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PA_Pro_April_2016_HR_FINAL

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Janette Rodrigues
Janette Rodrigues

PAs and PA students advocated for issues important to the PA profession during AAPA's 2016 Leadership and Advocacy Summit meetings with Congressional staffers. They stressed the role of PAs in addressing mental health and opioid addiction, highlighting that 1.9 million Americans struggle with prescription painkiller addiction while the need for mental healthcare continues to grow. The PA advocates met with 165 Congressional offices to bring awareness to these timely topics and emphasize the role PAs can play in treatment across the healthcare continuum.

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FINDING THE PATH,Leading the Way A DACA Applicant’s Journey to PA School 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 A P R I L 2 0 1 6
CONFERENC AA E PA Get hired – or just see what’s out there – when you meet face to face with 70+ employers from across the country. There’s so much more planned! Search all events at AAPAconference.org Join the PA Foundation for this brand new FUNdraising event! We’re taking over Howl at the Moon on the River Walk for a live dueling piano show and a lip-syncing competition. Make new contacts and recharge former connections on Alumni Night (Saturday) and Constituent Organization Night (Sunday). Networking Events Lonestar Live Career Fair Register Today & Save With Advance Rates AT AAPAConference.oRG Low Advance Rates End April 18 Power up your Network MAY 14 – 18, 2016 San Antonio, TX Don’t miss your chance to mingle with 6,000 PAs and students!
ContentsA P R I L 2 0 1 6 • V O L . 8 , N O . 4 Departments President’s Letter Power Up for AAPA Conference 2016 in San Antonio Laws+Legislation Bringing the PA message to Capitol Hill Payment Matters Meaningful use has significant implications for PAs under new Merit-Based Incentive Payment System STAT Win a lunch with“American Sniper”PA Kevin Lacz | Florida legislature passes historic PA prescribing legislation | ARC-PA names new executive director | Shenandoah University PA students and faculty to attend the 69th World Health Assembly in Geneva | and more Professional Practice How to set boundaries and be mindful to avoid burnout In Print A review of“Permanent Present Tense: The Unforgettable Life of the Amnesic Patient, H.M.” by Suzanne Corkin, PhD Reflections Advice on how new grads can navigate the blessing and burden of flexibility 6 17 9 12 41 39 43 ABOUT THE COVER PA student Simon Mendoza is the first Deferred Action for Childhood Arrivals program participant accepted to the University of Washington. Photo courtesy of the University of Washington MEDEX Northwest 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. Features C O V E R S T O R Y Finding the Path, Leading the Way A DACA Applicant’s Journey to PA School F E AT U R E S T O R I E S AAPA Board of Directors General Election Meet Your New Board Members PA Vision 2020: AAPA’s 2016-2020 Strategic Plan New Strategic Plan Highlights the Need for PA Value to Be Captured in Data 2016 AAPA Awards Recipients Congratulations to This Year’s Awardees 24 15 31 36 PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 1 
www.PAJobLink.com Find Your Direction With PA JobLink Whether you’re just graduating or looking for your next move, PA JobLink provides the tool you need to find and attain your next job. Click the Topics Above to Learn More Search Over 1,000+ PA Jobs Resolutions For Your PA Career Networking Opportunity Are You In The Right PA Job? Negotiating Salary As A New Grad Talk With A PA Career Coach Operation Resignation AAPA Salary Report 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
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
© 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 MANAGING 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 DIRECTOR-AT-LARGE Laurie E. Benton, PhD, MPAS, PA-C, RN 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 4 | A P R I L 2 0 1 6 AAPA.ORG PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 4 
Stop by our booth, #522, to register. 1 entry per person. Drawing will be held on 2nd day of conference. Prize is for 1 free year of monthly CME webinar, valued at $350. Need not be present to win. BOOTH #522 Benefits of CME Webiconference - Decrease cost and traveling time for CME - Provides high quality, relevant and current updates in medical & surgical practices - Constructs a medical library to help those preparing for their boards (either initial or recertification) Sign Up to Win! 1 FREE YEAR of Monthly CME Webinar www.CertMedEd.com What is our Webiconference? Our live program is approved by the AAPA for Category 1 CME and is also recorded so you can review it later. It is a comprehensive educational library of pharmacological, clinical and medical/surgical materials. WIN $350Value 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 Power Up at AAPA Conference 2016! W e’re a month away from the profession’s must attend annual event, AAPA Conference 2016! This year’s conference promises to be the best one yet and I’m happy to report we’ll be offering even more of the things PAs want. We will be featuring: ■ More than 260 hours of live CME to ensure you’ll always find something that’s relevant to you ■ High-profile speakers like: • Healthcare expert and national thought leader Terry Stone, who will provide an informative and provoca- tive glimpse into how PAs are positioned to reinvent the face of medicine • Former Navy SEAL and“American Sniper”actor Kevin Lacz, PA-C, who will inspire you to overcome risks and achieve your goals through his fascinating per- sonal story of courage and commitment ■ Hands-on leadership training symposia to help you advance your career ■ Fun events sponsored by the PA Foundation including a FUNdraising night at the dueling piano bar Howl at the Moon and the Pacers for Health 5K Fun Run ■ Exciting and engaging networking events to connect you with your PA colleagues from around the country ■ The AAPA Career Fair, with more than 70 employers eager to help you land your dream job More than 70 teams participated in Challenge Bowl in 2015, and even more are expected this year. PA PROFESSIONAL  |  APRIL 2016 |  AAPA.ORG | 6 
PRESIDENT’S LETTER | continued ■ Important discussions at the House of Delegates focusing on some of the most critical issues facing the profession, including the NCCPA recertification proposal and full practice responsibility The conference will be the capstone of an historic year for PAs. Working together, we tore down practice barriers, were voted one of the best jobs in the nation and got the country talking about the amazing things PAs do for healthcare. To top it off, we just approved a comprehensive new strategic plan for the profession—I can’t wait until we’re all in San Antonio so I can tell everyone about the great work AAPA is doing to create a better future for all PAs. And, while we’re talking about the future, it is my great pleasure to welcome our newly elected board members: ■ President-elect: L. Gail Curtis, MPAS, PA-C, DFAAPA ■ Secretary-Treasurer: Jonathan E. Sobel, MBA, PA-C, DFAAPA, FAPACVS ■ Director-at-Large: Lauren Dobbs, PA-C, MMS ■ Director-at-Large: Beth R. Smolko, MMS, PA-C These fine PA leaders represent the future of the profession. I welcome their experience, wisdom and guidance as they help lead us to even greater achievements. Thank you for your great work and I look forward to seeing many of you next month in San Antonio! Jeffrey A. Katz, PA-C, DFAAPA AAPA President and Chair of the Board The Exhibit Hall is popular with PAs looking for innovative products and new technologies. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 7 
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 PATIENTS FIRST. Cyndy Flores, PA-C Regional Medical Center - 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/team-based
LAWS+LEGISLATION Bringing the PA Message to Capitol Hill PAs and PA Students Stress Mental Health Issues in Meetings With Hill Staffers B Y K R I S T I N B U T T E R F I E L D , M A O n a brisk February day, nearly 170 PAs and PA students, from Vermont to Hawaii and 34 states in between, took to the halls of Congress to advocate for the PA profession and the patients PAs serve as part of AAPA’s 2016 Leadership and Advocacy Summit (LAS). “It was wonderful to interact with legislators and their staff on issues that are important to PAs,”said Chris Noth, PA-C, FAPACVS, president of the Michigan Academy of PAs. And interact they did! Participants met with 165 House and Senate offices, speaking with a unified voice on criti- cally important and timely topics, including opioid addic- tion treatment and the role of PAs in mental healthcare. In 2014, the Substance Abuse and Mental Health Ser- vices Administration found that 1.9 million Americans over 12 years of age struggled with addiction to prescription painkillers. At the same time, the National Alliance on KRISTIN BUTTERFIELD, MA, is AAPA’s director of grassroots and political advocacy. Contact her via email or at 571-319-4340. Stony Brook University PA program director Peter Kuemmel, PA-C, and (left to right) PA students Wesley Young, Marsha Thomas, Katherine Alexis Athanasiou and Christina Grimaldi. PHOTOCOURTESYOFSTONYBROOKUNIVERSITYPAPROGRAM PA PROFESSIONAL  |  APRIL 2016 |  AAPA.ORG | 9 
LAWS+LEGISLATION | continued Mental Illness has estimated that more than 40 million U.S. adults experi- ence mental illness in a given year. Yet, the U.S. Department of Health and Human Services estimates that more than 90 million Americans live in areas with little or no access to mental health or addiction medicine pro- fessionals. It is clear that additional providers—like PAs—are needed to combat both of these pressing public health concerns. PAs spent their time on the Hill with congressional offices discussing their experiences as“front line providers”who routinely see and treat indi- viduals struggling with addiction and mental illness. In particular, they described the need for PAs to be recognized in legislation as key members of the mental healthcare team. They also advocated for PAs to be autho- rized to prescribe buprenorphine for the treatment of opioid addiction. Although PAs are able to prescribe buprenorphine in most states for pain management purposes, federal law prevents them from prescribing it to treat opioid addiction. Several House and Senate committees have held hearings on both of these issues, and it is likely one or both bodies will take up comprehensive legislation this spring. As a result, participants reported great interest from both legislators and staff on how better utilization of PAs can—and should—be a part of the solution. More than a third of the Capitol Hill Day participants were PA students, who represented nearly 20 PA programs—a terrific show of commitment by the profession’s future PAs. And even though the students might have felt like novice advocates, they handled the visits with poise and professionalism. “As a student, I shared the structured training we received and also expanded on my four-week clinical psychiatry rotation,”recalled Wesley Young, who participated in the Hill Day with three classmates and their faculty advisor, Peter Kuemmel, MS, PA-C, director of the PA program at Stony Brook University in New York.“In these moments I was more proud than ever to advocate for our profession and for the well-being of our patients, and I am optimistic about the impact we have collectively.” Longtime advocate and returning attendee David Brissette, MMSc, PA-C, feels strongly that PAs must acquire the tools they need to advocate for patients and the profession by attending events like the LAS Hill day.“It is important to participate in opportunities like this, which can make it possible to provide the best care to patients that PAs are capable of,”he said. “PAs need to have a voice in order to effect change.”  David Brissette, MMSc, PA-C, (left) and members of the Connecticut delegation of PAs meet with Senate staff. PHOTOBYKRISCONNOR PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 10 
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 NEW PROFESSIONAL LAB COATS SLIM FIT, SOPHISTICATED STYLE AAPA MEMBERS RECEIVE 15% OFF ENTER CODE AAPAMEM15 AAT CHECKOUT To place an order, visit www.medelita.com
PAYMENTSMATTER Meaningful Use: Significant Implications for PAs PAs Must Participate in MU Now and Under MIPS B Y M I C H A E L P O W E M eaningful use (MU) is a program in which eli- gible professionals and hospitals use certified electronic health records (EHR) technology in a“meaningful way”to improve patient care when treat- ing Medicare and Medicaid beneficiaries. To achieve MU, eligible professionals and hospitals must meet certain objectives established by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act designated $19.2 billion to incentivize the development and imple- mentation of health information technology (HIT) in the form of EHRs. One of the major components of the HITECH Act was the MU program, which created financial incentives for MU and encouraged health professionals, healthcare orga- nizations and medical practices to expand the use of EHR technology. CMS began imposing penalties in 2015 for failing to demonstrate meaningful use of EHRs. For many health professionals there is a certain level of confusion regarding the MU program, including who may participate, what government requirements must be met and how penalties will be imposed for those who fail to meet the standards established by CMS and ONC. Participation in MU might be especially unclear for PAs due to the inequitable treatment PAs have received regarding Medicaid EHR incentive payments. While physi- cians and advanced practice nurses had across-the-board access to up to $63,750 in payments over six years if at least 30 percent of their patient volume consisted of Med- icaid beneficiaries, only PAs in PA-led federally qualified health centers or rural health clinics were eligible for the Medicaid incentive payments. And only physicians were entitled to receive financial incentives under the Medicare MU program. MICHAEL POWE is AAPA vice president of reimbursement and professional advocacy and an adjunct assistant professor at The George Washington University School of Medicine and Health Sciences. Contact him by email or at 571-319-4345. PA PROFESSIONAL  |  APRIL 2016 |  AAPA.ORG | 12 
PAYMENT MATTERS | continued Some PAs felt that since they were not fully entitled to the EHR incentive payments that they will not be required to participate in future iterations of the MU program. That is not true. As eligible professionals, PAs will be required to meet MU standards that will be incorporated into the larger payment framework known as the Merit-Based Incentive Payment System (MIPS) or qualify for an exemption. MIPS is a Medicare payment methodology that utilizes quality metrics, resource use, meaningful use of EHRs and clinical practice improvement concepts to develop a Composite Performance Score for eligible health- care professionals. That Composite Score will impact whether a health professional will receive an incentive or a downward payment adjustment on their Medicare reimbursement. MIPS will replace MU in addition to other current incentive programs such as the Physician Quality Reporting System and the value-based modifier. (Read this PA Professional article for more on MIPS.) Recent Headlines Muddled the Picture There was a palpable sense of shock within the healthcare community when at a January conference in Washington, D.C., CMS Acting Administrator Andy Slavitt was reported to have made the statement that MU was going away. What he actually said, in his prepared remarks, was that“the Meaningful Use program as it has existed, will now be effec- tively over and replaced with something better.”This statement likely signals that MU will shift from being a standalone program and be incor- porated into a MIPS. CMS has released limited details to date on the implementation of MIPS, but is expected to do so when it releases forthcoming regulations on MIPS and alternative payment models this spring. At this point the future of MU should be clearer. AAPA continues to advocate for full recognition and documentation of PA work under MIPS in order to promote an accurate and meaningful assessment of the patient care provided by PAs. In addi- tion, AAPA supports appropriate timelines and expectations for adoption and use of HIT, suitable thresholds for what is considered successful use of HIT, and the removal of any barriers that may prevent PAs from effectively using HIT or reporting on its use. All active users of HIT, such as PAs, should be properly incentivized as incentives for meaningful use move beyond the current separate programs, including the MU program, and into the more comprehensive MIPS. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 13 
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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.▼ AAPA Membership Benefits   Why do I need Disability insurance?                 •    •   •   •          •   •                            •                •             PHOTOS BY FRED GREAVES
The American Academy of PAs is pleased to announce the results of the 2016 AAPA Board of Directors General Election. These leaders will assume their positions on July 1. Thank you to all the candidates who stepped up and ran for the 2016-17 Board of Directors. Click here to view the certified results. 2016 AAPA Board of Directors General Election Results Meet Your New Board Members BY AAPA STAFF L. Gail Curtis MPAS, PA-C, DFAAPA Clemmons, N.C. Jonathan E. Sobel MBA, PA-C, DFAAPA, FAPACVS Rockville Centre, N.Y. Lauren Dobbs PA-C, MMS Aledo, Texas Secretary-TreasurerPresident-elect Directors-at-Large Beth R. Smolko MMS, PA-C Frederick, Md. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 15 
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STAT | Industry News FLORIDA GOVERNOR SIGNS LANDMARK PA LEGISLATION INTO LAW On April 14, 2016, Florida Gov. Rick Scott signed landmark legislation that will allow PAs in the Sunshine state to prescribe controlled medi- cations. This was an historic moment for Florida PAs and the patients they serve. In addition to the passage of a prescribing bill, legislation was also signed by the governor last month allowing for PA scope of practice to be determined at practice level. “This landmark legislation increases the availability of quality medical care by allowing PAs to better meet the needs of their patients,”said AAPA President Jeffrey A. Katz PA-C, DFAAPA.“Evidence clearly shows that when PAs are allowed to prac- tice to the full extent of their education and experience they increase access to healthcare services and improve out- comes, which is why PA positive legislation is critical. Today’s signing of this milestone bill by Gov. Scott demonstrates Florida’s commitment to ensuring the nearly 20 million residents of Florida have access to quality care.” The two bills, House Bill 423 and House Bill 375, are set to become law on July 1, 2016 with portions pertaining to PA prescribing becoming law on Jan. 1, 2017. “One of our goals as an organization is to advocate for a statutory framework in Florida that isn’t weighed-down with unnecessary regula- tion, but upholds standards of care,”said George Rego, President of the Florida Academy of Physician Assistants.“Implementation of this new legislation will improve access to care and patient outcomes in the State of Florida.” Read more here. MEET “AMERICAN SNIPER” PA KEVIN LACZ AT AAPA 2016 Want to break bread with“American Sniper”actor and PA Kevin Lacz, at AAPA Conference 2016, May 14-18, in San Antonio? Register for AAPA 2016 by April 18 and you could be among the 10 PAs randomly selected to have lunch with Lacz, who will also speak at General Session. A 2014 graduate of the Wake Forest PA program, Lacz was a Navy hospital corpsman when he earned a coveted spot on SEAL Team 3 as a combat medic, breacher and sniper. After serving two tours in Iraq, an experience he writes about in his upcoming memoir, he completed his enlistment and left the military to return home to begin his PA journey. Currently, Lacz specializes in sports medicine and physical rehabilitation in one of the nation’s top ortho- paedic practices, the Andrews Institute for Orthopaedics and Sports Medicine in Pensacola, Fla. He helps runs an Andrews Institute Foundation clinic that provides injured special operations forces troops with the same quality of care as professional athletes. Read more about Lacz in this 2014 PA Professional article, and don’t miss your chance to meet him at AAPA 2016. Register now! ADOBESTOCK.COM PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 17 
STAT | continued PA Emilie Thornhill UPDATED AAPA ISSUE BRIEFS AAPA issue briefs cover a wide range of topics that are important to PAs and PA practice, from specialty practice to third-party reimbursement for PAs. State and specialty PA organizations, as well as individual PAs, use them to educate employers, legislators and policy makers. The Academy recently updated the“Team Practice”and“PA Education”issue briefs, part of an ongoing project to revise and refresh these important documents over the next six months. Learn more about AAPA’s issue briefs here. PA NAMED TO SHM COMMITTEE Emilie Thornhill, MPAS, PA-C, was recently appointed chair of the Society of Hospital Medi- cine’s NP/PA Committee. The society, or SHM, is a professional medical organization represent- ing the nation’s practicing hospitalists. A graduate of the South University PA program in Savannah, Ga., Thornhill is a former stu- dent member of the AAPA Board of Directors. SHENANDOAH PA STUDENTS TO ATTEND WHO EVENT In May, Shenandoah University PA students and faculty will attend the 69th World Health Assembly of the World Health Organization (WHO) in Geneva, Switzerland. Part of Shenandoah’s Global Experien- tial Learning (GEL) program, the trip will provide a group of PA, nursing and pharmacy students with an interprofessional experience. During the trip, students will have the oppor- tunity to interact with key players from the Inter- national Society of Telemedicine and eHealth and International Council of Nurses, and visit the head- quarters of Doctors Without Borders, International Hospital Federation and the International Red Cross and Red Crescent. J. Leocadia Conlon, PA-C, MPH, an assistant pro- fessor in the Shenandoah PA program, said the trip will provide students with a unique opportunity to gain valuable knowledge and insight into global health through interaction with international lead- ers in the study, research and practice of improv- ing patient outcomes and achieving health equity worldwide. ARC-PA NAMES NEW EXECUTIVE DIRECTOR Sharon L. Luke, MSHS, PA-C, was recently named the new executive director of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Prior to that, she was the organization’s assistant director. Only the third executive leader of the commission since 1971, Luke is the first woman and first African American to lead it as well. She will take up the reins of the position July 1, 2016. In 2015, ARC-PA announced that longtime head John E. McCarty, MPAS, PA, planned to step down as executive director this year. He will continue to be involved in ARC-PA in another capacity, he said during a recent phone interview, adding that he is not retiring from the organization. McCarty has served as ARC-PA’s executive director since 1991. Prior to that, he was on the commission for six years, four of them as treasurer. The number of PA programs has jumped to 210 from just 54 during his tenure, and there are doz- ens more in the pipeline. ARC-PA is the accrediting agency that defines the standards for PA educa- tion and evaluates PA programs within the territorial United States. It also con- ducts site visits to ensure that PA programs are compliant with those standards through onsite monitoring and evaluation. PHOTOCOURTESYOFPAEA Sharon Luke will become the new executive director of ARC-PA on July 1. AAPAPHOTO PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 18 
STAT | continued NEW OPIOID GUIDELINES AIM TO REDUCE ADDICTION RISK The Centers for Disease Control and Prevention (CDC) recently revised the guidelines aimed at helping primary care providers safely and respon- sibly prescribe opioids to adults with chronic pain outside of active cancer treatment, palliative care and end-of-life care. The CDC urges providers to: • Use nonopioid therapy as the preferred treat- ment for chronic pain when possible • Use opioids only when benefits for pain and function are expected to outweigh risks • Before prescribing the medication, establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks • Prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concur- rent opioids and benzodiazepines whenever possible • Evaluate benefits and harms of continued opioid therapy with patients at least every three months and review prescription drug monitoring pro- gram data, when available, for high-risk combina- tions or dosages • Offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenor- phine or methadone, for patients with opioid-use disorder. 10 FASTEST GROWING JOBS FOR COLLEGE GRADS The U.S. Bureau of Labor Statistics compiled a list of the 10 fastest growing jobs for college graduates for the decade leading up to 2024 and PAs are at No. 4 with a growth rate of 30 percent. PAs also had the highest median salary of any of the listed pro- fessions, at $95,820. A number of other health pro- fessions also made the list, including nurse practi- tioners, genetic counselors and physical therapists. DEFINING SEPSIS An international task force’s new definitions of sep- sis and sepsis shock could help cut risks of deadly infection, according to an article published in the Journal of the American Medical Association. This is the first time in 15 years that the definitions and clinical criteria of both infections have been updated. Organized by the European Society of Inten- sive Care Medicine and the Society of Critical Care Medicine, the task force was comprised of 19 criti- cal care, infectious disease, surgical and pulmonary specialists. After two years of meetings, the group’s findings prompted them to define sepsis as a“life- threatening organ dysfunction caused by a dysreg- ulated host response to infection.” ADOBESTOCK.COM PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 19 
STAT | continued PROJECT ACCESS NEEDS YOU FOR AAPA 2016 Are you attending AAPA Conference 2016 in San Antonio? Are you interested in increas- ing access to healthcare in medically underserved communities? Do you think diversity matters in the health professions? Then add Project Access to your conference schedule. A PA Education Association (PAEA) outreach program, Project Access is looking for PA and student volunteers who want to inspire and motivate underrepresented minority high school, college and university students to become PAs. PAEA reports that while the PA profession enrolls a greater percentage of underrepre- sented minority students than other health professions, the number of underrepresented students has remained static for the last five years at about 22 percent. Studies indicate that among other benefits, a diverse healthcare workforce is associ- ated with improved access to healthcare for racial and ethnic minority patients, greater patient choice and satisfaction, and better educational experiences for health profes- sions students. What to learn more about Project Access and how AAPA and PAEA breathed new life into it? Read this PA Professional article and don’t forget to sign up to volunteer at AAPA 2016. All volunteers are welcome! Project Access volunteers take a few hours out of their AAPA Conference schedule to talk to middle schoolers about the PA profession. 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 The Original Chicago Course® Since 1996 CMERESOURCES.COM H 5-day program: 43 hours AAPA Cat 1 CME credits H CMExpress 3-day: 26 hours Cat1CME credits Visit us in Booth 714 at the AAPA 2016 Conference “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 Locations Coming to a city near you... Atlanta Atlantic City Baltimore Boston Charlotte Chicago Cleveland Dallas Denver Hilton Head Houston Las Vegas Los Angeles Milwaukee Minneapolis Orlando Philadelphia Pittsburgh San Antonio Scottsdale Seattle Washington, D.C.
STAT | continued UPDATED STATE-BY-STATE LAWS AND REGULATIONS BOOK RELEASED Get your copy of the newest version of PA State Laws and Regulations in the AAPA Store, and keep up to date on key provisions of the PA laws and regulations from each state and the District of Columbia. AAPA members get a 60 percent discount on the book, paying only $100 for more than 900 pages of valuable information. Your purchase includes the option to view as an e-book on your PC, Mac or mobile device. Just interested in your state’s PA Practice Act? Go here to read a free synopsis. PSYCHOLOGICAL DISORDERS AFFECT 1 IN 7 U.S. KIDS UNDER 9 One out of every seven children aged 2 to 8 years in the U.S. were reported to have a diagnosed men- tal, behavioral or developmental disorder (MBDD), according to a new study released by the Centers for Disease Control and Prevention (CDC). Researchers found that many family, community and health-care factors were related to the children with MBDDs, according to the article published in the CDC’s Morbidity and Mortality Weekly Report. Key findings include: • Non-Hispanic white male children, age 6 to 8 years, were more likely to have an MBDD • Children were more prone to have an MBDD if they were from poor families (those living at less than 100 percent of the federal poverty level) and families that spoke English in the home Data for the study came from the 2011-12 National Survey of Children’s Health (NSCH). The NSCH is a telephone-based survey that relies on parents reporting of child health and well- being, family characteristics and neighborhood environment. QUITTING ‘COLD TURKEY’ MAY WORK BEST FOR SMOKERS Quitting smoking abruptly is more likely to lead to lasting abstinence than quitting gradually, accord- ing to a study published in the Annals of Internal Medicine. Researchers who conducted a new clini- cal trial found that study participants who quit cold turkey were 25 percent more likely to remain absti- nent half a year from the date that they stopped than smokers who tried to wean themselves off slowly instead. PA EDUCATION SUMMIT In March, the PA Education Association (PAEA) convened a Stakeholder Summit that brought together 60 thought leaders to discuss the future of PA education. The goal of the event was to determine what new PA graduates need to thrive in this rapidly changing healthcare landscape. For two days, representatives from the“four orgs”—AAPA, PAEA, the National Commission on Certification of Physician Assistants (NCCPA) and the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)—considered various forward-thinking ideas to help develop the next chapter in PA education. PAEA plans to release a new roadmap for the future of PA education this fall. PA Student Paul Gonzales PHOTOCOURTESYOFPAEAVIAFACEBOOK ADOBESTOCK.COM PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 21 
STAT | continued • NEW PA LEADER’S EYE-OPENING EXPERIENCE AT LAS BY JANET A. ROBILLARD, PA-C In February, I attended AAPA’s Leadership and Advocacy Summit (LAS), in Washington, D.C., for the first time. LAS is an annual event designed to equip current and future PA leaders with the tools and information they need to become transformational leaders and PA advocates. I left LAS feeling fully equipped for my path ahead and have said over and over since that it was the best conference of my nearly 14-year PA career. I became interested in advocating for the PA profession after a recent job change. In that new role, I was expected to scribe for a physician group. This request caught me off guard. I had never encountered this situation or imag- ined functioning in any capacity other than as a medical provider. I had hoped to change this expectation through educating my employer about the PA profession. But I discovered that my state’s PA laws had not evolved and, sadly, supported my employer’s expectations. Fortunately, I found another position. But this frustrating experience opened my eyes to what PAs in Wisconsin and across the nation might be facing. I’ve since learned that my situa- tion is not unusual for PAs. That brings me back to LAS, where I found the support I needed in AAPA. More importantly, I found hope. Hope for the PA profession in Wisconsin and across the U.S. I realized that AAPA and PAs around the country are work- ing tirelessly to improve our profession in the face of continuing barriers to PA practice. Among AAPA’s top goals are to equip PAs for progressive opportunities and work environments, and push for true practice autonomy for PAs. AAPA outlined these and other goals in its new Strategic Plan and updated Model State Legislation. The Academy is also committed to tackling issues like mine through working with employers and advocating for state legislative changes. Changes for our profession are badly needed and PAs need to lead the way in making the needed changes for our profession, to truly improve patient care. In the past, there may have been merit to trusting the larger medical community to do our advocacy for us. But now and in the future, advocating for PAs needs to be the job of PAs. Janet A. Robillard, PA-C, is president-elect of the Wisconsin Academy of PAs. Robillard asks a question at this year's LAS. PHOTOBYJOSHYOSPYN PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 22 
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COVER STORY PA Simon Mendoza Finding the Path, Leading the Way A DACA Applicant’s Journey to PA School BY DENNIS N. RAYMOND W hen Simon Mendoza was a child living in a small farming community in central Washington state, the nearest medical clinic was 25 miles away in the city of Othello— population 7,364. Now a student in his clinical year with the Uni- versity of Washington MEDEX Northwest PA program, Mendoza is doing a four-month family medicine rotation at the very same clinic. At a time when rural America is hemorrhaging family physi- cians amidst an influx of new patients, and retirements are leaving medically underserved communities like the one Mendoza grew up in without a provider, he is going against the grain. “I feel at home here with the people, the community, and the patients I’ve seen,”he says.“Some of the patients here have been my classmates from middle school, some of my teachers, friends. It’s the great rural small community experience that I’ve always wanted.” At 24, Mendoza is the youngest in his class, and across all four MEDEX PA program sites. The median age for students entering the MEDEX PA Photos courtesy of the University of Washington MEDEX Northwest PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 24 
COVER STORY, continued program is 33, and the profession represents a second or third career path for most.“I tend to be a little mature for my age,”he says.“I really enjoy having older classmates. I felt comfortable with them.” But age belies Mendoza’s experience. At 16 he became a certified nurse assistant (CNA) through a program offered at his high school. A Will, a Way and a Hurricane As soon as Mendoza finished the CNA program, in his junior year of high school, he volunteered with the Red Cross and went to Houma, La., in the aftermath of Hurricane Gustav. “I had just turned 17, and I was one of the youngest medical services volunteers they ever had,”he says. Upon arrival in Houma, he was put solely in charge of an entire shelter housing more than 230 people. It was two weeks before some registered nurses arrived to relieve him. The central headquarters for medical services was in Baton Rouge, 85 miles from the shelter.“I could consult with them by phone, but it was a couple of hours drive from headquarters,”Mendoza says. At the shelter Mendoza was called on to treat a few acute injuries, but most of the medical issues he dealt with were chronic conditions.“We had a lot of people who were diabetic, who didn’t have their insulin,”he says. “Conditions at the shelter were challenging, as there was no electricity. “Some people were bedridden, and we had a couple of people who had heart attacks. I couldn’t do much for them besides give aspirin and call 9-1-1.” Mendoza has been working full time to pay for his education since the age of 16. Even now, while in the MEDEX PA program, he works as a tele- medicine triage coordinator on the weekends. Mendoza, center, has been working to pay for his medical education since he became a certified nurse assistant at the age of 16. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 25 
INTERVENTIONAL RADIOLOGY, CONTINUEDCOVER STORY, continued In high school he was in the Running Start program, which allowed him to simultaneously work towards his high school diploma and bachelor’s degree. Now in a two-year masters’program at the University of Washing- ton, his access to higher education is possible under DACA, the Deferred Action for Childhood Arrivals program established by executive order on Nov. 20, 2014. This is crucial because Mendoza is undocumented. He isn’t a U.S. citizen or a permanent resident. His was an infant when his parents left Mexico looking for economic opportunities and a better life for their children. Leaving Michoacán Facing a tough economy in Michoacán, Mexico, Mendoza’s parents immi- grated to Washington state in the 1990s.“My uncle was already in the United States and became a resident after President Reagan signed the Immigration and Reform Act in 1986,”he says.“My uncle was in contact with my father back in Mexico, and encour- aged him to come north to build a better life for us. That’s exactly what my father did.” Within months, Mendoza’s mother and the nine children followed. Simon was among the youngest of the siblings. They all settled in Grandview, Wash., sharing housing with their uncle’s family.“He also had nine children,”he says.“We all lived in one place for quite a while.”His father and uncle worked in the fields and orchards of Grandview as farm laborers, picking apples, asparagus, peaches and cherries. In time, Mendoza’s father was offered a good position an hour from Grandview at Smith Brothers Farms in Royal City, Wash. The senior Mendoza worked there for several years until the accident. “His arm was crushed in a manure strainer,”Mendoza says. The machinery broke his father’s arm, and mixed the manure in with his blood.“It was pretty much septic,”Men- Mendoza has wanted to be a healthcare provider since he was 8 years old and medical intervention saved his father’s life after a farming accident. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 26 
COVER STORY, continued “Simon’s story is interesting,” Kindle says. “He came to the United States as a young child. Based on conversations around his life, academic, and clinical experiences, he was clearly a mission fit. Before MEDEX admitted Simon to the program we spoke to him for a very long time….. Turns out he was an excellent applicant.” —Mariah Kindle, MEDEX admissions director doza remembers.“They nearly amputated his arm, but the surgeon was able to save it, thankfully.” It was his father’s near-death accident that first inspired the then 8-year- old Mendoza to think about medicine. Mendoza’s elder siblings had settled just south of Seattle in Kent, Wash. With the father unable to work the farms, the entire family relocated to Kent, where they remained. By middle school, Mendoza had begun to understand that he was undocumented and that there was a danger of deportation. At that time there were immigration raids in eastern Washington state, in the very town where the family had lived.“You would hear about it on the radio,”he says. “It was slightly terrifying to me. I began asking questions, and that’s when I learned what I was.” No DACA Students Need Apply In June 2012, President Obama issued the executive order that created DACA, a federal program that allows certain undocumented immigrants who entered the country before their 16th birthday and before June 2007 to receive a renewable two-year work permit and exemption from deportation. Soon after DACA was implemented, Mendoza applied. It took him months to put together the lengthy, complicated paperwork, but he now has a two-year renewable work permit as well as a social security number. Still, there was a problem. “A lot of graduate schools required permanent resident status in order to apply, and I didn’t have that status,”he says. The MEDEX PA program operates under UW Medicine and it is subject to the same constraints as the university. Uncertain of how this would work, Mendoza sent an email to the MEDEX admissions team.“Their main concern was my ability to work afterwards—to obtain national certification and a license from the state of Washington,”he says. That’s when Mariah Kindle, director of admissions at MEDEX, stepped in to research the issue. Overcoming an Obstacle Course of Concerns “Simon’s story is interesting,”Kindle says.“He came to the United States as a young child. Based on con- versations around his life, academic, and clinical expe- riences, he was clearly a mission fit. Before MEDEX admitted Simon to the program we spoke to him for a very long time, about nine months prior to him submit- ting an application. Turns out he was an excellent appli- cant. He had an undergraduate degree here at the UW with a very high GPA. He’s really our first deferred action status student.” When Kindle first started talking with Mendoza about his path, she met with members of the MEDEX leadership group to determine what his process would be.“That was after a lot of research I had done,”she says. She checked with the state of Wash- ington to understand the rules for DACA students. She spoke to the University of Washington concerning policies for financial aid and qualifications for masters’programs. She reached out to PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 27 
COVER STORY, continued NCCPA—the national certifying body for PAs—to make sure that after Mendoza finishes the program he can he sit for the board exam. She contacted the Medical Quality Assurance Commission, which licenses MEDEX. “Turns out the rules applied the same for Simon,”Kindle says.“Stu- dents with deferred action status must have a Social Security number, pass an accredited training program, sit for the national certifying exam, and they can practice in the state of Washington.” At that time UW did not accept students with DACA status. But on September 30, 2014, the UW School of Medicine announced a change in policy regarding DACA applicants, joining 35 other institutes of higher learning that now admit students who are undocumented. Deferred action status students cannot receive state or federal mon- ies. In fact, this is one of the largest hurdles that students with DACA status face. With his path to the admission process cleared, Mendoza began gathering the necessary documents for MEDEX.“I’m still considered undocumented even though I have DACA status because it’s only a temporary deferral,”he says.“It’s not like I have permanent status at all. I have to reapply every two years. There is a $465 fee and they grant you the two-year work permit every two years.” “Most people have no idea what all this means,”he says.“Some people ask me,‘Why don’t you just apply to be a citizen?’If it were that simple we’d all do that.” He’d get in line if he could find an end to the line. Mendoza with preceptor John Beauchamp, PA-C, at Columbia Basin Health Association’s Othello Family Clinic. Mendoza, who grew up in the rural area, plans to return there to practice medicine. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 28 
COVER STORY, continued Just Out of His Grasp What is puzzling is that Mendoza’s parents became permanent residents in 2013.“They brought me to this country,”he explains.“All of us were undocu- mented. They were undocumented, but they applied for a visa with my uncle’s sponsorship because he was a U.S. citizen at the time. We waited in that line for over 20 years. When our visa number became current I had already turned 21. So I was no longer eligible to become a citizen under them. They became residents, and then I was sort of left out. To me it makes no sense.” Mendoza’s undocumented status adds a whole other layer of stress to PA school. But he’s managing the uncertainty. “I try to take it one day at a time,”he says.“I don’t worry about several years ahead. I just look at it one day at a time. What can I do to better my situation and take the next step forward?”He is part of the Latino Medical Students Association and the National Hispanic Medical Association.“We are advocates for immigrant, undocumented students to get a higher edu- cation.”And by incrementally moving the ball forward, Mendoza opened up possibilities for other undocumented immigrants to access higher education. A Dream No Longer Deferred Mendoza recently did a clinical rotation at CBHA Othello Family Clinic, where it was clear that he is in his element. Migrant farm workers are the principal focus of the clinic. In fact, the mission statement of the clinic is“Keeping healthy those who feed the world.” We pride ourselves on serving agriculture and migrant farm workers, and we don’t discriminate against people who can’t afford healthcare,”Mendoza says.“We try to serve everybody without regards to ability to pay, no insur- ance, race, age or anything. That’s the great thing about CBHA.” “Patients remind me of my parents,”he says.“Cultural competence is necessary to provide great care to this community. This includes an under- standing of traditional healing practices commonly referred to as curander- ismo. Herbs, for example, are commonly used to treat anything from insom- nia to constipation. Understanding this and asking about it is very important because there may be serious interactions with certain prescrip- tion drugs.” Mendoza has already inquired with the CBHA leadership about returning to the Othello Family Clinic once he graduates from MEDEX and passes the PANCE.“I’m certain I want to end up here,”he says.“I love it.”  DENNIS N. RAYMOND is MEDEX communications manager at the University of Washington. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 29 
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New Strategic Plan Highlights the Need for PA Value to Be Captured in Data UNCOVERINGTHE“HIDDENVALUE” OFPAsBY STEVEN LANE IF A PA PERFORMS A PROCEDURE BUT NO ONE KNOWS ABOUT IT, DID IT REALLY HAPPEN? If a PA treats a patient but the service is billed under a physician’s NPI number, or performs pre-op services that are covered under a global surgery payment, did the PA contribute any rev- enue to the practice? These kinds of questions are becoming increasingly relevant as health- care systems and public and private payers look to become more data- driven in their approach to determining the productivity and value of health professionals, and as healthcare moves further towards fee-for-value reimbursement and rewarding quality. Uncovering the“hidden value”of PA practice is a major element of AAPA’s 2016-2020 Strategic Plan, approved by the Board in February.“Document- ing PA value through recognition and billing”was identified in the plan as one of the six key issues facing the profession, and the issue is also top of the list of concerns under one of AAPA’s four“strategic commitments to the profession”: Advance the PA Identity. (This story is the sixth in PA Profes- sional’s continuing series of strategic plan–related articles; you can read the other five in the PA Pro archives.) “This is one of the most important issues that AAPA will tackle in the coming months and years,”says AAPA President Jeffrey A. Katz, PA-C, DFAAPA.“As we move toward a system that will reimburse us based on the quality of our care, we must make sure that PAs are represented in the data that is collected on that care.” In fact, AAPA is already working hard on this issue. AAPA’s reimbursement team is undertaking an intensive research project to identify which of the major private third-party payers allow medical and surgical services deliv- ered by PAs to be billed under the PA’s name and provider number, making them trackable through the claims process. Policies regarding PA billing can vary both by plan type (basic fee-for-service, Medicare Advantage, Medicare supplement, PPO models, etc.) and by state. Reimbursement staff will then meet with and lobby identified payers to change those policies that do not authorize PA-provided services to be billed under the PA’s name. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 31 
DOCUMENTED PA VALUE PA CONTRIBUTIONS EMPLOYERS POLICYMAKERSPAYERS As well, an AAPA task force is at work on a white paper,“Unmasking the Hidden Value of PAs,”that examines the issues surrounding the need to document the value of PA practice. The paper is scheduled to be published later this year. “Our goal is to provide some tools that PAs and organizations can use to quantify the value of the care PAs provide,”says task force chair Folusho Ogunfiditimi, DM, MPH, PA-C, who over- sees PAs and NPs at Detroit Medical Center. The Hidden Value of PAs No definitive data are yet available, but the percentage of care that is provided by PAs but not billed for under the PA’s name is likely between 30 and 50 percent of all PA care, according to Michael Powe, AAPA vice president, reimbursement and professional advocacy. PAs in administrative and leadership roles around the country agree that the issue is diffi- cult to quantify, but of crucial importance. “We do not have good data yet; we are just scratching the surface—but this issue is very real every day for me,”says Tim Pysell, DrHA, MMSc, PA-C, DFAAPA, who oversees more than 100 PAs as director of PAs at OrthoCarolina in Charlotte, N.C.“Our PAs do a lot of work that is not directly revenue generating—often not quantified or even quantifiable. It’s going to take some different thought processes to get to the real costs and value of healthcare. As a patient goes through the clinic, how much does each person cost and how much do they contribute? How much time does the PA spend and what is the cost of the PA’s time? We need very granu- lar data to get to the real costs of healthcare as opposed to the historical way of doing it.” “It’s all about data, data, data,”agrees Todd Pickard, MMSc, PA-C, director of PA practice at MD Anderson Cancer Center in Houston, one of the largest employers of PAs in the country.“There is now so much pressure in the regulatory, reimbursement and accreditation arenas to generate the data to demonstrate how what we are doing is different from the fee-for-service model.” “Real value,”Pickard adds,“is not determined by how many bills you dropped. It’s about whether you got results for your patients in a timely fashion, and reporting such metrics as, PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 32 
“How many patients got urinary tract infections in the hospital from indwelling catheters? Much of what PAs and NPs do is about quality and safety.” But at present, much of this type of care, important as it is, is not cred- ited to the PAs who provide it. At MD Anderson, a recent survey found that about 60 percent of the patients seen by PAs were comanaged, due to the complexity of cancer treatment. This comanaged care is nearly always billed under physicians. The Role of Electronic Health Records One reason that the value of PAs and NPs is so often hidden is that electronic health records (EHR) systems are often designed primarily to capture the contributions of physi- cians. This is in part an issue with the inherent design of the systems and in part to do with the institutional rules of health systems and hospitals, PAs say. “Whenever I see a patient in the hospital, the note has to be cosigned,”says Lisa Shock, MHS, PA-C, senior director of clinical operations for WakeMed Key Accountable Care Organiza- tion in Raleigh, N.C.“If the EHR system changes the clinical care note and lists it under the physician’s name then it does not reflect the care that I personally delivered. We are working on this issue but it is hard to undo a process that has been programmed into the EHR system.” Some institutions are trying to change how PA care is captured in their systems. Just last month, MD Anderson transitioned to a new system, the widely used EPIC, that should allow them to capture much more granular data about PA practice, Pickard believes. “We will be able to more efficiently document the processes of care,”he says.“First generation electronic systems were very clunky, but newer ver- sions allow us to get that data. We can better understand the demand for services, where there might be gaps or deficiencies in services. It will drive staffing models.” But there is a lot of work to be done before EHR systems will truly be able to capture the nuances of real-world practice, says Alma Rodriguez, MD, vice president of medical affairs at MD Anderson.“One challenge has been to get [EPIC] to understand that we are multidisciplinary,”she says.“They are hung up on needing a primary care provider; in a cancer institution there are lots of different providers, all in it together. Another challenge is that in an interprofessional practice model the PA and I are tied at the hip. It is often hard to tell who should be billing for a particular service.” “They were able to make some customizations but this has been very challenging for them,”Rodriguez added.“We will see how it goes; we should have some meaningful data in a few months.” AAPA also has a work group of PAs and staff devoted to this specific issue. The EHR Work Group is developing educational materials aimed at both PAs and EHR vendors. The materials for PAs will be designed to help PAs understand the importance of proper EHR utilization and give them talking points for discussions with colleagues, while those for vendors will explain the value of identifying all health professionals who treat patients in order to promote transparency and accountability and to help identify quality teams. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 33 
Sharing in the Savings Making sure that PAs are present in the data will likely become even more important as healthcare systems and payers move further towards shared savings and other alternative payment models, even if the day when PAs will share in these savings is likely still some way off. “These discussions are very nascent,”Shock says.“Even the physicians haven’t figured out yet how to share the dollars. I don’t know of any model where the PA is getting any of the shared savings.” “Absolutely we are heading towards a place where quantifying value will affect PA incomes,”Ogunfiditimi says.“But the effect of PAs being hidden in the data is probably more personal than related to payment at this point. As a profes- sional you want to know how you are contribut- ing to the organization. And as healthcare evolves more toward a focus on quality it will become more and more essential for PAs to be represented. It is going to be incumbent on all of us to really quantify the work of PAs and to link it to quality and patient satisfaction.” “It is hard to tie payment to PA salary at this point,”Pysell says.“In my experience salaries will lag behind the performance. We need to look at how to identify value first and then look at compensation.” Creating the Future Uncovering the hidden value of PAs will only become more important as reimbursement continues to move toward payment for value rather than volume, say PAs interviewed for this story. And this makes it imperative for them to be involved in laying the groundwork as health systems and prac- tices begin to write the rules that may soon link how providers are paid to the data they are collecting. “The shift to value-based reimbursement is driving this,”Pysell says. “And this presents a huge opportunity for PAs to shine a spotlight on the value-added work they do that is not usually part of the process. I’m a firm believer that the best way to predict the future is to create it.” “Get involved,”Pysell adds.“Take some time to get to know the finance people and the leadership in your institution. Make sure that when the idea of measuring the cost of healthcare starts to take hold, PAs have input into that. Approach leadership with something to add. Bring value and the money will follow.”  STEVEN LANE, MA, MPP is senior writer for AAPA and managing editor of PA Professional. Contact him via email or 571-319-4364. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 34 
Learning Central. Connect learning with life. Identify your knowledge gaps, improve your practice and earn AAPA Category 1 Self-Assessment CME credit at the same time. Find approved activities in a variety of specialties, many free or discounted to AAPA members – all in Learning Central. FREE for PAs: Talking to Your Patients about Their Weight: A Self-Assessment Approach Earn up to 20 Self-Assessment credits with American College of Physicians’ Medical Knowledge Self-Assessment Program (MKSAP 17) April 24-30 is World Immunization Week! eCase Challenge: Optimal Immunization Strategies in Adults Under 65 LEARN HERE
2016 AAPA Awards Recipients Announced Congratulations to This Year’s Awardees BY SARAH SONIES T he AAPA Awards Committee in March announced the recipients of the 2016 AAPA Awards. These awards are the highest recognition bestowed on Academy members and are awarded to PAs who have distinguished themselves in service to patients, their community and the PA profession. The 2016 AAPA Award recipients are: AAPA/PAEA PRECEPTOR OF THE YEAR Maureen Barrett, MPAS, PA-C Preceptors hold the keys to the future of the profession as they guide the clinical education of the next generation of PAs. The preceptor award recognizes those who demonstrate a commitment to excellence in the clinical edu- cation of PA students as mentors and instructors. As the chief PA for Bethlehem, Pa.–based St. Luke’s University Health Network, Maureen Barrett, MPAS, PA-C, approaches her role with determination and passion, mentoring tomor- row’s PAs in eastern Pennsylvania and western New Jersey, where she over- sees administration for rotations on all six Saint Luke’s campuses and out- patient centers. Barrett has demonstrated great advocacy for the PA profession through her leadership in establishing a PA shadowing internship program, allow- ing high school and undergraduate students to rotate with PAs in the Saint Luke’s network through all aspects of practice, providing each student with more than 70 hours of shadowing time. AAPA MILITARY SERVICE PA OF THE YEAR Col. Rene’ Chadwell, U.S. Air Force, MPAS, PA-C The PA profession has its roots in the military and this award honors that heritage and the commitment of military PAs to exemplary healthcare service in their community, to current members of the military or veterans and their families, and to the medically underserved at home and abroad. Col. Rene’Chadwell, U.S. Air Force, PA-C, is being recognized for her work in advancing military healthcare services and commitment to patient care, patient education and community health promotion. A leader in the Air Force and PA education communities, she served as an OB/GYN preceptor for future PAs and developed a preventive care tracking, training and AAPA AWARD RECIPIENTS PA Maureen Barrett PHOTOCOURTESYOFMAUREENBARRETT PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 36 
AAPA AWARD RECIPIENTS, continued education system that significantly decreased health risks for female patients in her community. A skilled medical readiness officer, Chadwell has made a positive impact in public health and service in more than 40 countries around the world. Requested by name for assignment to the Pentagon, Chadwell was selected to serve in the Health Services Support Division of the Pentagon, where she was the medical lead for the Chairman of the Joint Chiefs of Staff’s Wounded Warrior Task Force, spearheading $243 million in legislative proposals in support of 38,000 wounded or killed servicemen and women and their families. As chief PA consul- tant to the Air Force Surgeon General, Chadwell has distinguished herself as an outstanding clinician, military officer and healthcare leader. AAPA PUBLISHING AWARD Alicia Quella, PhD, MPAS, PA-C One of the pivotal ways in which PAs can effect change in healthcare is to harness their inner curiosity and uncover new ideas through research and publishing. The publishing award is given to a PA who has published a new clinical or research article expressing original or scientifically rigorous ideas. Quella did just this and is being recognized for her in-depth analysis of PA compensation and the influence of PAs and NPs on the healthcare market in her article,“Physician assistant wages and employment, 2000-2025.” Published in the Journal of the American Academy of PAs, Quella’s analysis highlights the growth of the profession and found the future of the PA profession promising in terms of employment and wages, with PA wage increases projected to consistently exceed inflation rates for more than a decade. AAPA will honor these extraordi- nary PAs during the AAPA Confer- ence 2016 General Session. Look for profiles on this year’s recipients in the May issue of PA Professional. Congratulations to all 2016 AAPA Award recipients!  SARAH SONIES is AAPA’s manager of online communications and a staff writer for PA Professional. Contact her via email or 571-319-4485. Col. Rene’Chadwell PA Alicia Quella PHOTOCOURTESYOFALICIAQUELLA PHOTOCOURTESYOFRENE’CHADWELL PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 37 
• Give back locally and globally • Improve community health • Inspire and support the next generation of PAs • Engage patients in their own healthcare Support your PA Foundation and empower PAs to: See what the power of you can do. Donate today! pa-foundation.org/powerofu
PROFESSIONALPRACTICE PA, Heal Thyself Setting Boundaries, Being Mindful the Keys to Wellness and Burnout Prevention B Y J E N N I F E R A N N E H O H M A N W hat does it mean to practice medicine in a healthy, sustainable way, one that promotes the well-being of your patients and also yourself? How can you prevent the main symptoms of burnout—exhaustion, depersonalization and discourage- ment—from eroding your career and personal well-being? From my discussions with PAs, I’ve learned that burnout comes mostly from unsustainable schedules and from a feeling of being taken for granted or unable to offer per- sonalized medical care to patients. Given their dedication to patients and to team practice, it is easy for PAs to over- commit, overextend and even to be exploited by unethi- cal employers. One way of making any position healthier is through diligent contract negotiation—to help ensure a fair and sustainable work arrangement. Step one in burnout prevention is careful assessment of both the contract and practice culture offered by an employer. Ask yourself: On the whole, is this a place where I can practice in balanced manner? Do the physicians I’ll be working with seem to be doing so? Finally, given the centrality of quality working relation- ships to PA practice, if you are unable to make the neces- sary changes and find yourself working with seriously negative practice partners, who are perhaps burned out themselves and have become either absent or abusive in their collaborative style—move on. Being in a toxic clinical partnership is an express route to burnout. Take Care of Yourself An important key to a healthy career is cultivating a healthy life beyond clinical practice. Amid the demands of work, how well are you taking care of your own wellbeing in terms of diet, exercise, sleep, and time for family and the interests outside of your practice that engage and inspire you? Are there ways you can commit to improvements in these areas, even sharing your journey with patients when appropriate? Beyond these basic pillars of health, a new practice in medicine offers a vital new way to practice optimally and prevent burnout: mindfulness. Mindfulness has been 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  |  APRIL 2016 |  AAPA.ORG | 39 
PROFESSIONAL PRACTICE | continued described as the intentional cultivation of a nonjudgmental, attentive state of mind that enhances all interactions, including those between provider and patient. How might it apply to and benefit PA practice? PAs’attentive, empathic listening skills—inculcated during PA education and put into practice every day—are appreciated as an empowering, healing force by patients and offer a model of interaction for the healthcare system. Many of the skills and attitudes identified with mindfulness lie at the heart of the PA approach to medicine: My clients tell me that connecting personally with patients and acting as their trusted health advocates is key to their professional satisfaction—and also what makes the frequent frus- trations of working within a far from ideal healthcare system worthwhile. Mindfulness brings a new awareness of the subjective dimensions of practice—the need for both PAs and physicians to have the resources they need to be present, cultivate calmness and offer compassion to self and patient. This is an exciting development in the culture of medicine and one that PAs may be uniquely qualified to lead as the profession gains new levels of recognition. As communication, compassion and respect are increasingly understood as keys to effective practice, PAs, already grounded in these principles, are well placed to promote them in the world of medicine. It is my hope that in this area, as in others, PAs will be the standard bearers for a more humane and progressive way of practicing medicine. At a practical level, mindfulness and other wellness promotion efforts can only help you preserve vital resources—of energy, clarity of mind, and positivity that are essential to the demanding work of being a PA. There is a wealth of online resources for medical providers interested in exploring mindfulness. One of the most comprehensive, featuring videos and interactive exercises, has been collected for clinicians at the University of Wisconsin Department of Family Medicine and Community Health’s Mindfulness in Medicine program. This program was created to“support the well-being of health care practitioners, residents, medical students, patients, and others through mindfulness, and investigate how mindful- ness training influences compassion, joy, career satisfaction, and resilience of clinicians”and is well worth a visit. I hope that readers who may be expe- riencing burnout or feel on the cusp of doing so will avail themselves of these resources as well as remember that they deserve to have healthy and happy careers. ADDITIONAL WELLNESS AND MINDFULNESS RESOURCES FOR PAs Harvard Pilgrim Health Care Burnout Resources for Providers U Mass Medical School Center for Mindfulness in Medicine, Health Care and Society Goodness of Heart Resources on Clinician Wellness PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 40 
INPRINT Short-term Memories A Review of “Permanent Present Tense: The Unforgettable Life of the Amnesic Patient, H.M.” B Y J O H N W . “J J ” J E N K I N S , PA - C T he story of H.M., or the late Henry Molaison, is a fascinating tale about one man’s surgical misfortune turned long-running scientific investigation. It is the story of a man whose memory was stolen and a lifetime forgotten. Recently this story was turned into a book, by Suzanne Corkin, a neuroscientist at MIT who studied Molaison for nearly 50 years. Corkin deftly combines the personal and the scientific, weaving a beautiful tale about the science and the man. Her articulate nature and attention to detail allows the reader to join in her memoir,“Permanent Present Tense: The Unforgettable Life of the Amnesic Patient, H.M.”I highly recom- mend the audio version of the book, as the folksy voicing of Molaison adds another element to the experience. Henry Molaison lived a life like no other human in history. He had a relatively normal childhood, but was plagued by epileptic seizures. In his late 20s he saw a neurosurgeon who recommended surgery to alleviate his condition. Sadly, the procedure, a bilateral medial temporal lobectomy and removal of a portion of his hippocampus, resulted in permanent loss of his long-term memory. This meant that from the day of his surgery in 1953 to his death in 2008 he was unable to remember almost anything (with very few exceptions) for more than 20 or 30 seconds. An even more bitter reality was that it did not cure his epilepsy. Scientific interest in Molaison developed early on and actually still persists today. Corkin’s experiments and studies provided a wealth of information JOHN W. “JJ” JENKINS, PA-C, works in general and vascular surgery at Aurora Baycare Medical Centerin Green Bay, Wis. He is a Wisconsin Army National Guard PA and a 2014 graduate of the Carroll University PA Program. Contact him by email. PA PROFESSIONAL  |  APRIL 2016 |  AAPA.ORG | 41 
IN PRINT | continued about not only H.M., but how the human brain functions and the struc- tures necessary for various processes. Her lab developed tests that helped to map the human brain and determine pathways that had never been studied or understood before. With the advent of brain imaging, initially with computerized tomography and later magnetic resonance imaging (MRI), specifically functional MRI, they were able to observe the activity of various brain structures during actual experiments. H.M.’s final and most permanent contribution was the post mortem donation of his brain to science. In the first 24 hours after his death, extensive MRI studies were done on his brain and extremely fine slices of it were sent for pathologic analysis. One aspect of the book I found especially pleasing was the vivid imagery and colorful language Corkin used to describe her interactions with Molai- son. She painted beautiful word pictures of the experiments her team con- ducted and the responses Molaison gave each time. She captured both the trees and the forest in broad strokes with finely timed crescendos and decrescendos, culminating with strokes of insight. The astonishing thing is that no matter how many times a given experiment was conducted or repeated, Molaison would never remember. Likewise, he never remem- bered Corkin. When she would ask if they had met, which she did many times over the years, he would respond,“Yes. From high school.”This was despite an almost 20-year age difference between them. At times the book can get too dense and cerebral. The extensive, thor- ough explanations of some of the experiments can be distracting and even caused me to lose interest at times. For some readers, these detailed expla- nations may be desirable, but to me they pull us away from the story of Henry as a person and toward the tale of H.M. the science experiment. By the end of the book, though, you will feel like you have been there by Corkin and Molaison’s side for the whole journey, and that the journey was on the whole worthwhile. You will be saddened to hear of his death, but relieved that his suffering is over. You will certainly close up the text and pass it off to someone, recommending it for almost any reader. Hopefully, when you finish, you aren’t asking,“What was that all about?”Enjoy. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 42 
REFLECTIONS The Blessing and Burden of Flexibility A Guide for New Grads on How to Choose Your Specialty B Y V E R D A L E B E N S O N , PA - C W hile providing mentorship to a PA student recently, I was asked whether he should ini- tially pursue a primary care job to solidify his medical foundation before entering a specialty field. I found this to be a great question that I’m sure many soon- to-be graduates are pondering. Reflecting on the ques- tion, I realized how the flexibility of our profession could feel like both a blessing and burden at times. Bottom line up front: Pursue the specialty you are pas- sionate about. My advice to new PAs is to get into the specialty for which you have the most passion early in your career and rise within it so that you can maximize your growth in that specialty over your career. The knowledge and experience you gain will grow every year and that will increase your market value. The concept is very similar to starting a financial savings plan early in life to maximize the effects of compound interest. Practicing PAs know that your education isn’t nearly over once you graduate from school. As a new graduate work- ing in a specialty or even in primary care, you’ll still have to read up on disease states and best treatment practices. My experience has been that your collaborating physicians will train you to practice as they do, so the sooner you get into the niche, the more you will know about what you love to do! I will say that broadening your general medicine roots isn’t a bad move, if that is what you want to do initially. It is how I started my PA career. But I would caution that you should do it because you genuinely want to practice in primary care and not for a potential future benefit. The return on invested time might not be worth it, depending on how you are utilized in a specialty practice. A good grounding in broad medical knowledge will always be useful, though, and career paths can often take unexpected turns. Early in my career, I entered the Atlanta VERDALE BENSON, PA-C, is a 2012 graduate of the Emory University PA program. He completed a residency in primary care with a focus in the patient-centered medical home (PCMH) model. He currently practices emergency medicine at Memorial Medical Center and resides in the San Francisco Bay area. Contact him by email. PA PROFESSIONAL  |  APRIL 2016 |  AAPA.ORG | 43 
REFLECTIONS | continued Veterans Affairs PA residency program to broaden my medical knowl- edge—in order to be a better job candidate and solidify a path into the Veterans Affairs organization. Later, a private practice position in orthope- dics opened up in the area I wanted to relocate to and I chose to explore that opportunity. Then, while in orthopedics, I realized that I wanted to practice a broader scope of medicine to better utilize my advanced train- ing and found that emergency medicine fulfilled that need, along with a more flexible schedule. So I have recently transitioned to emergency medi- cine and have been able to pull from my general medicine experience working in that specialty. But maybe I would have learned those pearls anyway if I had started out in the specialty. Preparing for PANRE This debate also has implications for the PA National Recertifying Examina- tion (PANRE). We have all heard stories of specialty PAs failing the boards because they have only practiced in one field. But while having to study for the PANRE is a burden that all specialty PAs will have to bear, general medi- cine PAs are not immune from the hardship. Even primary practices vary based on population or location, which can mean that certain types of cases or patients are not seen very often, and that certain topics will require review. Whatever the situation, it will behoove every PA to stay abreast of current general medical practices so that when the PANRE comes up, you aren’t trying to catch up from years of not applying that information. This is one reason for continuing medical education activities. While pondering this debate, I looked at the possible influence of our physician colleagues and their residency training. Physicians who branch into specialties such as cardiology or gastroenterology have to train in internal medicine before attending their fellowships. And since PAs are trained in the medical model, and were originally intended to help supple- ment the primary care workforce, it may be that our profession’s origin influences some PAs to feel they need to have primary care experience in order to establish a successful career. This model doesn’t translate exactly into the PA profession, however, particularly with those entering into surgical specialties. The truth is, most of us forget what we don’t actively practice on the job. That goes for all of us, including physicians! Most PAs likely will have to study before the PANRE regardless of what specialty is practiced. As PAs, it is our blessing and burden that we have the freedom to change specialties, but we will always be held responsible for the knowledge that flexibility entails. I think this is a great problem to have. I love knowing a lot about many subjects and while I might not be an expert, I can have an intelligent con- versation on most medical topics. This is one of my joys and what helped draw me to the PA profession. So, pursue what you have the most interest in! If that is primary care, then great! If it is urology, then great! Either way, you’ll always have to know a little about everything, so keep your knowledge base up so that when the PANRE comes around, you won’t sweat it. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 44 

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PA_Pro_April_2016_HR_FINAL

  • 1. FINDING THE PATH,Leading the Way A DACA Applicant’s Journey to PA School 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 A P R I L 2 0 1 6
  • 2. CONFERENC AA E PA Get hired – or just see what’s out there – when you meet face to face with 70+ employers from across the country. There’s so much more planned! Search all events at AAPAconference.org Join the PA Foundation for this brand new FUNdraising event! We’re taking over Howl at the Moon on the River Walk for a live dueling piano show and a lip-syncing competition. Make new contacts and recharge former connections on Alumni Night (Saturday) and Constituent Organization Night (Sunday). Networking Events Lonestar Live Career Fair Register Today & Save With Advance Rates AT AAPAConference.oRG Low Advance Rates End April 18 Power up your Network MAY 14 – 18, 2016 San Antonio, TX Don’t miss your chance to mingle with 6,000 PAs and students!
  • 3. ContentsA P R I L 2 0 1 6 • V O L . 8 , N O . 4 Departments President’s Letter Power Up for AAPA Conference 2016 in San Antonio Laws+Legislation Bringing the PA message to Capitol Hill Payment Matters Meaningful use has significant implications for PAs under new Merit-Based Incentive Payment System STAT Win a lunch with“American Sniper”PA Kevin Lacz | Florida legislature passes historic PA prescribing legislation | ARC-PA names new executive director | Shenandoah University PA students and faculty to attend the 69th World Health Assembly in Geneva | and more Professional Practice How to set boundaries and be mindful to avoid burnout In Print A review of“Permanent Present Tense: The Unforgettable Life of the Amnesic Patient, H.M.” by Suzanne Corkin, PhD Reflections Advice on how new grads can navigate the blessing and burden of flexibility 6 17 9 12 41 39 43 ABOUT THE COVER PA student Simon Mendoza is the first Deferred Action for Childhood Arrivals program participant accepted to the University of Washington. Photo courtesy of the University of Washington MEDEX Northwest 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. Features C O V E R S T O R Y Finding the Path, Leading the Way A DACA Applicant’s Journey to PA School F E AT U R E S T O R I E S AAPA Board of Directors General Election Meet Your New Board Members PA Vision 2020: AAPA’s 2016-2020 Strategic Plan New Strategic Plan Highlights the Need for PA Value to Be Captured in Data 2016 AAPA Awards Recipients Congratulations to This Year’s Awardees 24 15 31 36 PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 1 
  • 4. www.PAJobLink.com Find Your Direction With PA JobLink Whether you’re just graduating or looking for your next move, PA JobLink provides the tool you need to find and attain your next job. Click the Topics Above to Learn More Search Over 1,000+ PA Jobs Resolutions For Your PA Career Networking Opportunity Are You In The Right PA Job? Negotiating Salary As A New Grad Talk With A PA Career Coach Operation Resignation AAPA Salary Report 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 MANAGING 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 DIRECTOR-AT-LARGE Laurie E. Benton, PhD, MPAS, PA-C, RN 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 4 | A P R I L 2 0 1 6 AAPA.ORG PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 4 
  • 7. Stop by our booth, #522, to register. 1 entry per person. Drawing will be held on 2nd day of conference. Prize is for 1 free year of monthly CME webinar, valued at $350. Need not be present to win. BOOTH #522 Benefits of CME Webiconference - Decrease cost and traveling time for CME - Provides high quality, relevant and current updates in medical & surgical practices - Constructs a medical library to help those preparing for their boards (either initial or recertification) Sign Up to Win! 1 FREE YEAR of Monthly CME Webinar www.CertMedEd.com What is our Webiconference? Our live program is approved by the AAPA for Category 1 CME and is also recorded so you can review it later. It is a comprehensive educational library of pharmacological, clinical and medical/surgical materials. WIN $350Value 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 Power Up at AAPA Conference 2016! W e’re a month away from the profession’s must attend annual event, AAPA Conference 2016! This year’s conference promises to be the best one yet and I’m happy to report we’ll be offering even more of the things PAs want. We will be featuring: ■ More than 260 hours of live CME to ensure you’ll always find something that’s relevant to you ■ High-profile speakers like: • Healthcare expert and national thought leader Terry Stone, who will provide an informative and provoca- tive glimpse into how PAs are positioned to reinvent the face of medicine • Former Navy SEAL and“American Sniper”actor Kevin Lacz, PA-C, who will inspire you to overcome risks and achieve your goals through his fascinating per- sonal story of courage and commitment ■ Hands-on leadership training symposia to help you advance your career ■ Fun events sponsored by the PA Foundation including a FUNdraising night at the dueling piano bar Howl at the Moon and the Pacers for Health 5K Fun Run ■ Exciting and engaging networking events to connect you with your PA colleagues from around the country ■ The AAPA Career Fair, with more than 70 employers eager to help you land your dream job More than 70 teams participated in Challenge Bowl in 2015, and even more are expected this year. PA PROFESSIONAL  |  APRIL 2016 |  AAPA.ORG | 6 
  • 9. PRESIDENT’S LETTER | continued ■ Important discussions at the House of Delegates focusing on some of the most critical issues facing the profession, including the NCCPA recertification proposal and full practice responsibility The conference will be the capstone of an historic year for PAs. Working together, we tore down practice barriers, were voted one of the best jobs in the nation and got the country talking about the amazing things PAs do for healthcare. To top it off, we just approved a comprehensive new strategic plan for the profession—I can’t wait until we’re all in San Antonio so I can tell everyone about the great work AAPA is doing to create a better future for all PAs. And, while we’re talking about the future, it is my great pleasure to welcome our newly elected board members: ■ President-elect: L. Gail Curtis, MPAS, PA-C, DFAAPA ■ Secretary-Treasurer: Jonathan E. Sobel, MBA, PA-C, DFAAPA, FAPACVS ■ Director-at-Large: Lauren Dobbs, PA-C, MMS ■ Director-at-Large: Beth R. Smolko, MMS, PA-C These fine PA leaders represent the future of the profession. I welcome their experience, wisdom and guidance as they help lead us to even greater achievements. Thank you for your great work and I look forward to seeing many of you next month in San Antonio! Jeffrey A. Katz, PA-C, DFAAPA AAPA President and Chair of the Board The Exhibit Hall is popular with PAs looking for innovative products and new technologies. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 7 
  • 10. 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 PATIENTS FIRST. Cyndy Flores, PA-C Regional Medical Center - 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/team-based
  • 11. LAWS+LEGISLATION Bringing the PA Message to Capitol Hill PAs and PA Students Stress Mental Health Issues in Meetings With Hill Staffers B Y K R I S T I N B U T T E R F I E L D , M A O n a brisk February day, nearly 170 PAs and PA students, from Vermont to Hawaii and 34 states in between, took to the halls of Congress to advocate for the PA profession and the patients PAs serve as part of AAPA’s 2016 Leadership and Advocacy Summit (LAS). “It was wonderful to interact with legislators and their staff on issues that are important to PAs,”said Chris Noth, PA-C, FAPACVS, president of the Michigan Academy of PAs. And interact they did! Participants met with 165 House and Senate offices, speaking with a unified voice on criti- cally important and timely topics, including opioid addic- tion treatment and the role of PAs in mental healthcare. In 2014, the Substance Abuse and Mental Health Ser- vices Administration found that 1.9 million Americans over 12 years of age struggled with addiction to prescription painkillers. At the same time, the National Alliance on KRISTIN BUTTERFIELD, MA, is AAPA’s director of grassroots and political advocacy. Contact her via email or at 571-319-4340. Stony Brook University PA program director Peter Kuemmel, PA-C, and (left to right) PA students Wesley Young, Marsha Thomas, Katherine Alexis Athanasiou and Christina Grimaldi. PHOTOCOURTESYOFSTONYBROOKUNIVERSITYPAPROGRAM PA PROFESSIONAL  |  APRIL 2016 |  AAPA.ORG | 9 
  • 12. LAWS+LEGISLATION | continued Mental Illness has estimated that more than 40 million U.S. adults experi- ence mental illness in a given year. Yet, the U.S. Department of Health and Human Services estimates that more than 90 million Americans live in areas with little or no access to mental health or addiction medicine pro- fessionals. It is clear that additional providers—like PAs—are needed to combat both of these pressing public health concerns. PAs spent their time on the Hill with congressional offices discussing their experiences as“front line providers”who routinely see and treat indi- viduals struggling with addiction and mental illness. In particular, they described the need for PAs to be recognized in legislation as key members of the mental healthcare team. They also advocated for PAs to be autho- rized to prescribe buprenorphine for the treatment of opioid addiction. Although PAs are able to prescribe buprenorphine in most states for pain management purposes, federal law prevents them from prescribing it to treat opioid addiction. Several House and Senate committees have held hearings on both of these issues, and it is likely one or both bodies will take up comprehensive legislation this spring. As a result, participants reported great interest from both legislators and staff on how better utilization of PAs can—and should—be a part of the solution. More than a third of the Capitol Hill Day participants were PA students, who represented nearly 20 PA programs—a terrific show of commitment by the profession’s future PAs. And even though the students might have felt like novice advocates, they handled the visits with poise and professionalism. “As a student, I shared the structured training we received and also expanded on my four-week clinical psychiatry rotation,”recalled Wesley Young, who participated in the Hill Day with three classmates and their faculty advisor, Peter Kuemmel, MS, PA-C, director of the PA program at Stony Brook University in New York.“In these moments I was more proud than ever to advocate for our profession and for the well-being of our patients, and I am optimistic about the impact we have collectively.” Longtime advocate and returning attendee David Brissette, MMSc, PA-C, feels strongly that PAs must acquire the tools they need to advocate for patients and the profession by attending events like the LAS Hill day.“It is important to participate in opportunities like this, which can make it possible to provide the best care to patients that PAs are capable of,”he said. “PAs need to have a voice in order to effect change.”  David Brissette, MMSc, PA-C, (left) and members of the Connecticut delegation of PAs meet with Senate staff. PHOTOBYKRISCONNOR PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 10 
  • 13. 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 NEW PROFESSIONAL LAB COATS SLIM FIT, SOPHISTICATED STYLE AAPA MEMBERS RECEIVE 15% OFF ENTER CODE AAPAMEM15 AAT CHECKOUT To place an order, visit www.medelita.com
  • 14. PAYMENTSMATTER Meaningful Use: Significant Implications for PAs PAs Must Participate in MU Now and Under MIPS B Y M I C H A E L P O W E M eaningful use (MU) is a program in which eli- gible professionals and hospitals use certified electronic health records (EHR) technology in a“meaningful way”to improve patient care when treat- ing Medicare and Medicaid beneficiaries. To achieve MU, eligible professionals and hospitals must meet certain objectives established by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act designated $19.2 billion to incentivize the development and imple- mentation of health information technology (HIT) in the form of EHRs. One of the major components of the HITECH Act was the MU program, which created financial incentives for MU and encouraged health professionals, healthcare orga- nizations and medical practices to expand the use of EHR technology. CMS began imposing penalties in 2015 for failing to demonstrate meaningful use of EHRs. For many health professionals there is a certain level of confusion regarding the MU program, including who may participate, what government requirements must be met and how penalties will be imposed for those who fail to meet the standards established by CMS and ONC. Participation in MU might be especially unclear for PAs due to the inequitable treatment PAs have received regarding Medicaid EHR incentive payments. While physi- cians and advanced practice nurses had across-the-board access to up to $63,750 in payments over six years if at least 30 percent of their patient volume consisted of Med- icaid beneficiaries, only PAs in PA-led federally qualified health centers or rural health clinics were eligible for the Medicaid incentive payments. And only physicians were entitled to receive financial incentives under the Medicare MU program. MICHAEL POWE is AAPA vice president of reimbursement and professional advocacy and an adjunct assistant professor at The George Washington University School of Medicine and Health Sciences. Contact him by email or at 571-319-4345. PA PROFESSIONAL  |  APRIL 2016 |  AAPA.ORG | 12 
  • 15. PAYMENT MATTERS | continued Some PAs felt that since they were not fully entitled to the EHR incentive payments that they will not be required to participate in future iterations of the MU program. That is not true. As eligible professionals, PAs will be required to meet MU standards that will be incorporated into the larger payment framework known as the Merit-Based Incentive Payment System (MIPS) or qualify for an exemption. MIPS is a Medicare payment methodology that utilizes quality metrics, resource use, meaningful use of EHRs and clinical practice improvement concepts to develop a Composite Performance Score for eligible health- care professionals. That Composite Score will impact whether a health professional will receive an incentive or a downward payment adjustment on their Medicare reimbursement. MIPS will replace MU in addition to other current incentive programs such as the Physician Quality Reporting System and the value-based modifier. (Read this PA Professional article for more on MIPS.) Recent Headlines Muddled the Picture There was a palpable sense of shock within the healthcare community when at a January conference in Washington, D.C., CMS Acting Administrator Andy Slavitt was reported to have made the statement that MU was going away. What he actually said, in his prepared remarks, was that“the Meaningful Use program as it has existed, will now be effec- tively over and replaced with something better.”This statement likely signals that MU will shift from being a standalone program and be incor- porated into a MIPS. CMS has released limited details to date on the implementation of MIPS, but is expected to do so when it releases forthcoming regulations on MIPS and alternative payment models this spring. At this point the future of MU should be clearer. AAPA continues to advocate for full recognition and documentation of PA work under MIPS in order to promote an accurate and meaningful assessment of the patient care provided by PAs. In addi- tion, AAPA supports appropriate timelines and expectations for adoption and use of HIT, suitable thresholds for what is considered successful use of HIT, and the removal of any barriers that may prevent PAs from effectively using HIT or reporting on its use. All active users of HIT, such as PAs, should be properly incentivized as incentives for meaningful use move beyond the current separate programs, including the MU program, and into the more comprehensive MIPS. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 13 
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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.▼ AAPA Membership Benefits   Why do I need Disability insurance?                 •    •   •   •          •   •                            •                •             PHOTOS BY FRED GREAVES
  • 17. The American Academy of PAs is pleased to announce the results of the 2016 AAPA Board of Directors General Election. These leaders will assume their positions on July 1. Thank you to all the candidates who stepped up and ran for the 2016-17 Board of Directors. Click here to view the certified results. 2016 AAPA Board of Directors General Election Results Meet Your New Board Members BY AAPA STAFF L. Gail Curtis MPAS, PA-C, DFAAPA Clemmons, N.C. Jonathan E. Sobel MBA, PA-C, DFAAPA, FAPACVS Rockville Centre, N.Y. Lauren Dobbs PA-C, MMS Aledo, Texas Secretary-TreasurerPresident-elect Directors-at-Large Beth R. Smolko MMS, PA-C Frederick, Md. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 15 
  • 18. By Specializing in PA Placement we can partner with you to find the ideal situation to suit your strengths, your priorities, your dreams. Your dedicated personal coordinator is looking forward to your call. 855-671-1058 UnitedHealthHire.com THE SCIENCE OF PA PlACEmENT  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 INTRODUCING THE NEW PA PROFESSIONAL APP! It's now easier than ever to find career advice and practice news just for PAs. DOWNLOAD NOW!
  • 19. STAT | Industry News FLORIDA GOVERNOR SIGNS LANDMARK PA LEGISLATION INTO LAW On April 14, 2016, Florida Gov. Rick Scott signed landmark legislation that will allow PAs in the Sunshine state to prescribe controlled medi- cations. This was an historic moment for Florida PAs and the patients they serve. In addition to the passage of a prescribing bill, legislation was also signed by the governor last month allowing for PA scope of practice to be determined at practice level. “This landmark legislation increases the availability of quality medical care by allowing PAs to better meet the needs of their patients,”said AAPA President Jeffrey A. Katz PA-C, DFAAPA.“Evidence clearly shows that when PAs are allowed to prac- tice to the full extent of their education and experience they increase access to healthcare services and improve out- comes, which is why PA positive legislation is critical. Today’s signing of this milestone bill by Gov. Scott demonstrates Florida’s commitment to ensuring the nearly 20 million residents of Florida have access to quality care.” The two bills, House Bill 423 and House Bill 375, are set to become law on July 1, 2016 with portions pertaining to PA prescribing becoming law on Jan. 1, 2017. “One of our goals as an organization is to advocate for a statutory framework in Florida that isn’t weighed-down with unnecessary regula- tion, but upholds standards of care,”said George Rego, President of the Florida Academy of Physician Assistants.“Implementation of this new legislation will improve access to care and patient outcomes in the State of Florida.” Read more here. MEET “AMERICAN SNIPER” PA KEVIN LACZ AT AAPA 2016 Want to break bread with“American Sniper”actor and PA Kevin Lacz, at AAPA Conference 2016, May 14-18, in San Antonio? Register for AAPA 2016 by April 18 and you could be among the 10 PAs randomly selected to have lunch with Lacz, who will also speak at General Session. A 2014 graduate of the Wake Forest PA program, Lacz was a Navy hospital corpsman when he earned a coveted spot on SEAL Team 3 as a combat medic, breacher and sniper. After serving two tours in Iraq, an experience he writes about in his upcoming memoir, he completed his enlistment and left the military to return home to begin his PA journey. Currently, Lacz specializes in sports medicine and physical rehabilitation in one of the nation’s top ortho- paedic practices, the Andrews Institute for Orthopaedics and Sports Medicine in Pensacola, Fla. He helps runs an Andrews Institute Foundation clinic that provides injured special operations forces troops with the same quality of care as professional athletes. Read more about Lacz in this 2014 PA Professional article, and don’t miss your chance to meet him at AAPA 2016. Register now! ADOBESTOCK.COM PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 17 
  • 20. STAT | continued PA Emilie Thornhill UPDATED AAPA ISSUE BRIEFS AAPA issue briefs cover a wide range of topics that are important to PAs and PA practice, from specialty practice to third-party reimbursement for PAs. State and specialty PA organizations, as well as individual PAs, use them to educate employers, legislators and policy makers. The Academy recently updated the“Team Practice”and“PA Education”issue briefs, part of an ongoing project to revise and refresh these important documents over the next six months. Learn more about AAPA’s issue briefs here. PA NAMED TO SHM COMMITTEE Emilie Thornhill, MPAS, PA-C, was recently appointed chair of the Society of Hospital Medi- cine’s NP/PA Committee. The society, or SHM, is a professional medical organization represent- ing the nation’s practicing hospitalists. A graduate of the South University PA program in Savannah, Ga., Thornhill is a former stu- dent member of the AAPA Board of Directors. SHENANDOAH PA STUDENTS TO ATTEND WHO EVENT In May, Shenandoah University PA students and faculty will attend the 69th World Health Assembly of the World Health Organization (WHO) in Geneva, Switzerland. Part of Shenandoah’s Global Experien- tial Learning (GEL) program, the trip will provide a group of PA, nursing and pharmacy students with an interprofessional experience. During the trip, students will have the oppor- tunity to interact with key players from the Inter- national Society of Telemedicine and eHealth and International Council of Nurses, and visit the head- quarters of Doctors Without Borders, International Hospital Federation and the International Red Cross and Red Crescent. J. Leocadia Conlon, PA-C, MPH, an assistant pro- fessor in the Shenandoah PA program, said the trip will provide students with a unique opportunity to gain valuable knowledge and insight into global health through interaction with international lead- ers in the study, research and practice of improv- ing patient outcomes and achieving health equity worldwide. ARC-PA NAMES NEW EXECUTIVE DIRECTOR Sharon L. Luke, MSHS, PA-C, was recently named the new executive director of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Prior to that, she was the organization’s assistant director. Only the third executive leader of the commission since 1971, Luke is the first woman and first African American to lead it as well. She will take up the reins of the position July 1, 2016. In 2015, ARC-PA announced that longtime head John E. McCarty, MPAS, PA, planned to step down as executive director this year. He will continue to be involved in ARC-PA in another capacity, he said during a recent phone interview, adding that he is not retiring from the organization. McCarty has served as ARC-PA’s executive director since 1991. Prior to that, he was on the commission for six years, four of them as treasurer. The number of PA programs has jumped to 210 from just 54 during his tenure, and there are doz- ens more in the pipeline. ARC-PA is the accrediting agency that defines the standards for PA educa- tion and evaluates PA programs within the territorial United States. It also con- ducts site visits to ensure that PA programs are compliant with those standards through onsite monitoring and evaluation. PHOTOCOURTESYOFPAEA Sharon Luke will become the new executive director of ARC-PA on July 1. AAPAPHOTO PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 18 
  • 21. STAT | continued NEW OPIOID GUIDELINES AIM TO REDUCE ADDICTION RISK The Centers for Disease Control and Prevention (CDC) recently revised the guidelines aimed at helping primary care providers safely and respon- sibly prescribe opioids to adults with chronic pain outside of active cancer treatment, palliative care and end-of-life care. The CDC urges providers to: • Use nonopioid therapy as the preferred treat- ment for chronic pain when possible • Use opioids only when benefits for pain and function are expected to outweigh risks • Before prescribing the medication, establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks • Prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concur- rent opioids and benzodiazepines whenever possible • Evaluate benefits and harms of continued opioid therapy with patients at least every three months and review prescription drug monitoring pro- gram data, when available, for high-risk combina- tions or dosages • Offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenor- phine or methadone, for patients with opioid-use disorder. 10 FASTEST GROWING JOBS FOR COLLEGE GRADS The U.S. Bureau of Labor Statistics compiled a list of the 10 fastest growing jobs for college graduates for the decade leading up to 2024 and PAs are at No. 4 with a growth rate of 30 percent. PAs also had the highest median salary of any of the listed pro- fessions, at $95,820. A number of other health pro- fessions also made the list, including nurse practi- tioners, genetic counselors and physical therapists. DEFINING SEPSIS An international task force’s new definitions of sep- sis and sepsis shock could help cut risks of deadly infection, according to an article published in the Journal of the American Medical Association. This is the first time in 15 years that the definitions and clinical criteria of both infections have been updated. Organized by the European Society of Inten- sive Care Medicine and the Society of Critical Care Medicine, the task force was comprised of 19 criti- cal care, infectious disease, surgical and pulmonary specialists. After two years of meetings, the group’s findings prompted them to define sepsis as a“life- threatening organ dysfunction caused by a dysreg- ulated host response to infection.” ADOBESTOCK.COM PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 19 
  • 22. STAT | continued PROJECT ACCESS NEEDS YOU FOR AAPA 2016 Are you attending AAPA Conference 2016 in San Antonio? Are you interested in increas- ing access to healthcare in medically underserved communities? Do you think diversity matters in the health professions? Then add Project Access to your conference schedule. A PA Education Association (PAEA) outreach program, Project Access is looking for PA and student volunteers who want to inspire and motivate underrepresented minority high school, college and university students to become PAs. PAEA reports that while the PA profession enrolls a greater percentage of underrepre- sented minority students than other health professions, the number of underrepresented students has remained static for the last five years at about 22 percent. Studies indicate that among other benefits, a diverse healthcare workforce is associ- ated with improved access to healthcare for racial and ethnic minority patients, greater patient choice and satisfaction, and better educational experiences for health profes- sions students. What to learn more about Project Access and how AAPA and PAEA breathed new life into it? Read this PA Professional article and don’t forget to sign up to volunteer at AAPA 2016. All volunteers are welcome! Project Access volunteers take a few hours out of their AAPA Conference schedule to talk to middle schoolers about the PA profession. 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 The Original Chicago Course® Since 1996 CMERESOURCES.COM H 5-day program: 43 hours AAPA Cat 1 CME credits H CMExpress 3-day: 26 hours Cat1CME credits Visit us in Booth 714 at the AAPA 2016 Conference “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 Locations Coming to a city near you... Atlanta Atlantic City Baltimore Boston Charlotte Chicago Cleveland Dallas Denver Hilton Head Houston Las Vegas Los Angeles Milwaukee Minneapolis Orlando Philadelphia Pittsburgh San Antonio Scottsdale Seattle Washington, D.C.
  • 23. STAT | continued UPDATED STATE-BY-STATE LAWS AND REGULATIONS BOOK RELEASED Get your copy of the newest version of PA State Laws and Regulations in the AAPA Store, and keep up to date on key provisions of the PA laws and regulations from each state and the District of Columbia. AAPA members get a 60 percent discount on the book, paying only $100 for more than 900 pages of valuable information. Your purchase includes the option to view as an e-book on your PC, Mac or mobile device. Just interested in your state’s PA Practice Act? Go here to read a free synopsis. PSYCHOLOGICAL DISORDERS AFFECT 1 IN 7 U.S. KIDS UNDER 9 One out of every seven children aged 2 to 8 years in the U.S. were reported to have a diagnosed men- tal, behavioral or developmental disorder (MBDD), according to a new study released by the Centers for Disease Control and Prevention (CDC). Researchers found that many family, community and health-care factors were related to the children with MBDDs, according to the article published in the CDC’s Morbidity and Mortality Weekly Report. Key findings include: • Non-Hispanic white male children, age 6 to 8 years, were more likely to have an MBDD • Children were more prone to have an MBDD if they were from poor families (those living at less than 100 percent of the federal poverty level) and families that spoke English in the home Data for the study came from the 2011-12 National Survey of Children’s Health (NSCH). The NSCH is a telephone-based survey that relies on parents reporting of child health and well- being, family characteristics and neighborhood environment. QUITTING ‘COLD TURKEY’ MAY WORK BEST FOR SMOKERS Quitting smoking abruptly is more likely to lead to lasting abstinence than quitting gradually, accord- ing to a study published in the Annals of Internal Medicine. Researchers who conducted a new clini- cal trial found that study participants who quit cold turkey were 25 percent more likely to remain absti- nent half a year from the date that they stopped than smokers who tried to wean themselves off slowly instead. PA EDUCATION SUMMIT In March, the PA Education Association (PAEA) convened a Stakeholder Summit that brought together 60 thought leaders to discuss the future of PA education. The goal of the event was to determine what new PA graduates need to thrive in this rapidly changing healthcare landscape. For two days, representatives from the“four orgs”—AAPA, PAEA, the National Commission on Certification of Physician Assistants (NCCPA) and the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)—considered various forward-thinking ideas to help develop the next chapter in PA education. PAEA plans to release a new roadmap for the future of PA education this fall. PA Student Paul Gonzales PHOTOCOURTESYOFPAEAVIAFACEBOOK ADOBESTOCK.COM PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 21 
  • 24. STAT | continued • NEW PA LEADER’S EYE-OPENING EXPERIENCE AT LAS BY JANET A. ROBILLARD, PA-C In February, I attended AAPA’s Leadership and Advocacy Summit (LAS), in Washington, D.C., for the first time. LAS is an annual event designed to equip current and future PA leaders with the tools and information they need to become transformational leaders and PA advocates. I left LAS feeling fully equipped for my path ahead and have said over and over since that it was the best conference of my nearly 14-year PA career. I became interested in advocating for the PA profession after a recent job change. In that new role, I was expected to scribe for a physician group. This request caught me off guard. I had never encountered this situation or imag- ined functioning in any capacity other than as a medical provider. I had hoped to change this expectation through educating my employer about the PA profession. But I discovered that my state’s PA laws had not evolved and, sadly, supported my employer’s expectations. Fortunately, I found another position. But this frustrating experience opened my eyes to what PAs in Wisconsin and across the nation might be facing. I’ve since learned that my situa- tion is not unusual for PAs. That brings me back to LAS, where I found the support I needed in AAPA. More importantly, I found hope. Hope for the PA profession in Wisconsin and across the U.S. I realized that AAPA and PAs around the country are work- ing tirelessly to improve our profession in the face of continuing barriers to PA practice. Among AAPA’s top goals are to equip PAs for progressive opportunities and work environments, and push for true practice autonomy for PAs. AAPA outlined these and other goals in its new Strategic Plan and updated Model State Legislation. The Academy is also committed to tackling issues like mine through working with employers and advocating for state legislative changes. Changes for our profession are badly needed and PAs need to lead the way in making the needed changes for our profession, to truly improve patient care. In the past, there may have been merit to trusting the larger medical community to do our advocacy for us. But now and in the future, advocating for PAs needs to be the job of PAs. Janet A. Robillard, PA-C, is president-elect of the Wisconsin Academy of PAs. Robillard asks a question at this year's LAS. PHOTOBYJOSHYOSPYN PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 22 
  • 25. STRONGER. TOGETHER. Today, we helped Lauren save by refinancing her student loans. Tomorrow, we will help her find her next PA position – at no charge. Next month, we will help her save hundreds on trusted malpractice insurance. Next year, we will connect her with free CME to maintain her certification. AAs an AAPA member, Lauren saves thousands each year on resources that help her practice strong and advance her career. Put the power of AAPA to work for you. Explore the latest benefits available to AAPA members. aapa.org/savings
  • 26. COVER STORY PA Simon Mendoza Finding the Path, Leading the Way A DACA Applicant’s Journey to PA School BY DENNIS N. RAYMOND W hen Simon Mendoza was a child living in a small farming community in central Washington state, the nearest medical clinic was 25 miles away in the city of Othello— population 7,364. Now a student in his clinical year with the Uni- versity of Washington MEDEX Northwest PA program, Mendoza is doing a four-month family medicine rotation at the very same clinic. At a time when rural America is hemorrhaging family physi- cians amidst an influx of new patients, and retirements are leaving medically underserved communities like the one Mendoza grew up in without a provider, he is going against the grain. “I feel at home here with the people, the community, and the patients I’ve seen,”he says.“Some of the patients here have been my classmates from middle school, some of my teachers, friends. It’s the great rural small community experience that I’ve always wanted.” At 24, Mendoza is the youngest in his class, and across all four MEDEX PA program sites. The median age for students entering the MEDEX PA Photos courtesy of the University of Washington MEDEX Northwest PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 24 
  • 27. COVER STORY, continued program is 33, and the profession represents a second or third career path for most.“I tend to be a little mature for my age,”he says.“I really enjoy having older classmates. I felt comfortable with them.” But age belies Mendoza’s experience. At 16 he became a certified nurse assistant (CNA) through a program offered at his high school. A Will, a Way and a Hurricane As soon as Mendoza finished the CNA program, in his junior year of high school, he volunteered with the Red Cross and went to Houma, La., in the aftermath of Hurricane Gustav. “I had just turned 17, and I was one of the youngest medical services volunteers they ever had,”he says. Upon arrival in Houma, he was put solely in charge of an entire shelter housing more than 230 people. It was two weeks before some registered nurses arrived to relieve him. The central headquarters for medical services was in Baton Rouge, 85 miles from the shelter.“I could consult with them by phone, but it was a couple of hours drive from headquarters,”Mendoza says. At the shelter Mendoza was called on to treat a few acute injuries, but most of the medical issues he dealt with were chronic conditions.“We had a lot of people who were diabetic, who didn’t have their insulin,”he says. “Conditions at the shelter were challenging, as there was no electricity. “Some people were bedridden, and we had a couple of people who had heart attacks. I couldn’t do much for them besides give aspirin and call 9-1-1.” Mendoza has been working full time to pay for his education since the age of 16. Even now, while in the MEDEX PA program, he works as a tele- medicine triage coordinator on the weekends. Mendoza, center, has been working to pay for his medical education since he became a certified nurse assistant at the age of 16. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 25 
  • 28. INTERVENTIONAL RADIOLOGY, CONTINUEDCOVER STORY, continued In high school he was in the Running Start program, which allowed him to simultaneously work towards his high school diploma and bachelor’s degree. Now in a two-year masters’program at the University of Washing- ton, his access to higher education is possible under DACA, the Deferred Action for Childhood Arrivals program established by executive order on Nov. 20, 2014. This is crucial because Mendoza is undocumented. He isn’t a U.S. citizen or a permanent resident. His was an infant when his parents left Mexico looking for economic opportunities and a better life for their children. Leaving Michoacán Facing a tough economy in Michoacán, Mexico, Mendoza’s parents immi- grated to Washington state in the 1990s.“My uncle was already in the United States and became a resident after President Reagan signed the Immigration and Reform Act in 1986,”he says.“My uncle was in contact with my father back in Mexico, and encour- aged him to come north to build a better life for us. That’s exactly what my father did.” Within months, Mendoza’s mother and the nine children followed. Simon was among the youngest of the siblings. They all settled in Grandview, Wash., sharing housing with their uncle’s family.“He also had nine children,”he says.“We all lived in one place for quite a while.”His father and uncle worked in the fields and orchards of Grandview as farm laborers, picking apples, asparagus, peaches and cherries. In time, Mendoza’s father was offered a good position an hour from Grandview at Smith Brothers Farms in Royal City, Wash. The senior Mendoza worked there for several years until the accident. “His arm was crushed in a manure strainer,”Mendoza says. The machinery broke his father’s arm, and mixed the manure in with his blood.“It was pretty much septic,”Men- Mendoza has wanted to be a healthcare provider since he was 8 years old and medical intervention saved his father’s life after a farming accident. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 26 
  • 29. COVER STORY, continued “Simon’s story is interesting,” Kindle says. “He came to the United States as a young child. Based on conversations around his life, academic, and clinical experiences, he was clearly a mission fit. Before MEDEX admitted Simon to the program we spoke to him for a very long time….. Turns out he was an excellent applicant.” —Mariah Kindle, MEDEX admissions director doza remembers.“They nearly amputated his arm, but the surgeon was able to save it, thankfully.” It was his father’s near-death accident that first inspired the then 8-year- old Mendoza to think about medicine. Mendoza’s elder siblings had settled just south of Seattle in Kent, Wash. With the father unable to work the farms, the entire family relocated to Kent, where they remained. By middle school, Mendoza had begun to understand that he was undocumented and that there was a danger of deportation. At that time there were immigration raids in eastern Washington state, in the very town where the family had lived.“You would hear about it on the radio,”he says. “It was slightly terrifying to me. I began asking questions, and that’s when I learned what I was.” No DACA Students Need Apply In June 2012, President Obama issued the executive order that created DACA, a federal program that allows certain undocumented immigrants who entered the country before their 16th birthday and before June 2007 to receive a renewable two-year work permit and exemption from deportation. Soon after DACA was implemented, Mendoza applied. It took him months to put together the lengthy, complicated paperwork, but he now has a two-year renewable work permit as well as a social security number. Still, there was a problem. “A lot of graduate schools required permanent resident status in order to apply, and I didn’t have that status,”he says. The MEDEX PA program operates under UW Medicine and it is subject to the same constraints as the university. Uncertain of how this would work, Mendoza sent an email to the MEDEX admissions team.“Their main concern was my ability to work afterwards—to obtain national certification and a license from the state of Washington,”he says. That’s when Mariah Kindle, director of admissions at MEDEX, stepped in to research the issue. Overcoming an Obstacle Course of Concerns “Simon’s story is interesting,”Kindle says.“He came to the United States as a young child. Based on con- versations around his life, academic, and clinical expe- riences, he was clearly a mission fit. Before MEDEX admitted Simon to the program we spoke to him for a very long time, about nine months prior to him submit- ting an application. Turns out he was an excellent appli- cant. He had an undergraduate degree here at the UW with a very high GPA. He’s really our first deferred action status student.” When Kindle first started talking with Mendoza about his path, she met with members of the MEDEX leadership group to determine what his process would be.“That was after a lot of research I had done,”she says. She checked with the state of Wash- ington to understand the rules for DACA students. She spoke to the University of Washington concerning policies for financial aid and qualifications for masters’programs. She reached out to PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 27 
  • 30. COVER STORY, continued NCCPA—the national certifying body for PAs—to make sure that after Mendoza finishes the program he can he sit for the board exam. She contacted the Medical Quality Assurance Commission, which licenses MEDEX. “Turns out the rules applied the same for Simon,”Kindle says.“Stu- dents with deferred action status must have a Social Security number, pass an accredited training program, sit for the national certifying exam, and they can practice in the state of Washington.” At that time UW did not accept students with DACA status. But on September 30, 2014, the UW School of Medicine announced a change in policy regarding DACA applicants, joining 35 other institutes of higher learning that now admit students who are undocumented. Deferred action status students cannot receive state or federal mon- ies. In fact, this is one of the largest hurdles that students with DACA status face. With his path to the admission process cleared, Mendoza began gathering the necessary documents for MEDEX.“I’m still considered undocumented even though I have DACA status because it’s only a temporary deferral,”he says.“It’s not like I have permanent status at all. I have to reapply every two years. There is a $465 fee and they grant you the two-year work permit every two years.” “Most people have no idea what all this means,”he says.“Some people ask me,‘Why don’t you just apply to be a citizen?’If it were that simple we’d all do that.” He’d get in line if he could find an end to the line. Mendoza with preceptor John Beauchamp, PA-C, at Columbia Basin Health Association’s Othello Family Clinic. Mendoza, who grew up in the rural area, plans to return there to practice medicine. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 28 
  • 31. COVER STORY, continued Just Out of His Grasp What is puzzling is that Mendoza’s parents became permanent residents in 2013.“They brought me to this country,”he explains.“All of us were undocu- mented. They were undocumented, but they applied for a visa with my uncle’s sponsorship because he was a U.S. citizen at the time. We waited in that line for over 20 years. When our visa number became current I had already turned 21. So I was no longer eligible to become a citizen under them. They became residents, and then I was sort of left out. To me it makes no sense.” Mendoza’s undocumented status adds a whole other layer of stress to PA school. But he’s managing the uncertainty. “I try to take it one day at a time,”he says.“I don’t worry about several years ahead. I just look at it one day at a time. What can I do to better my situation and take the next step forward?”He is part of the Latino Medical Students Association and the National Hispanic Medical Association.“We are advocates for immigrant, undocumented students to get a higher edu- cation.”And by incrementally moving the ball forward, Mendoza opened up possibilities for other undocumented immigrants to access higher education. A Dream No Longer Deferred Mendoza recently did a clinical rotation at CBHA Othello Family Clinic, where it was clear that he is in his element. Migrant farm workers are the principal focus of the clinic. In fact, the mission statement of the clinic is“Keeping healthy those who feed the world.” We pride ourselves on serving agriculture and migrant farm workers, and we don’t discriminate against people who can’t afford healthcare,”Mendoza says.“We try to serve everybody without regards to ability to pay, no insur- ance, race, age or anything. That’s the great thing about CBHA.” “Patients remind me of my parents,”he says.“Cultural competence is necessary to provide great care to this community. This includes an under- standing of traditional healing practices commonly referred to as curander- ismo. Herbs, for example, are commonly used to treat anything from insom- nia to constipation. Understanding this and asking about it is very important because there may be serious interactions with certain prescrip- tion drugs.” Mendoza has already inquired with the CBHA leadership about returning to the Othello Family Clinic once he graduates from MEDEX and passes the PANCE.“I’m certain I want to end up here,”he says.“I love it.”  DENNIS N. RAYMOND is MEDEX communications manager at the University of Washington. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 29 
  • 32. Are you preparing for PANCE or PANRE? WoltERs KluWER CAN hElP! Endorsed by AAPA! If you are just starting to prepare, there is no better resource than the highly popular review book edited by Claire O’Connell, A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants. n The foremost trusted preparation resource for the PANCE and PANRE. n Features high-yield outline-format review and pretest and post-test questions based on the blueprint of the National Commission on Certification of Physician Assistants (NCCPA). n Developed and endorsed by the American Academy of PAs (AAPA) and the Physician Assistant Education Association (PAEA), and reviewed and validated by subject matter experts working in the field. If you’ve read the book, make certain you are ready for the test with Q&A Review for PANCE and PANRE Powered by PrepU. n PrepU is an online quizzing application that can be used anywhere you have an internet connection. PrepU’s adaptive quizzing approach has been proven effective in helping students achieve higher levels of mastery in their subject areas. n PrepU contains over 3,000 questions to help you prepare for PANCE or PANRE! n Over 500 questions come directly from O’Connell’s, A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants. n Used by students preparing for certification and PAs undergoing recertification AAPA Members take 30% off the already discounted package rate. Buy online today and get an additional 30% off plus free shipping. FiNd othER REsoURCEs At www.lww.CoM
  • 33. New Strategic Plan Highlights the Need for PA Value to Be Captured in Data UNCOVERINGTHE“HIDDENVALUE” OFPAsBY STEVEN LANE IF A PA PERFORMS A PROCEDURE BUT NO ONE KNOWS ABOUT IT, DID IT REALLY HAPPEN? If a PA treats a patient but the service is billed under a physician’s NPI number, or performs pre-op services that are covered under a global surgery payment, did the PA contribute any rev- enue to the practice? These kinds of questions are becoming increasingly relevant as health- care systems and public and private payers look to become more data- driven in their approach to determining the productivity and value of health professionals, and as healthcare moves further towards fee-for-value reimbursement and rewarding quality. Uncovering the“hidden value”of PA practice is a major element of AAPA’s 2016-2020 Strategic Plan, approved by the Board in February.“Document- ing PA value through recognition and billing”was identified in the plan as one of the six key issues facing the profession, and the issue is also top of the list of concerns under one of AAPA’s four“strategic commitments to the profession”: Advance the PA Identity. (This story is the sixth in PA Profes- sional’s continuing series of strategic plan–related articles; you can read the other five in the PA Pro archives.) “This is one of the most important issues that AAPA will tackle in the coming months and years,”says AAPA President Jeffrey A. Katz, PA-C, DFAAPA.“As we move toward a system that will reimburse us based on the quality of our care, we must make sure that PAs are represented in the data that is collected on that care.” In fact, AAPA is already working hard on this issue. AAPA’s reimbursement team is undertaking an intensive research project to identify which of the major private third-party payers allow medical and surgical services deliv- ered by PAs to be billed under the PA’s name and provider number, making them trackable through the claims process. Policies regarding PA billing can vary both by plan type (basic fee-for-service, Medicare Advantage, Medicare supplement, PPO models, etc.) and by state. Reimbursement staff will then meet with and lobby identified payers to change those policies that do not authorize PA-provided services to be billed under the PA’s name. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 31 
  • 34. DOCUMENTED PA VALUE PA CONTRIBUTIONS EMPLOYERS POLICYMAKERSPAYERS As well, an AAPA task force is at work on a white paper,“Unmasking the Hidden Value of PAs,”that examines the issues surrounding the need to document the value of PA practice. The paper is scheduled to be published later this year. “Our goal is to provide some tools that PAs and organizations can use to quantify the value of the care PAs provide,”says task force chair Folusho Ogunfiditimi, DM, MPH, PA-C, who over- sees PAs and NPs at Detroit Medical Center. The Hidden Value of PAs No definitive data are yet available, but the percentage of care that is provided by PAs but not billed for under the PA’s name is likely between 30 and 50 percent of all PA care, according to Michael Powe, AAPA vice president, reimbursement and professional advocacy. PAs in administrative and leadership roles around the country agree that the issue is diffi- cult to quantify, but of crucial importance. “We do not have good data yet; we are just scratching the surface—but this issue is very real every day for me,”says Tim Pysell, DrHA, MMSc, PA-C, DFAAPA, who oversees more than 100 PAs as director of PAs at OrthoCarolina in Charlotte, N.C.“Our PAs do a lot of work that is not directly revenue generating—often not quantified or even quantifiable. It’s going to take some different thought processes to get to the real costs and value of healthcare. As a patient goes through the clinic, how much does each person cost and how much do they contribute? How much time does the PA spend and what is the cost of the PA’s time? We need very granu- lar data to get to the real costs of healthcare as opposed to the historical way of doing it.” “It’s all about data, data, data,”agrees Todd Pickard, MMSc, PA-C, director of PA practice at MD Anderson Cancer Center in Houston, one of the largest employers of PAs in the country.“There is now so much pressure in the regulatory, reimbursement and accreditation arenas to generate the data to demonstrate how what we are doing is different from the fee-for-service model.” “Real value,”Pickard adds,“is not determined by how many bills you dropped. It’s about whether you got results for your patients in a timely fashion, and reporting such metrics as, PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 32 
  • 35. “How many patients got urinary tract infections in the hospital from indwelling catheters? Much of what PAs and NPs do is about quality and safety.” But at present, much of this type of care, important as it is, is not cred- ited to the PAs who provide it. At MD Anderson, a recent survey found that about 60 percent of the patients seen by PAs were comanaged, due to the complexity of cancer treatment. This comanaged care is nearly always billed under physicians. The Role of Electronic Health Records One reason that the value of PAs and NPs is so often hidden is that electronic health records (EHR) systems are often designed primarily to capture the contributions of physi- cians. This is in part an issue with the inherent design of the systems and in part to do with the institutional rules of health systems and hospitals, PAs say. “Whenever I see a patient in the hospital, the note has to be cosigned,”says Lisa Shock, MHS, PA-C, senior director of clinical operations for WakeMed Key Accountable Care Organiza- tion in Raleigh, N.C.“If the EHR system changes the clinical care note and lists it under the physician’s name then it does not reflect the care that I personally delivered. We are working on this issue but it is hard to undo a process that has been programmed into the EHR system.” Some institutions are trying to change how PA care is captured in their systems. Just last month, MD Anderson transitioned to a new system, the widely used EPIC, that should allow them to capture much more granular data about PA practice, Pickard believes. “We will be able to more efficiently document the processes of care,”he says.“First generation electronic systems were very clunky, but newer ver- sions allow us to get that data. We can better understand the demand for services, where there might be gaps or deficiencies in services. It will drive staffing models.” But there is a lot of work to be done before EHR systems will truly be able to capture the nuances of real-world practice, says Alma Rodriguez, MD, vice president of medical affairs at MD Anderson.“One challenge has been to get [EPIC] to understand that we are multidisciplinary,”she says.“They are hung up on needing a primary care provider; in a cancer institution there are lots of different providers, all in it together. Another challenge is that in an interprofessional practice model the PA and I are tied at the hip. It is often hard to tell who should be billing for a particular service.” “They were able to make some customizations but this has been very challenging for them,”Rodriguez added.“We will see how it goes; we should have some meaningful data in a few months.” AAPA also has a work group of PAs and staff devoted to this specific issue. The EHR Work Group is developing educational materials aimed at both PAs and EHR vendors. The materials for PAs will be designed to help PAs understand the importance of proper EHR utilization and give them talking points for discussions with colleagues, while those for vendors will explain the value of identifying all health professionals who treat patients in order to promote transparency and accountability and to help identify quality teams. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 33 
  • 36. Sharing in the Savings Making sure that PAs are present in the data will likely become even more important as healthcare systems and payers move further towards shared savings and other alternative payment models, even if the day when PAs will share in these savings is likely still some way off. “These discussions are very nascent,”Shock says.“Even the physicians haven’t figured out yet how to share the dollars. I don’t know of any model where the PA is getting any of the shared savings.” “Absolutely we are heading towards a place where quantifying value will affect PA incomes,”Ogunfiditimi says.“But the effect of PAs being hidden in the data is probably more personal than related to payment at this point. As a profes- sional you want to know how you are contribut- ing to the organization. And as healthcare evolves more toward a focus on quality it will become more and more essential for PAs to be represented. It is going to be incumbent on all of us to really quantify the work of PAs and to link it to quality and patient satisfaction.” “It is hard to tie payment to PA salary at this point,”Pysell says.“In my experience salaries will lag behind the performance. We need to look at how to identify value first and then look at compensation.” Creating the Future Uncovering the hidden value of PAs will only become more important as reimbursement continues to move toward payment for value rather than volume, say PAs interviewed for this story. And this makes it imperative for them to be involved in laying the groundwork as health systems and prac- tices begin to write the rules that may soon link how providers are paid to the data they are collecting. “The shift to value-based reimbursement is driving this,”Pysell says. “And this presents a huge opportunity for PAs to shine a spotlight on the value-added work they do that is not usually part of the process. I’m a firm believer that the best way to predict the future is to create it.” “Get involved,”Pysell adds.“Take some time to get to know the finance people and the leadership in your institution. Make sure that when the idea of measuring the cost of healthcare starts to take hold, PAs have input into that. Approach leadership with something to add. Bring value and the money will follow.”  STEVEN LANE, MA, MPP is senior writer for AAPA and managing editor of PA Professional. Contact him via email or 571-319-4364. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 34 
  • 37. Learning Central. Connect learning with life. Identify your knowledge gaps, improve your practice and earn AAPA Category 1 Self-Assessment CME credit at the same time. Find approved activities in a variety of specialties, many free or discounted to AAPA members – all in Learning Central. FREE for PAs: Talking to Your Patients about Their Weight: A Self-Assessment Approach Earn up to 20 Self-Assessment credits with American College of Physicians’ Medical Knowledge Self-Assessment Program (MKSAP 17) April 24-30 is World Immunization Week! eCase Challenge: Optimal Immunization Strategies in Adults Under 65 LEARN HERE
  • 38. 2016 AAPA Awards Recipients Announced Congratulations to This Year’s Awardees BY SARAH SONIES T he AAPA Awards Committee in March announced the recipients of the 2016 AAPA Awards. These awards are the highest recognition bestowed on Academy members and are awarded to PAs who have distinguished themselves in service to patients, their community and the PA profession. The 2016 AAPA Award recipients are: AAPA/PAEA PRECEPTOR OF THE YEAR Maureen Barrett, MPAS, PA-C Preceptors hold the keys to the future of the profession as they guide the clinical education of the next generation of PAs. The preceptor award recognizes those who demonstrate a commitment to excellence in the clinical edu- cation of PA students as mentors and instructors. As the chief PA for Bethlehem, Pa.–based St. Luke’s University Health Network, Maureen Barrett, MPAS, PA-C, approaches her role with determination and passion, mentoring tomor- row’s PAs in eastern Pennsylvania and western New Jersey, where she over- sees administration for rotations on all six Saint Luke’s campuses and out- patient centers. Barrett has demonstrated great advocacy for the PA profession through her leadership in establishing a PA shadowing internship program, allow- ing high school and undergraduate students to rotate with PAs in the Saint Luke’s network through all aspects of practice, providing each student with more than 70 hours of shadowing time. AAPA MILITARY SERVICE PA OF THE YEAR Col. Rene’ Chadwell, U.S. Air Force, MPAS, PA-C The PA profession has its roots in the military and this award honors that heritage and the commitment of military PAs to exemplary healthcare service in their community, to current members of the military or veterans and their families, and to the medically underserved at home and abroad. Col. Rene’Chadwell, U.S. Air Force, PA-C, is being recognized for her work in advancing military healthcare services and commitment to patient care, patient education and community health promotion. A leader in the Air Force and PA education communities, she served as an OB/GYN preceptor for future PAs and developed a preventive care tracking, training and AAPA AWARD RECIPIENTS PA Maureen Barrett PHOTOCOURTESYOFMAUREENBARRETT PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 36 
  • 39. AAPA AWARD RECIPIENTS, continued education system that significantly decreased health risks for female patients in her community. A skilled medical readiness officer, Chadwell has made a positive impact in public health and service in more than 40 countries around the world. Requested by name for assignment to the Pentagon, Chadwell was selected to serve in the Health Services Support Division of the Pentagon, where she was the medical lead for the Chairman of the Joint Chiefs of Staff’s Wounded Warrior Task Force, spearheading $243 million in legislative proposals in support of 38,000 wounded or killed servicemen and women and their families. As chief PA consul- tant to the Air Force Surgeon General, Chadwell has distinguished herself as an outstanding clinician, military officer and healthcare leader. AAPA PUBLISHING AWARD Alicia Quella, PhD, MPAS, PA-C One of the pivotal ways in which PAs can effect change in healthcare is to harness their inner curiosity and uncover new ideas through research and publishing. The publishing award is given to a PA who has published a new clinical or research article expressing original or scientifically rigorous ideas. Quella did just this and is being recognized for her in-depth analysis of PA compensation and the influence of PAs and NPs on the healthcare market in her article,“Physician assistant wages and employment, 2000-2025.” Published in the Journal of the American Academy of PAs, Quella’s analysis highlights the growth of the profession and found the future of the PA profession promising in terms of employment and wages, with PA wage increases projected to consistently exceed inflation rates for more than a decade. AAPA will honor these extraordi- nary PAs during the AAPA Confer- ence 2016 General Session. Look for profiles on this year’s recipients in the May issue of PA Professional. Congratulations to all 2016 AAPA Award recipients!  SARAH SONIES is AAPA’s manager of online communications and a staff writer for PA Professional. Contact her via email or 571-319-4485. Col. Rene’Chadwell PA Alicia Quella PHOTOCOURTESYOFALICIAQUELLA PHOTOCOURTESYOFRENE’CHADWELL PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 37 
  • 40. • Give back locally and globally • Improve community health • Inspire and support the next generation of PAs • Engage patients in their own healthcare Support your PA Foundation and empower PAs to: See what the power of you can do. Donate today! pa-foundation.org/powerofu
  • 41. PROFESSIONALPRACTICE PA, Heal Thyself Setting Boundaries, Being Mindful the Keys to Wellness and Burnout Prevention B Y J E N N I F E R A N N E H O H M A N W hat does it mean to practice medicine in a healthy, sustainable way, one that promotes the well-being of your patients and also yourself? How can you prevent the main symptoms of burnout—exhaustion, depersonalization and discourage- ment—from eroding your career and personal well-being? From my discussions with PAs, I’ve learned that burnout comes mostly from unsustainable schedules and from a feeling of being taken for granted or unable to offer per- sonalized medical care to patients. Given their dedication to patients and to team practice, it is easy for PAs to over- commit, overextend and even to be exploited by unethi- cal employers. One way of making any position healthier is through diligent contract negotiation—to help ensure a fair and sustainable work arrangement. Step one in burnout prevention is careful assessment of both the contract and practice culture offered by an employer. Ask yourself: On the whole, is this a place where I can practice in balanced manner? Do the physicians I’ll be working with seem to be doing so? Finally, given the centrality of quality working relation- ships to PA practice, if you are unable to make the neces- sary changes and find yourself working with seriously negative practice partners, who are perhaps burned out themselves and have become either absent or abusive in their collaborative style—move on. Being in a toxic clinical partnership is an express route to burnout. Take Care of Yourself An important key to a healthy career is cultivating a healthy life beyond clinical practice. Amid the demands of work, how well are you taking care of your own wellbeing in terms of diet, exercise, sleep, and time for family and the interests outside of your practice that engage and inspire you? Are there ways you can commit to improvements in these areas, even sharing your journey with patients when appropriate? Beyond these basic pillars of health, a new practice in medicine offers a vital new way to practice optimally and prevent burnout: mindfulness. Mindfulness has been 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  |  APRIL 2016 |  AAPA.ORG | 39 
  • 42. PROFESSIONAL PRACTICE | continued described as the intentional cultivation of a nonjudgmental, attentive state of mind that enhances all interactions, including those between provider and patient. How might it apply to and benefit PA practice? PAs’attentive, empathic listening skills—inculcated during PA education and put into practice every day—are appreciated as an empowering, healing force by patients and offer a model of interaction for the healthcare system. Many of the skills and attitudes identified with mindfulness lie at the heart of the PA approach to medicine: My clients tell me that connecting personally with patients and acting as their trusted health advocates is key to their professional satisfaction—and also what makes the frequent frus- trations of working within a far from ideal healthcare system worthwhile. Mindfulness brings a new awareness of the subjective dimensions of practice—the need for both PAs and physicians to have the resources they need to be present, cultivate calmness and offer compassion to self and patient. This is an exciting development in the culture of medicine and one that PAs may be uniquely qualified to lead as the profession gains new levels of recognition. As communication, compassion and respect are increasingly understood as keys to effective practice, PAs, already grounded in these principles, are well placed to promote them in the world of medicine. It is my hope that in this area, as in others, PAs will be the standard bearers for a more humane and progressive way of practicing medicine. At a practical level, mindfulness and other wellness promotion efforts can only help you preserve vital resources—of energy, clarity of mind, and positivity that are essential to the demanding work of being a PA. There is a wealth of online resources for medical providers interested in exploring mindfulness. One of the most comprehensive, featuring videos and interactive exercises, has been collected for clinicians at the University of Wisconsin Department of Family Medicine and Community Health’s Mindfulness in Medicine program. This program was created to“support the well-being of health care practitioners, residents, medical students, patients, and others through mindfulness, and investigate how mindful- ness training influences compassion, joy, career satisfaction, and resilience of clinicians”and is well worth a visit. I hope that readers who may be expe- riencing burnout or feel on the cusp of doing so will avail themselves of these resources as well as remember that they deserve to have healthy and happy careers. ADDITIONAL WELLNESS AND MINDFULNESS RESOURCES FOR PAs Harvard Pilgrim Health Care Burnout Resources for Providers U Mass Medical School Center for Mindfulness in Medicine, Health Care and Society Goodness of Heart Resources on Clinician Wellness PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 40 
  • 43. INPRINT Short-term Memories A Review of “Permanent Present Tense: The Unforgettable Life of the Amnesic Patient, H.M.” B Y J O H N W . “J J ” J E N K I N S , PA - C T he story of H.M., or the late Henry Molaison, is a fascinating tale about one man’s surgical misfortune turned long-running scientific investigation. It is the story of a man whose memory was stolen and a lifetime forgotten. Recently this story was turned into a book, by Suzanne Corkin, a neuroscientist at MIT who studied Molaison for nearly 50 years. Corkin deftly combines the personal and the scientific, weaving a beautiful tale about the science and the man. Her articulate nature and attention to detail allows the reader to join in her memoir,“Permanent Present Tense: The Unforgettable Life of the Amnesic Patient, H.M.”I highly recom- mend the audio version of the book, as the folksy voicing of Molaison adds another element to the experience. Henry Molaison lived a life like no other human in history. He had a relatively normal childhood, but was plagued by epileptic seizures. In his late 20s he saw a neurosurgeon who recommended surgery to alleviate his condition. Sadly, the procedure, a bilateral medial temporal lobectomy and removal of a portion of his hippocampus, resulted in permanent loss of his long-term memory. This meant that from the day of his surgery in 1953 to his death in 2008 he was unable to remember almost anything (with very few exceptions) for more than 20 or 30 seconds. An even more bitter reality was that it did not cure his epilepsy. Scientific interest in Molaison developed early on and actually still persists today. Corkin’s experiments and studies provided a wealth of information JOHN W. “JJ” JENKINS, PA-C, works in general and vascular surgery at Aurora Baycare Medical Centerin Green Bay, Wis. He is a Wisconsin Army National Guard PA and a 2014 graduate of the Carroll University PA Program. Contact him by email. PA PROFESSIONAL  |  APRIL 2016 |  AAPA.ORG | 41 
  • 44. IN PRINT | continued about not only H.M., but how the human brain functions and the struc- tures necessary for various processes. Her lab developed tests that helped to map the human brain and determine pathways that had never been studied or understood before. With the advent of brain imaging, initially with computerized tomography and later magnetic resonance imaging (MRI), specifically functional MRI, they were able to observe the activity of various brain structures during actual experiments. H.M.’s final and most permanent contribution was the post mortem donation of his brain to science. In the first 24 hours after his death, extensive MRI studies were done on his brain and extremely fine slices of it were sent for pathologic analysis. One aspect of the book I found especially pleasing was the vivid imagery and colorful language Corkin used to describe her interactions with Molai- son. She painted beautiful word pictures of the experiments her team con- ducted and the responses Molaison gave each time. She captured both the trees and the forest in broad strokes with finely timed crescendos and decrescendos, culminating with strokes of insight. The astonishing thing is that no matter how many times a given experiment was conducted or repeated, Molaison would never remember. Likewise, he never remem- bered Corkin. When she would ask if they had met, which she did many times over the years, he would respond,“Yes. From high school.”This was despite an almost 20-year age difference between them. At times the book can get too dense and cerebral. The extensive, thor- ough explanations of some of the experiments can be distracting and even caused me to lose interest at times. For some readers, these detailed expla- nations may be desirable, but to me they pull us away from the story of Henry as a person and toward the tale of H.M. the science experiment. By the end of the book, though, you will feel like you have been there by Corkin and Molaison’s side for the whole journey, and that the journey was on the whole worthwhile. You will be saddened to hear of his death, but relieved that his suffering is over. You will certainly close up the text and pass it off to someone, recommending it for almost any reader. Hopefully, when you finish, you aren’t asking,“What was that all about?”Enjoy. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 42 
  • 45. REFLECTIONS The Blessing and Burden of Flexibility A Guide for New Grads on How to Choose Your Specialty B Y V E R D A L E B E N S O N , PA - C W hile providing mentorship to a PA student recently, I was asked whether he should ini- tially pursue a primary care job to solidify his medical foundation before entering a specialty field. I found this to be a great question that I’m sure many soon- to-be graduates are pondering. Reflecting on the ques- tion, I realized how the flexibility of our profession could feel like both a blessing and burden at times. Bottom line up front: Pursue the specialty you are pas- sionate about. My advice to new PAs is to get into the specialty for which you have the most passion early in your career and rise within it so that you can maximize your growth in that specialty over your career. The knowledge and experience you gain will grow every year and that will increase your market value. The concept is very similar to starting a financial savings plan early in life to maximize the effects of compound interest. Practicing PAs know that your education isn’t nearly over once you graduate from school. As a new graduate work- ing in a specialty or even in primary care, you’ll still have to read up on disease states and best treatment practices. My experience has been that your collaborating physicians will train you to practice as they do, so the sooner you get into the niche, the more you will know about what you love to do! I will say that broadening your general medicine roots isn’t a bad move, if that is what you want to do initially. It is how I started my PA career. But I would caution that you should do it because you genuinely want to practice in primary care and not for a potential future benefit. The return on invested time might not be worth it, depending on how you are utilized in a specialty practice. A good grounding in broad medical knowledge will always be useful, though, and career paths can often take unexpected turns. Early in my career, I entered the Atlanta VERDALE BENSON, PA-C, is a 2012 graduate of the Emory University PA program. He completed a residency in primary care with a focus in the patient-centered medical home (PCMH) model. He currently practices emergency medicine at Memorial Medical Center and resides in the San Francisco Bay area. Contact him by email. PA PROFESSIONAL  |  APRIL 2016 |  AAPA.ORG | 43 
  • 46. REFLECTIONS | continued Veterans Affairs PA residency program to broaden my medical knowl- edge—in order to be a better job candidate and solidify a path into the Veterans Affairs organization. Later, a private practice position in orthope- dics opened up in the area I wanted to relocate to and I chose to explore that opportunity. Then, while in orthopedics, I realized that I wanted to practice a broader scope of medicine to better utilize my advanced train- ing and found that emergency medicine fulfilled that need, along with a more flexible schedule. So I have recently transitioned to emergency medi- cine and have been able to pull from my general medicine experience working in that specialty. But maybe I would have learned those pearls anyway if I had started out in the specialty. Preparing for PANRE This debate also has implications for the PA National Recertifying Examina- tion (PANRE). We have all heard stories of specialty PAs failing the boards because they have only practiced in one field. But while having to study for the PANRE is a burden that all specialty PAs will have to bear, general medi- cine PAs are not immune from the hardship. Even primary practices vary based on population or location, which can mean that certain types of cases or patients are not seen very often, and that certain topics will require review. Whatever the situation, it will behoove every PA to stay abreast of current general medical practices so that when the PANRE comes up, you aren’t trying to catch up from years of not applying that information. This is one reason for continuing medical education activities. While pondering this debate, I looked at the possible influence of our physician colleagues and their residency training. Physicians who branch into specialties such as cardiology or gastroenterology have to train in internal medicine before attending their fellowships. And since PAs are trained in the medical model, and were originally intended to help supple- ment the primary care workforce, it may be that our profession’s origin influences some PAs to feel they need to have primary care experience in order to establish a successful career. This model doesn’t translate exactly into the PA profession, however, particularly with those entering into surgical specialties. The truth is, most of us forget what we don’t actively practice on the job. That goes for all of us, including physicians! Most PAs likely will have to study before the PANRE regardless of what specialty is practiced. As PAs, it is our blessing and burden that we have the freedom to change specialties, but we will always be held responsible for the knowledge that flexibility entails. I think this is a great problem to have. I love knowing a lot about many subjects and while I might not be an expert, I can have an intelligent con- versation on most medical topics. This is one of my joys and what helped draw me to the PA profession. So, pursue what you have the most interest in! If that is primary care, then great! If it is urology, then great! Either way, you’ll always have to know a little about everything, so keep your knowledge base up so that when the PANRE comes around, you won’t sweat it. PA PROFESSIONAL  |  APRIL 2016  |  AAPA.ORG | 44