as
clergy, social worker, and marriage and family therapist. Anesthesiologists,
obstetricians and gynecologists, internists, and psychiatrists were among
the most meaningful jobs with the highest salary.

STAT | continued
Mia McDonald, PA-S2
PA Carolann Murphy
PA NAMED TO NJ COMMISSION ON
SPINAL CORD RESEARCH
PA Carolann Murphy was nominated to serve on the
New Jersey Commission on Spinal Cord Research by
Gov. Chris Christie earlier this year. In September, the
state senate approved her appointment to the com-
mission. The commission reviews proposed research
projects, approves state grant funding, and monitors
clinical trials.
A former editor of AAPA’s“Physician Assistant”jour-
nal, Murphy currently serves as assistant editor of the
Journal of Spinal Cord Medicine, the official journal of
the Academy of SCI Professionals.
A graduate of the Yale University PA program, she is the communica-
tions manager at Kessler Foundation, a global leader in rehabilitation
research that seeks to improve cognition, mobility and long-term out-
comes, including employment, for people with neurological disabilities
caused by diseases and injuries of the brain and spinal cord.
PA STUDENT JOINS GLMA
BOARD OF DIRECTORS
Mia McDonald, a second-year PA
student at Jefferson College of
Health Sciences in Roanoke, Va.,
was appointed to the GLMA Board
of Directors as a student member
in September. She will also cochair
GLMA’s Health Professionals in
Training (HPIT) committee, which
addresses issues of importance to
HPIT members, plans content for the
GLMA annual conference and men-
tors upcoming student leaders.
GLMA is an international organization of lesbian,
gay, bisexual, transgender, (LGBT) and ally health-
care professionals and students of all disciplines.
Formerly the Gay and Lesbian Medical Association,
the organization is now formerly known as GLMA:
Health Professionals Advancing LGBT Equality.
McDonald was named the Virginia Academy of
PAs’2016 PA Student of the Year. Along with being
selected as a 2016 Student Leadership Fellow by
the LBGT PA Caucus of AAPA this year, she will
represent the Student Academy in the House of
Delegates at AAPA Conference 2017 in Las Vegas.
Prior to PA school she taught human anatomy as
visiting faculty at the University of North Carolina
at Greensboro. Currently, she is the editor of First
Rounds, PA Professional’s student news section.
ARC-PA ANNOUNCES NINE NEW
PA PROGRAMS
In September, the Accreditation Review Commission
on Education for the Physician Assistant (ARC-PA)
awarded provisional accreditation to nine new
PA programs. With the closure of the Riverside
Community College/Moreno Valley College PA
program in California, the total number of accred-
ited entry-level PA programs is now 218. According
to ARC-PA, there are currently 32 potential PA
programs in the pipeline that could go online by
January 2019 if they make it through the accredita-
tion process.
The new PA programs are: University of South
Carolina School of Medicine-Columbia in Columbia,
S.C.; Chapman University in Irvine, Calif.; Dominican
University in River Forest, Ill.; University of Saint
Joseph in West Hartford, Conn.; University of the
Pacific in Sacramento, Calif.; North Greenville
University in Greer, S.C.; University of Evansville
in Evansville, Ind.; South University–Richmond
in Glen Allen, Va.; and University of South Florida
in Tampa, Fla.
CGMS RECOMMENDED FOR ADULTS
WITH TYPE 1 DIABETES
The Endocrine Society recently issued a guide-
line recommending continuous glucose monitors
(CGMs) for adults with type 1 diabetes published
online and in November’s Journal of Clinical Endo-
crinology & Metabolism.
“Studies have found that people with Type 1
diabetes who use CGMs are able to maintain bet-
ter control of their blood sugar without increasing
episodes of hypoglycemia when blood sugar drops
to dangerous levels, compared to those who self-
monitor blood glucose with periodic fingersticks,”
said Anne L. Peters, MD, who chaired the task force
that authored the guideline. Read more here.
PAs interested in including diabetes care in their
practice should check out Diabetes Leadership
Edge, AAPA’s call to action to fight this growing
health concern and give PAs the tools to effectively
manage and treat it.

STAT | continued
PA Gina Venditti
PAs, NPs AND PHARMACISTS GATHER TO DISCUSS CONVENIENT CARE ISSUES
The 2nd Annual Convenient Healthcare and Phar-
macy Collaborative Conference was held July 19-21,
2016, in Orlando. The event brought together
pharmacists, PAs and NPs to focus on retail-based
healthcare issues. The conference is cohosted by the
Convenient Care Association (CCA) and Pharmacy
& Healthcare Communications, LLC, which pub-
lishes the monthly journal Pharmacy Times. CCA is
the national professional association of companies
representing retail-based healthcare locations, and
Pharmacy Times is a clinically based journal provid-
ing practical information for pharmacists.
Gina Venditti, field educator for CVS/MinuteClinic,
and leader of AAPA’s special interest group PAs in
Retail Medicine, attended the conference. The pri-
mary program provided medical education focused
on disease prevention, healthcare screenings,
chronic care management and treatment of com-
mon conditions. The CCA Executive Track focused
on management of retail health clinics and those
interested in learning more about the growing retail
clinic industry. According to a recent article, retail
clinics are expected to reach 30 million patients
by 2022. Representatives from Rite-Aid/RediClinic,
Walgreens and Walmart also participated.
This new collaborative approach to retail-based
medicine has proven beneficial for both hosting
organizations as they strive to provide relevant edu-
cation for all who work in the retail-healthcare set-
ting. For additional information about PAs in Retail
Medicine, contact PA Gina Venditti or Penny Gaillard,
AAPA senior director, constituent organization out-
reach and advocacy.
CANCER PREVENTION BENEFITS OF
COLONOSCOPY MAY DIMINISH AFTER
AGE 75
Researchers found that having a colonoscopy
reduced the eight-year risk of colorectal cancer
only slightly among older patients: from 2.6 per-
cent to 2.2 percent in individuals aged 70 to 74 and
from 3.0 percent to 2.8 percent in individuals 75
to 79, according to an article recently published in
the Annals of Internal Medicine. The study authors
termed this decrease a“modest benefit.”
NIH REPORT HIGHLIGHTS STRATEGIES
FOR OPTIMIZING YOUTH SUICIDE
PREVENTION PROGRAMS
The National Institutes of Health (NIH) has issued a
final report from its Pathways to Prevention work-
shop on youth suicide prevention. The abridged
version of the final report, published in Annals of
Internal Medicine, provides a roadmap for opti-
mizing youth suicide prevention efforts by high-
lighting strategies for guiding the next decade
of research in the area. The strategies identified
include recommendations for improving data
systems, enhancing data collection and analysis
methods, and strengthening the research and
practice community.

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COVER STORY
Preparing PAs to Become Leaders
in Diabetes Management
BY JENNIFER WALKER
AAPAbelieves that PAs, particularly those in primary care, have
the opportunity to become leaders in diabetes manage-
ment. To help, the Academy developed the Diabetes Leadership Edge
(DLE) initiative, a curriculum that will cover, among other topics, how to
talk to patients about lifestyle interventions, what medications to prescribe
and how to take a population management approach to diabetes care.
The DLE initiative started in 2013, but the curriculum is being com-
pletely rewritten—with new modules rolling out in late 2016 and ending
in 2017—to reflect the fast-moving science that surrounds this disease. In
2017, AAPA will also roll out its Obesity Leadership Edge initiative curricu-
lum focused on obesity, which is a major risk factor for diabetes.
“Some people consider diabetes to be even worse than cancer,”says PA
Ji Hyun“CJ”Chun, who practices at Endocrinology Associates, P.A., in Scott-
sdale, Ariz. This is because patients with diabetes have elevated amounts
of sugar in their blood, which can lead to serious complications through-
out their bodies.“Name one organ that is not connected to a vessel. There
isn’t [one]. Any organ has the potential to get damaged,”Chun says.

The 29.1 million Americans who have type 2 diabetes— nearly 10 percent of
the population—are at risk of being diagnosed with comorbidities, such as high
blood pressure and high cholesterol, macrovascular complications, microvascu-
lar complications, and neuropathy. In fact, according to the CDC, diabetes is the
leading cause of blindness, kidney failure, and amputations that are not caused
by injury.
So it’s not surprising this is an expensive disease: In 2012, diabetes cost $176
billion in direct medical costs, and people who had the disease had medical
expenditures of about $13,700 a year, more than half of which was attributed to
their diabetes, according to the American Diabetes Association.
With a staggering 86 million people in the U.S. diagnosed with prediabetes in
2012—up from 79 million just two years earlier—many more people are poised
to get a diabetes diagnosis in the future.“Prediabetes and diabetes are the same
disease on a different spectrum,”Chun says.“It’s very important that we catch
patients early and start intervening.”
The first step in improving diabetes care is taking a population management
approach to treating patients, says Eric Peterson, AAPA’s senior director for
education and quality. This starts by establishing a way of identifying patients
within a practice who have diabetes. Often this involves a registry. From there,
PAs can evaluate whether their offices are meeting certain metrics, such as how
many patients have been referred to a diabetes educator or have had an annual
A1C test, which looks at how their glucose was managed over the previous
three months.
Then the curriculum will focus on the various treatment options for diabetes.
The first step is working with patients on lifestyle interventions, which is particu-
larly important for those who have prediabetes. By making small lifestyle
changes, these patients can get their A1C back to normal levels without ever
going on medication, says PA Nancy McLaughlin, assistant professor in the Phila-
delphia College of Osteopathic Medicine’s Department of Physician Assistant
Studies. When patients decrease their sugar intake, their bodies don’t have as
much sugar to process; then, by exercising, their bodies can more effectively use
the blood sugar that is there.
“The more exercise you can do, and the less sugar [you eat], the more you are
going to control your blood sugars,”McLaughlin says. Lifestyle interventions are
also important for patients who have obesity, and, therefore, are at greater risk
of being diagnosed with diabetes in the future.
But instead of simply offering diet and exercise recommendations, PAs can
use a technique called motivational interviewing to learn their patients’motiva-
tions for making changes and thereby steer them to making good decisions for
themselves. For example, instead of telling patients they have to eat less and

exercise more, a PA might say,‘What changes would you like to see in your
diet or exercise pattern?’“It’s very important for us to not accuse them of
anything, but to try to build rapport to really show them that we care. It’s a
long-term process,”Chun says.
Then there is pharmacology, which is a rapidly evolving aspect of diabe-
tes care. Chun says there are now 13 classes of medications with three to
four companies producing drugs in each class.“It’s very difficult to keep up
with everything,”he adds.“[However], we have so many different classes of
medications that are not being utilized enough.”
While Metformin remains the first medication prescribed, the second
medication that should be used, if needed, is not as clear. The pharmacol-
ogy module in the DLE curriculum will talk about what the second agent
should be based on what is going on clinically for each patient. For exam-
ple, recent research has shown that for the first time in 50-plus years there
are two classes of diabetes medications that can reduce the risk of cardio-
vascular disease.
For patients who have been diagnosed with both diabetes and obesity,
bariatric surgery is a potential treatment option. Research has shown that
patients with obesity who have this surgery“can see their diabetes disease
and hypertension almost completely reversed to where they might not
even need medications anymore,”McLaughlin says. However, surgery is a
drastic option that comes with challenges, and these need to be discussed
with patients who are good candidates for this treatment.
With the DLE curriculum, the ultimate goal is for PAs to have the tools
they need to improve care for their patients.“You may be in a practice that

JENNIFER WALKER is a Baltimore-based
freelance writer and a regular contributor to
PA Professional. She can be reached by email.
has 10 providers and perhaps you’re the one who calls every-
one in a room says,“How can we get more organized around
our patients with diabetes?”Peterson says.“PAs could be
the ones who step up and provide leadership when no one
else does.”
Chun and McLaughlin are members of AAPA’s Educational
Advisory Board. Chun is the secretary of the American Society
of Endocrine Physician Assistants, and McLaughlin is a member
of AAPA’s Commission on Continuing Professional Develop-
ment and Education.
A Call for Providers to Treat Obesity as a
Primary Condition
Promoting Awareness During National Obesity Care Week
For the past three years, AAPA has participated in the combined annual meetings
of the American Society for Metabolic & Bariatric Surgery (ASMBS) and The Obesity
Society (TOS). An international gathering of healthcare professionals, the event
focuses on the basic science, clinical application, surgical intervention and preven-
tion of obesity. Along with ASMBS and TOS, AAPA is also collaborating with the
Treat & Reduce Obesity Coalition, Obesity Action Coalition, Strategies to Overcome
& Prevent Obesity Alliance, Healthy Weight Commitment Foundation and the
National Obesity Care Week Campaign. Turning the tide on this growing epidemic
will require a group effort, and PAs are more than ready to claim their place on
the team.
AAPA also participates in National Obesity Care Week, October 30 to November 5,
a campaign to facilitate a national conversation and shining an annual spotlight on
the need for a comprehensive approach to care for those living with the disease of
obesity. The Academy is a“Champion-level”partner of National Obesity Care Week.
In 2015, AAPA started focusing on obesity with the publication“A Framework for
Physician Assistant Intervention for Overweight and Obesity”in JAAPA. The Obesity
Leadership Edge initiative is the next phase of AAPA’s focus on obesity. The initiative
provides a call for all providers to regard obesity as a primary disease that requires
prevention and treatment strategies, and will include a modular curriculum to help
PAs gain the competencies required to effectively manage patients affected by
obesity PAs are in an ideal position to lead teams of healthcare providers in treating
this disease. The Academy strives to keep PAs at the forefront of key health issues in
America, such as obesity, diabetes and cardiac health. As part of the initiative, AAPA
has also worked closely with other national organizations that have devoted confer-
ences and position papers to addressing obesity.

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Connect learning with life.

FEATURE STORY
U.S. Coast Guard PAs
Aboard the Eagle
Providing Healthcare on the High Seas
BY HILLEL KUTTLER
T
he alleys between the mess hall’s long, brown tables constitute an ideal site to
practice carrying stretchers for when they’d be most needed in the U.S. Coast
Guard Cutter Eagle’s narrow corridors. The elegant ward room, with a display
case that includes a strip of the cutter’s original sail, would be utilized as a triage center
if disaster strikes. First-aid training of staff is conducted almost anywhere on board.
Throughout the 295-foot-long cutter—a“ship”in the Navy is a“cutter”in Coast Guard
parlance—are stationed 20 kit bags, so well-stocked with the basics for handling emer-
gencies that instructions are included. Painted arrows and medical-cross symbols
appear in light-reflective red on interior walls—some just six inches from the floor,
where sailors crawling in the dark would see them.
The 80-year-old cutter serves an important function for the U.S. Coast Guard Acad-
emy (USCGA), and attention to detail helps keep those on board healthy and safe,
according to PAs who have served aboard the tall ship.
PAs have been a part of this branch of the Uniformed Services since the early 1970s. In
fact, the first PA commissioned to serve in the Coast Guard was Victor“Vic”Germino, Jr.,
who has the distinction of being a member of the first class to graduate from the Duke
University PA program on Oct. 6, 1967.
The Eagle is the
only active
commissioned
sailing vessel in
American military
service, and one
of only two
commissioned
sailing vessels,
along with USS
Constitution.

USGA PAs, continued
Now, PAs are firmly entrenched in the Coast Guard and among the med-
ical professionals staffing the Eagle. The largest tall ship flying the stars and
stripes, and the only active square-rigger in U.S. government service, it can
berth up to 237 people. That number includes the crew and those in train-
ing when the cutter is at sea for several weeks at a time. The trainees are
mainly USCGA cadets and officer candidates, along with some from the
U.S. Naval Academy and elsewhere.
Lt. Cmdr. Tommy Brackins, U.S. Coast Guard, retired, PA-C, had always
wanted to serve on the cutter. Last summer, before he retired, he checked
it off his bucket list. He spent 22 days on the tall ship, sailing from Bermuda
to Portland, Maine, to Boston.
Along with seizing the opportunity to provide care on the tall ship, he
also mentored and taught crew members about leadership.
“I spoke with cadets, junior officers, and enlisted members regarding
career progression and certain careers in the Coast Guard,”said Brackins,
who served in the Coast Guard for 23 years, 13 of them as a PA.“I am also
an Aeromedical PA (flight surgeon trained PA), which opened up the com-
munication channels with a number of cadets who desired going into
Coast Guard Aviation.”
Brackins, who calls Gatlinburg, Tenn., home, was the third highest rank-
ing officer onboard the Eagle during the 2015 voyage.
Healthcare on the High Seas
Every summer, the Eagle sails in the Atlantic Ocean for several weeks of
training in such basics of seamanship as learning to read the wind and sea,
steering, navigating by the stars, and raising and lowering the sails. The
time at sea also builds teamwork and develops leadership capabilities.
The rest of the year, the cutter is moored at the USCGA’s base in New
London, Conn., or sails to other American ports for public relations and
outreach purposes. Currently, it’s in the midst of a four-year program of
maintenance and refurbishing each winter. Those repairs are done at the
Coast Guard’s repair facility at southern Baltimore’s Curtis Creek, just inland
from the Chesapeake Bay.
“I love it,”said Lt. Cmdr. Charlene Criss, U.S. Coast Guard, PA-C, who
served on the Eagle approximately 10 times in the past decade.“It’s the
camaraderie with the crew. You see the most beautiful sea, sunrises, sun-
sets and stars anywhere. I had no idea I’d love it this much.”
On a recent, dreary morning, workers were waterproofing the Eagle’s
cables, thoroughly cleaning hoses’interiors and stripping pipes of their
paint to prepare for a fresh coat. In the galley, a cook placed tins on the
counter to begin preparing lunch. An announcer tested the public-address
system: the cutter’s whistle, the alarm for a collision and a signal to dis-
patch sailors to their stations.
Lt. Cmdr. Charlene Criss, left, aboard the Eagle with then Coast Guard Academy Cadet Elise Sako.
PHOTOCOURTESYOFCHARLENECRISS

USGA PAs, continued
There were about 50 people onboard to handle deck, navigation, engineering
and seamanship operations as well as support staff, such as the cooks. Adam
Carter, a corpsman and health services technician, was on duty. On-the-job inju-
ries and workers getting sick can occur at any time in port or at sea, of course.
Carter also occasionally leaves the sick bay to monitor food conditions, such as
ensuring that proper storage temperatures are maintained and looking for any
evidence of rodents’presence.
Even while the cutter is docked, the PAs’medical tasks continue apace.“We
would gladly see anyone at anytime,”said Brackins.“I had members knock on my
berthing room door after hours needing help.”
On the Eagle, all medical notes are hand written and prescriptions are filled
from the limited medication supply onboard the cutter. The medications cov-
ered most of the essentials such as antibiotics, NSAIDS, muscle relaxants, cough
and cold medications, and even narcotics if needed.
And on a typical day, PAs see crew members with“Uri’s, pink eye, sea sickness,
musculoskeletal disorders, and life adjustment issues with being underway.”
Brackins said that PAs can also perform limited CLIA waived lab testing such
as urine dipstick, urine pregnancy, mono spot, rapid strep. They could also do
minor procedural interventions such IV fluid rehydration, wound repair, nebu-
lizer tx, unguinectomies, I&Ds and splinting.
Tight Quarters
The Eagle’s sick bay is a tight, L-shaped room that’s less than 100 square feet. It
lacks equipment like an X-ray machine and a real lab, but it contains plenty. A
defibrillator hangs next to a porthole, alongside an eye chart. Atop a file cabinet
sits a blue advanced-cardio-life-support bag. Next to it is an EMT pack.
A cabinet stores an oxygen tank, one of many on board. File drawers display
labels for things like antibiotics, antifungals, pain medications, ophthalmic medi-
cations, dental supplies, needles and syringes, bandages, scalpels, wound care,
water testing, sutures. Medical books stand on a shelf across the room, since the
Internet isn’t always available.
The room might resemble most small clinics, except for the homemade sign
taped to the sick bay’s door:
Seasickness Medication:
If you feel OK, just drink water.
If you know you get sick, chew one now.
It will give you a dry mouth and mild drowsiness.
Drink water!!!
Do not give to your shipmates.
If you’re sick, go on deck.
No more than 1 2X a day!
Officer candidates work together during a team-building exercise aboard the U.S. Coast
Guard Cutter Eagle.
PHOTOCOURTESYOFU.S.COASTGUARD

USGA PAs, continued
Unsurprisingly, seasickness pills are well stocked. A few hours before the
Eagle sails, those on board are asked if they tend to get seasick; if they do,
they’re given a chewable tablet, which is good for a day, or a patch that
lasts three days.
Being at sea also means increased risk of sunstroke and dehydration.
That’s why the medical staff circulates on sunny days to hand out sun-
block lotion, and almost every day to make sure that people are drinking
enough water. Space restrictions mean that bottled water isn’t stocked.
Still, drinking supply is hardly an issue: A reverse osmosis filtration system
makes the seawater potable.
The Challenges Are Unique
About six years ago, when the cutter was sailing off the coast of Colombia,
almost everyone on board had presumed food poisoning said Criss, who
has been a member of the Coast Guard for more than 24 years.
Anti-nausea medications and anti-diarrheals were given out, and IVs
utilized. The three medical professionals on duty“worked non-stop to take
care of people,”she said.
Another time, a patient had food stuck in his esophagus. Criss, who has
been a PA for about 15 years, used a combitube to successfully force the
food down into the man’s gut. On land, she would have sent him to an
emergency room.“It worked, thank goodness. If it didn’t work, he was
going to have to be medevaced,”she said.
The cutter’s distance from land represents the greatest challenge to
health care, the PAs said. In difficult circumstances, satellite telephones are
used to reach an advisor, known as a flight surgeon, who is trained to con-
sult from a distance. Preparation and the ability to think on one’s feet are
paramount.
Coast Guard Boatswain's Mate "A" School students
climb the foremast rigging aboard the Eagle.

USGA PAs, continued
“You have to deliver a high level of care on board, because you’re kind of‘it,’”said
Lt. j.g. Robert Prevatt, a PA from West Palm Beach, Fla., who served on the Eagle in
the summers of 2014 and 2015. A PA for about three years, he has served in the
Coast Guard for nine years.
Criss noted,“There are a handful of quick tests we can do. There’s a finite number
of medications and supplies, and we can’t restock until we get to port, and there’s
no specialist on board, so there’s no way to tell for sure if, say, someone has a broken
bone, unless you see it. There’s pressure because you have to make a lot of decisions.
A lot of times, you’re on your own and have to rely on your own knowledge and skills.”
An unusual challenge that healthcare professionals aboard the tall ship face is the
configuration of the vessel itself. Because of the masts and sails, helicopters cannot
evacuate a patient from the deck. The solution: The patient and several crew mem-
bers are lowered in one of two 35-foot motorized lifeboats. The boat travels away
from the cutter, and the helicopter lowers a basket. The patient is secured in it and
is raised to the helicopter, whereupon the crew members return to the tall ship.
In the summer of 2015, a squall—a sudden burst of strong wind, often accompa-
nied by heavy rain—struck the tall ship, yanking a pin rail from the side of the deck.
A pin rail is a horizontal wooden ledge-like plank with a row of holes in it, in which
belaying pins hold the lines rising to the sails and the mast. When it tore away from
the side of the vessel, it could have struck someone flush. Fortunately, said Criss,
who was on the cutter then, no one was hurt.
Accidents are liable to happen though, she explained. Hydraulic equipment and
other heavy items can fall when being moved. The cutter will roll and lurch without
warning. Head trauma can result.
“A ship is a dangerous place,”said Criss, who hails from Falmouth, Mass., a town
on Cape Cod familiar with tall ships.
Lt. Cmdr. Tommy Brackins, retired, spent 22 days aboard the Eagle, sailing
from Bermuda to Boston.
PHOTOCOURTESYOFTOMMYBRACKINS

A Fascinating Place to Work
This vessel is a historical place, too. On the wall of a the corridor leading to the
captain’s quarters hangs a framed tribute to author Alex Haley, who worked as a
messboy in the Coast Guard in 1939 and wrote part of his landmark book“Roots”
while a guest on the Eagle in the early 1970s. Further along, a photograph shows
President John F. Kennedy and Vice President Lyndon B. Johnson standing on the
deck in 1962. Another picture shows President Harry S. Truman visiting.
It was during Truman’s presidency that the tall ship became American property
after being captured during World War II. A plaque on another wall states that it
was German-built and originally named Horst Wessel. A staircase near the plaque
brings a visitor down to the mess deck, where meals are eaten and that doubles as
an unofficial medical annex—beyond the stretcher-bearing drills. Open a door to
the lounge room and one will glimpse a high-definition television playing a film;
the lounge doubles as a battle-dressing station, containing items like IV fluids,
splints, triage tags, gauze pads and nasopharyngeal airway kits.
Serving on the Eagle is a singular experience for PAs and the crew members for
whom they care.
“Anytime you have to leave your family behind it is a challenge, but the friend-
ships you make on the Eagle can last a lifetime”Brackins said.
HILLEL KUTTLER is a freelance writer and editor,
until recently based in Baltimore, who has written
about PAs and healthcare for many years. He can
be reached by email.
A cap is placed on the fife rail for safe keeping by a
member of the crew as the U.S.C.G. Cutter Eagle begins
its journey north towards the coast of Maine during the
finally leg of a summer cruise.

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your practice

PROFESSIONALPRACTICE
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.
Making a Good Transition to a
New Specialty or Practice Setting
How to Make the Most of PA Career Flexibility
B Y J E N N I F E R A N N E H O H M A N
O
ne of the most amazing and unique aspects of being
a PA is the unparalleled career and clinical flexibility
of the profession. The 2016 AAPA Salary Report con-
tains some interesting facts about how PAs are utilizing
choice and creativity to choose their specialties, roles and
employer types over time.
“AAPA examined changes in PA career status during 2015,
for specialty, but also for a number of other work character-
istics, including role (e.g., from clinician to educator), work
setting and employer. About a sixth (16.2 percent) of PAs
made a change in one or more of these areas in 2015. The
most common change was of employer;
11 percent of PAs found new employers during 2015, while
roughly 5 percent of PAs switched their role, setting or spe-
cialty. The movement of PAs among specialties is not over-
whelmingly from primary care specialties to nonprimary
care specialties, as is sometimes assumed.
Nearly three-quarters (73.4 percent) of all PAs who
changed specialty
in 2015 moved either from a non-primary care specialty to
another non-primary care specialty, or from one primary
care specialty to another primary care specialty. The percent-
age of specialty-changing PAs who moved from a primary
care specialty to a non-primary care specialty was 15.7 per-
cent, which was indeed higher than PAs moving the other
direction; it is notable, however, that nearly 11 percent of
specialty changers actually moved from a non-primary care
specialty into primary care (see Figure 14).”
I suggest using the 2016 Report as a data resource to
research key aspects of a career transition—whether to a
new specialty, new setting, or new state. Here are some key
sections to examine:
To assess which specialties have the highest compensation
Base Salary and Bonus from Primary Clinical Employer by
Specialty (Table 10, page 65)

PROFESSIONAL PRACTICE | continued
Identifying states with the highest proportions
of practicing PAs
See page 11, Figure 6
Identifying the most popular PA specialty practice areas
Median base salary by work setting
Identifying Your Key Elements of Career Satisfaction
As a PA career advisor, I help clients interested in career transitions to first
assess where they are and where they’d like to go, professionally speaking.
The potential career pathways open to PAs can indeed seem overwhelm-
ing at times, but essentially this is a great“problem”to have. There is no
other medical profession in which you can choose a specialty not just at
the outset of your career, but throughout the entire spectrum of your
career.
Successful job transitions are rooted in self-knowledge. For that reason
I’ve developed a questionnaire to help sharpen one’s understanding of
job-related learning experiences and goals. (See Text Box)
Additional Questions to Consider:
■ What is my mission in the world of medicine? How can I best make
a difference? How can changing specialties and/or role allow me to
achieve this?
■ What have I found rewarding and unrewarding about my current job
and my PA career to date?
■ What is the income potential for the specialty I’m considering a switch
to? (see 2016 Salary Report)
■ What are the areas of expertise/skills I bring from my current practice
into a new one?
■ Do I want to transition to a non-clinical role?
■ How important is increased compensation to my transition goal?
■ Do I want to improve my work-life balance?
■ Is there a practice area I’ve always been interested in but have not
pursued? If so, which one?
Career Goals and Preferences Exercise
■ Ideally, I would like to work as a PA in the following specialty, with the
following roles, scope of practice and responsibilities:
■ An optimal professional relationship with my collaborating
physician(s) could have the following characteristics:
■ I would describe an ideal practice environment atmosphere and pace
of work in the following terms:
■ Ideally I’d like to work for the following type of employer and in the
following setting:
■ My peak experiences as a provider to date:

Looking Before You Leap: Resources for Exploring
a New Specialty or Role
Learning as much information as you can about a new specialty is advis-
able and is a strategic way to broaden your professional network in the
process. AAPA—and the PA community as a whole—offers a wealth of
resources to explore, including:
■ PA specialty organizations and special interest group websites
(and events)
■ PAs in your network, community, alumni group
■ AAPA’s Huddle
■ LinkedIn: current or potential contacts (PA, physician, other) who work
in your field of interest
■ Volunteer opportunities in your field of interest
■ CME activities in your field of interest
Tips for the Job Search and Negotiation During
a Transition
While it may be a little challenging to re-tool one’s CV to look for a position
in a new field, it can be done! Here are some tips. This process also is great
practice for the articulating points to make in interviews about the rel-
evance of your skills and experience. After brainstorming all of your trans-
ferable skill sets, aptitudes and accomplishments most relevant to a new
specialty, edit your CV to emphasize them as part of your descriptions of
positions you’ve held to date. Take a look at your LinkedIn page and
update it to reflect your transition goals in the same way, and by joining
specialty-related groups and organizations.

Let’s say you were interested in practicing in pediatrics for the first time,
having held positions in family medicine to date. Review and underscore
those aspects of our practice where you skillfully provided care to pediatric
patients, and ask your references, where appropriate, to mention those
aspects of your work.
Your cover letter is probably the most effective territory to make a pitch
to an employer in a new field: allowing you to (concisely) tell your profes-
sional story and why you’ll make a skilled, resourceful addition to the prac-
tice team.
A small decrease in salary may be part of the cost of changing to a new
field, but be sure to keep it within reasonable bounds. Some employers
will underestimate the invaluable foundation of your PA medical education
and the practice experience you’ve gained in a different field. Be prepared
to educate them, and please don’t accept a low-ball salary offer based on
the notion that you’ll require extensive training. The 2016 AAPA Salary
Report’s Base Salary and Bonus From Primary Clinical Employer by Spe-
cialty and Experience data (Chart 12, page 71) can help you define an
acceptable salary range (and is just one more way in which the new Salary
Report is a career-boosting resource for all PAs).
Have you recently made a transition that brought your career to a
rewarding new place? Have you made some missteps along the way which
you now see as lessons? I’d like to hear your stories! Email me at pacareer-
coach@gmail.com.
Salary Report Series
This is one in a series of articles for PAs, both new
graduates and experienced PAs, interested in shap-
ing their own personally determined future through
career development. The articles will help you get
the most value out of the latest AAPA Salary Report,
and use the data to negotiate your way to a better
salary, bonus and more.
2016 AAPA
Salary Report

ONEONONE
JANETTE RODRIGUES is the
editorial director of AAPA and
editor-in-chief of PA Professional.
Contact her via email or
571-319-4382.
PA Randall L. Owen
From NASA to Harvard Medical School
Catching Up With PA Randall L. Owen
B Y J A N E T T E R O D R I G U E S
F
irst, PA Randall L. Owen went where few members of the profession have gone before—NASA.
Now the George Washington University PA program graduate is forging another new path as a
visiting research fellow in bioethics at the Harvard Medical School for the 2016-2017 academic
year. He was previously an health maintenance systems (HMS) clinical instructor at the NASA Johnson
Space Center (JSC) in Houston before going on to complete a PA surgical residency at the Norwalk
Hospital and Yale School of Medicine.
Q. What is your research area of interest at Harvard?
A. My current research is focused on how professionalism,
especially the use of evidence-based information, might
be influenced by the context of the clinician-patient rela-
tionship within large government or commercial organiza-
tions, such as NASA, when both parties are employed by
the same organization. A closely-related question is
whether, and in what specific ways, the clinician-patient
relationship is affected when the employment of the
patient may depend on the evaluation or recommenda-
tions of the clinician. An understanding of the context of
the clinician-patient relationship may be used to suggest
strategies for implementing more efficient healthcare
systems within these large organizations.
Q. What do you hope to accomplish with
this research?
A. I plan to apply the results of my bioeth-
ics research, along with my clinical and
engineering experience, to the develop-
ment of healthcare policies that will guide
the design and implementation of life
support and medical care systems for
long-duration and exploration-class space
missions. These systems, properly
designed and implemented, may have a
profound impact on the delivery of both terrestrial medi-
cine and in-flight medical and surgical care.
PHOTOCOURTESYOFRANDALLOWEN

ONE ON ONE | continued
PA Owen with other members of the Harvard Medical School fellowship program.
Q. What was your NASA experience like?
A. I was part of the HMS medical training group at the JSC. My responsibili-
ties included delivering space medicine training for assigned International
Space Station (ISS) expeditions, training astronauts and flight controllers
on various medical procedures, working in JSC’s Houston Mission Control
Center guiding the astronauts in performing in-flight medical procedures
(such as phlebotomy, ocular health or ultrasound), monitoring astronauts
during spacewalks (e.g., vital signs, ECGs), and serving as a subject matter
expert for all space medicine remote guidance activities.
Q. What does a PA at NASA do?
A. There is really no defined PA role within NASA. I was the first PA hired in
more than five years at the Johnson Space Center and was hired into a role
that, at the time, was also being performed by two registered nurses. In
fact, the role did not specify any particular type of prerequisite medical
background. In addition to the nurses, previous HMS medical trainers had
a variety of professional backgrounds, including biomedical engineering
and emergency medical technicians. Interestingly, the HMS medical trainer
role had originally been developed and performed by a PA who had left
NASA some years prior to my arrival.
Q. What was an average day at NASA like?
A. A typical day would start at 8:00 a.m. and might include preparing and
delivering medical training to one or more astronauts. Alternatively, I
might attend planning meetings for upcoming ISS medical operations,
during which I would be working in Mission Control, providing guidance to
the crew during those medical operations. During other parts of my day I
might be reviewing the in-flight medical procedures for new or existing
medical operations. On some mornings my day would start even earlier if I
was scheduled work as a phlebotomist in the JSC Occupational Medicine
Clinic.
On other days my day might start at midnight, when I would be on con-
sole in Mission Control during early morning ISS phlebotomy sessions.
These sessions occur when the crew first wakes up and, since the ISS oper-
ates on Greenwich Mean Time, I would have to be in Mission Control six
hours earlier. During these sessions I would be available on-console to
PHOTOCOURTESYOFRANDALLOWEN

ONE ON ONE | continued
answer any questions that the astronauts might have while drawing blood
to be stored for subsequent analysis back on Earth.
During a spacewalk, my day would start around 4:00 a.m. in Mission
Control. During these sessions I would be on console monitoring the ECGs
of the two crewmembers during the entire time they are working outside
the ISS. At the completion of the spacewalk, a report would be generated
containing all of the ECG data, which would be forwarded to the flight
surgeons for review.
Q. What are you most proud of accomplishing at NASA?
A. The accomplishment of which I am most proud is making NASA aware
of the vital role that a PA could have within the space medicine commu-
nity. Although many of the flight surgeons were current or former military
and had worked with PAs, the latter are not being used to deliver medical
care at NASA. At one point I had the opportunity to meet with the ISS pro-
gram manager, who was unaware of all of the medical services and func-
tions that a PA could perform, and at a reduced cost [relative to a physi-
cian]. The meeting was timely, since the ISS program is always looking for
ways to reduce costs while maintaining safety.
Q. What were the challenges of the job?
A. The biggest challenge of the job is convincing NASA management that a
PA could support, or even perform, a number of functions currently being
performed by the MD or DO flight surgeons. Like many large organizations,
NASA has been doing things the same way for a long time and can be very
resistant to change. In some ways the culture within the NASA medical
community seems to be 20 or even 30 years in the past, when the PA pro-
fession was new and not as well-accepted as it is today.
Q. What is your long-range plan?
A. My eventual goal is to return to aerospace medicine, either at NASA, the
FAA or one of the commercial space companies.

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