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J A N U A R Y 2 0 1 6

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ContentsJ A N U A R Y 2 0 1 6 • V O L . 8 , N O . 1
Departments
President’s Letter
Pushing the PA profession forward
Laws+Legislation
Helping patients navigate end-of-life decisions
Payment Matters
The value of PA recognition in the Medicaid program
STAT
Bass introduces PA education bill | Call for AAPA
Awards nominees | Breastfeeding and high-risk
pregnancies | Screening for Hep C in prisons | Join
Huddle | Take A Stand Initiative | Constituent Beat—
DermCare Team update and more.
Clinical Alert
Promoting antibiotic stewardship
Professional Practice
Assessing a job offer
Reflections
Five tips for new PA grads
5
11
16
8
37
40
43
Features
C O V E R S T O R Y
From Physician Assistant to PA
Great Progress Is Being Made on AAPA’s Initiative to Use PA
F E AT U R E S T O R I E S
Resolve to Make 2016 a Year of Leadership
and Advocacy
Sign Up for Next Month’s LAS and Learn How to Lead
PA Executive: Javier Esquivel-Acosta
Increasing Access to Care From a Leadership Position
Retail Clinics: An Opportunity
for PAs and NPs to Work Together
Q&A With MinuteClinic Chief Nurse Practitioner Officer Angela Patterson
23
14
28
33
AAPA’s Navigating Healthcare
Look for AAPA’s Navigating Healthcare icon to read
stories on the Affordable Care Act and the
broader changes impacting PAs in this rapidly
changing healthcare environment.
Visit us at aapa.org to see what else we
are doing for you.
PA PROFESSIONAL | JANUARY 2016 | AAPA.ORG | 1

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
Set Sail
explore 1,000+ jobs today
www.PAJobLink.com

© 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
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MANAGING EDITOR
Steven Lane
slane@aapa.org
GRAPHIC DESIGNER
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CLASSIFIED AND DISPLAY ADVERTISING SALES
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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 1 | J A N U A R Y 2 0 1 6
AAPA.ORG

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PRESIDENT’SLETTER
Pushing the PA Profession Forward
A
s we start off 2016, I feel the need to pause and
recognize the important progress our profession
has made, particularly in the last year. Do we
have more to overcome and accomplish? Of course, but it
is important to recognize that we have an incredible foun-
dation to work from, built on the commitment, passion
and determination of the PA community. We need that
groundswell to continue pushing forward to accomplish
even more this year and beyond. But it’s not easy. Nothing
worthwhile ever is.
A few months ago I had an“a-ha!”moment. I was on
Capitol Hill discussing legislation related to our profession
and some of the challenges it faces when it dawned on
me that this takes more work than I realized! Even though
I’ve been involved in PA issues for decades, it wasn’t until
I became president that I realized how much planning,
strategizing and elbow grease our leaders, volunteers and
staff put into keeping the profession moving forward.
I now intimately understand the incredible amount of
effort it takes just to keep the profession on pace with
healthcare changes—let alone achieving these great wins
on so many fronts. And 2015 has been a great year for wins.
Last year, 49 states and the District of Columbia made a
total of 201 PA-positive changes. We also achieved univer-
sal adoption of the first one of our“Six Key Elements of a
PAs and PA students discuss issues affecting PAs at AAPA’s Leadership and
Advocacy Summit.
PHOTOBYFREDGREAVES
PA PROFESSIONAL | JANUARY 2016| AAPA.ORG | 5

PRESIDENT’S LETTER | continued
Modern PA Practice Act”—using licensure as the standard regulatory term.
And we’ve seen the profession receive tremendous recognition with the place-
ment of several educational, high-profile media stories, as well as being named
the No. 1 job in America by several national publications. We’ve done all this
while providing 155,731 CME credits to PAs and launching our brand new
Center for Healthcare Leadership and Management.
We will continue to make strides in many areas this year, including updating
the“physician assistant”name. This year the AAPA board and I have made a
strong commitment to using only our initials—PA—to describe our profession.
To learn more about this important undertaking, I encourage everyone to read
“From Physician Assistant to PA,”right here in this month’s PA Professional (see
page 23).
With this momentum, 2016 will be a watershed year for the PA profession
and a great time to kick off our brand new strategic plan, which we will unveil
shortly. I want to express my thanks to so many of you who have helped create
this plan, from our PA leadership volunteers to our AAPA staff and the hundreds
of PAs around the country who shared their ideas with us. We have put a lot of
thought into the future of the profession and the new plan includes some very
ambitious goals. I can’t wait to share more of the details with you, but in the
meantime don’t forget to use PA, the name we all trust.
Jeffrey A. Katz, PA-C, DFAAPA
AAPA President and Chair of the Board
PAs and PA students advocating for the profession on Capitol Hill.
PHOTOBYJOHNNELSON

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LAWS+LEGISLATION
ADAM S. PEER, is an AAPA director
of constituent organization
outreach and advocacy. Contact
him via email or 571-319-4314.
MOLSTs Are Emerging
as Important Documents
PAs Need to Help Patients Navigate End-of-Life Decisions
B Y A D A M S . P E E R
A
medical order for life-sustaining treatment or
MOLST (also known as a physician or provider
order for life-sustaining treatment, or POLST) is an
approach to end-of-life care that emphasizes a patient’s
wishes about the care they receive. It is an emerging area
of medicine and the law. For patients with a serious illness,
creating a MOLST with their provider is an important way
for patients to reach important end-of-life decisions and
ensure that those decisions are honored.
Intended to complement and implement an advanced
directive, a MOLST is a medical order on a standard state
form that communicates to all health professionals
whether the patient wants CPR performed, medical inter-
vention or artificially administered nutrition.
Providers are central to the process of creating MOLSTs
with patients. Patients (and their families) need a pro-
vider’s knowledge and experience to guide their decision-
making. Once a patient’s healthcare goals and preferences
have been articulated, the provider creates and executes
the MOLST as a medical order. A MOLST may also be cre-
ated with the help of a patient’s healthcare representative
(typically designated in the advance directive) if the
patient has already lost capacity. MOLSTs are valid in all
healthcare settings.
It is not uncommon for a PA to be the provider guiding a
patient and their loved ones through this process. As that
provider, it is critical that PAs be authorized to execute
these forms and not have to involve another provider to
sign the form. AAPA, in partnership with state constituent
organizations (COs), have made great progress in ensuring
that PAs are included in state MOLST laws. Here are some
recent examples:
■ Connecticut passed legislation (S. 413) in 2014 to estab-
lish a pilot program implementing the use of medical
orders for life-sustaining treatment. The bill authorizes
PAs to write the orders and sit on the advisory group.

LAWS+LEGISLATION | continued
■ California enacted legislation (A. 637) in August 2015 that authorizes
both PAs and nurse practitioners to create a valid POLST.
■ Georgia enacted legislation (S. 109) in July 2015 that allows healthcare
providers to create a POLST. Healthcare provider is defined to include PAs.
■ Maryland adopted a regulation (COMAR 10.01.21.02 to .04) amending
the medical orders for life-sustaining treatment to reflect a 2013 statu-
tory change that authorized PAs to sign MOLST forms.
■ Illinois amended its existing POLST laws (S. 3076) in August 2014 to
include PAs in the definition of practitioners that may create a POLST.
■ New Hampshire created the POLST Registry Act (S. 213) in August 2014
that also authorizes PAs to execute POLSTs.
If your state is considering enacting or amending a MOLST statute or
rule, be sure to be a part of the process early. State legislatures and agen-
cies often create an advisory committee comprised of health, legal and
government representatives to draft language creating or amending
MOLST laws. Often, these will be the same individuals that will help imple-
ment a MOLST law. Be sure to educate and engage these people about the
role PAs have in healthcare as well as in end-of-life decisions. Be prepared
to dissuade stakeholders from additional PA-related requirements like
additional CME or cosignature requirements that do not apply to any other
provider executing a MOLST.
Of course, the best way to engage members is to actively pursue adding
a PA to be a member of the advisory committee.
As always, AAPA’s Constituent Organization Outreach and Advocacy
(COOA) department is eager to assist COs interested in improving state
MOLST and POLST laws or PA practice acts.
An Advanced Directive
■ Is for adults
■ Provides instruction for future treatment
■ Appoints a healthcare representative
■ Does not guide emergency medical personnel
■ Guides inpatient treatment decisions
A Medical Order for Life-Sustaining Treatment
(MOLST or POLST)
■ Is for persons with a serious illness at any age
■ Provides medical orders for current treatment
■ Guides actions by emergency medical personnel when made available
■ Guides inpatient treatment decisions when made available
Source: National POLST Paradigm online.

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PAYMENTMATTERS
Time to Enroll PAs in Medicaid
The Value of PA Recognition in the Medicaid Program
B Y T R E V O R S I M O N
M
edicaid is a federal and state joint insurance pro-
gram focused on helping low-income residents
gain access to healthcare. While federal law pro-
vides a blueprint for patient eligibility and covered services in
Medicaid, many details of the program are left to the purview
of the states. The option to enroll PAs is among those deci-
sions left to the states.
As various stakeholders have different definitions of this
term, it is important to indicate what we mean when we use
the word“enrollment.” To AAPA, enrollment is the ability of
PAs to submit claims using their own name and National Pro-
vider Identification (NPI) number, rather than under the physi-
cian’s number, to indicate that they rendered a service. (It is in
this sense that the word is used throughout this article.)
As we move into 2016, it’s important to take stock of recent
advancements and to recognize the work still to be done
regarding PA recognition by major health programs such as
Medicaid. Generally, PAs are covered when providing services
to Medicaid patients in all 50 states and the District of Colum-
bia (D.C.). However, in some states those services are not
attributed to PAs because of the requirement to bill the ser-
vice under the name of the collaborating physician. AAPA is
working with state chapters and Medicaid agencies in certain
states to bolster the recognition of PAs’contributions to the
Medicaid program by having all PAs enrolled in their respec-
tive state Medicaid programs.
Every year, more states enroll PAs. Currently, 38 states
require, or have announced that they will require, enrollment
of PAs in their Medicaid program, and this number is
expected to grow. Four states made this commitment in 2015.
Active efforts are underway in the majority of the remaining
12 states and D.C. to convey to state Medicaid agencies the
importance and advantages of PA enrollment. In addition,
language in the Affordable Care Act requiring the enrollment
of ordering and referring providers in Medicaid, as well as
subsequent regulatory actions by Centers for Medicare and
Medicaid Services (CMS), makes clear the federal govern-
ment’s prioritization of increased transparency in knowing
who is actually delivering care.
So why have some states yet to permit the enrollment of
PAs in their respective Medicaid programs? One reason can
be a simple misunderstanding of what PA enrollment would
TREVOR SIMON is AAPA
assistant director, regulatory
affairs. Contact him via email
or at 571-319-4405.

PAYMENT MATTERS | continued
mean. The enrollment of PAs does not increase costs for a state’s Medicaid
program or duplicate services, as some state Medicaid agencies may
believe. It is important for states in which PAs are not enrolled to under-
stand that PAs are already providing services, but billing under the physi-
cian’s provider number. In addition, it is important that they understand
that if PAs were enrolled, payment would continue to go to the employer
as the“billing provider,”with PAs being recognized as the“rendering
provider.”
Another reason some states have yet to make the change is that there
is a need for more understanding of the benefits of PA enrollment, both
to the Medicaid program and to patients. Some of these benefits are
described briefly below:
■ Accountability: When PAs are not enrolled in their state’s Medicaid pro-
gram, they are“hidden providers”as they bill under the physician. This
arrangement prevents patients, regulators, employers and legislators
from knowing which healthcare professional is accountable for providing
a patient’s care.
■ Transparency: Because PAs are hidden providers when not enrolled,
potentially inaccurate data might be used by policymakers regarding
workforce studies and in determining whether a Medicaid program has a
sufficient number of appropriate health professionals in its network. In
addition, accurate data allows for incentives such as bonus payments for
electronic health record utilization to be provided to the correct health
professionals.
■ Benefits to patients: The value of PA enrollment to patients can be seen
in many ways. The first is through quality improvements brought about
by documentation that can help improve adherence to quality metrics.
The second is through reduced patient confusion due to increased speci-
ficity and accuracy when the provider listed on billing records is the
same as the health professional who actually provided the care. Finally,
enrollment of PAs in Medicaid ought to lead to the listing of PAs in pro-
vider directories. This clear identification of health professionals locally
delivering care would make it easier for patients, especially those in
underserved communities, to find care options in a time of worsening
physician shortage.
The occasional lack of awareness surrounding the benefits of PA enroll-
ment in some state Medicaid programs underscores the importance of the
actions of individual PAs, state chapters and AAPA in educating stakehold-
ers on the value of PA recognition and taking steps toward achieving
enrollment. All stakeholders who value transparency, accountability and
increased access for patients stand to benefit from PA enrollment in state
Medicaid programs and all other payer systems.
PHOTOBYADAMHUNGER

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ARV6JVWB AD-11-14-0122.A
American Academy of Physician Assistants members:
References: 1. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Physician Assistants, on the Internet at http://www.bls.gov/ooh/healthcare/physician-assistants.
htm (visited March 05, 2015). 2. Expanding Access to Primary Care: The Role of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives in the Health Center Workforce. National Association of Community
Health Centers website. http://www.nachc.com/client/documents/Workforce_FS_0913.pdf. Accessed November 11, 2014. 3. NSAIDs and Renal Toxicity in the Community Setting. The Institute for Continuing Healthcare
Education website. http://www.iche.edu/pain2/ painarticle2.pdf. Accessed November 11, 2014. 4. Alliance for the Rationale Use of NSAIDs. Data on file. 5. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley
TJ, et al. Adverse drug reactions as a cause for admission to hospital: prospective analysis of 18 820 patients. BMJ 2004;329: 15-9. (3 July.) ©2015. Western Pain Society. All rights reserved.
Together, we’re making
NSAID use safer.
MEMBERS OF THE ALLIANCE INCLUDE
SUPPORTED BY
The demand for physician assistants (PAs) and
their primary care services has never been higher.
Approximately 40,000 PAs in the United States
practice primary care.1
By utilizing staffing models
that include PAs, health care facilities are better
able to offer patients access to comprehensive
primary and preventative care services.2
A common but challenging condition managed in
primary care is pain. Perhaps more than any other
condition, pain may be managed by the clinician
and/or by the patient, which can compound care.
For example, many patients take over-the-counter
(OTC) non-steroidal anti-inflammatory drugs
(NSAIDs) to manage pain, and clinicians may be
unaware of OTC NSAID use. NSAIDs represent
approximately 60% of OTC analgesic agents used
in the United States.3
In addition, approximately
5% of the US population uses a prescription
NSAID.4
Although NSAID use is ubiquitous, many
patients are unfamiliar with the class name and do
not know which products are NSAIDs or contain
NSAIDs in combination with other agents.4
Data on
national patterns of NSAID use show that 26% to
44% of individuals are consuming more NSAIDs
than they should.3,4
In addition to individual risk
stratification, the medical literature demonstrates
that NSAID-related adverse events are dose and
duration dependent, and there are potentially
serious risks associated with their improper
use. For example, a British study concluded that
12% of medication-related preventable hospital
admissions were related to use of NSAIDs.5
These facts place primary care clinicians, like PAs,
at the critical intersections of diagnosis, treatment,
and patient education. It is important for all HCPs,
including PAs, to educate patients about how to
take NSAIDs in a responsible way that provides
a therapeutic benefit while minimizing risks. This
means that PAs not only need to know how to
manage pain but also must make sure they ask
the questions and get the information needed
to make sound decisions and best educate their
patients. Asking about how patients manage pain
and making NSAID use a standard part of any
medication history and reconciliation process can
lessen the likelihood of a serious NSAID-related
adverse event. Similarly, reminding patients to
take one NSAID at a time at the lowest effective
dose for the shortest duration of time required can
help ensure the safest and most appropriate way
to manage pain with OTC or prescription NSAID
medications.
To address this important issue, the Alliance for
Rational Use of NSAIDs is proud to announce that
it is partnering with the American Academy
of Physician Assistants (AAPA) over the
coming months to offer a comprehensive NSAID
awareness program with educational resources
and patient support materials.
When recommending NSAIDs,
advise your patients to:
The Alliance for the Rational Use of NSAIDs – A Public Health
Coalition – aims to bridge the gap between guidance and clinical
practice, educating health care professionals and the public at
large to ensure appropriate and safe use of NSAIDs.
To download educational materials and learn more about the Alliance
for Rational Use of NSAIDs, visit www.NSAIDAlliance.com.

Resolve to Make 2016 a Year of Leadership and Advocacy
Sign up for Next Month’s LAS and Learn How to Lead
B Y P E N N Y G A I L L A R D , C A E
The current healthcare landscape requires bold leadership from professionals
who possess a vision for the future and the ability to implement positive change.
PAs must be the leaders who set the direction and lead that change!
So sign up now to attend AAPA’s premier leadership event, Leadership and Advo-
cacy Summit (LAS), Febrary 4 – 6, in Arlington, Va. This event will equip attendees
with the tools and information to become transformational leaders and PA advo-
cates and is open to all current and future PA and student leaders. Attendees can
build on established skills or create the founda-
tion for future leadership.
Join your peers on Thursday, February 4, for a
full day of interactive PA advocacy training where
attendees will be briefed on federal issues and
participate in role play to gain confidence in deliv-
ering the PA message during afternoon meetings
on Capitol Hill. AAPA makes it easy by coordinat-
ing visits with lawmakers and staff, and assisting
throughout the process.
In addition to Hill visits, this 2.5 day event
includes a diverse, multitrack program with topics
ranging from“Optimizing State Laws for New
Models of Care”to“Recruitment and Retention of
PA and Student Members: Lessons Learned.”On
Friday, Feb. 5, AAPA President Jeffrey A. Katz, PA-C, DFAAPA, and AAPA CEO Jennifer
L. Dorn will provide a welcome address. Tara Koslov, deputy director, Federal Trade
Commission (FTC), Office of Policy Planning (OPP) will provide a timely presenta-
tion,“Promoting Health Care Competition Through Advocacy and Enforcement.”
Learn how the recent decision of the U.S. Supreme Court, in North Carolina Board
of Dental Examiners v. Federal Trade Commission, may affect PAs and constituent
organizations. On Saturday, Febrary 6, join another special session,“Breaking Into
and Sustaining Leadership–Getting There and Staying There,”facilitated by Dorn,
where attendees will benefit from the experiences of several successful corporate
and nonprofit leaders.
New this year, LAS offers three contiguous breakout sessions, grouped under
the umbrella of“Strategic Priorities: Tackling the Issues That Matter Most for PAs.”
During each of the three one-hour sessions, attendees will discuss a unique and
specific professional challenge. Designed for those with questions, ideas and a
vision for the profession, attendees are encouraged to participate in these highly
interactive discussions.
This program is being planned in accordance with AAPA’s CME Standards for
Live Programs and for Commercial Support of Live Programs. Request will be made
for a maximum of 13.5 hours Category 1 CME credit. Review the full agenda and
register by January 20 for this informative and educational event. Make 2016 the
year for igniting your leadership and advocacy spirit!
Former
Congressman
Lee Terry at
LAS in 2015
PENNY GAILLARD, CAE, is AAPA director of
constituent organization outreach and advocacy.
Contact her via email or 571-319-4434.
PHOTOBYJOHNNELSON

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Means More!

STAT | Industry News
BASS INTRODUCES PA EDUCATION BILL
U.S. Rep. Karen Bass, PA, (D-Calif.) recently intro-
duced two pieces of legislation to expand the schol-
arships available for quali-
fied students and ensure
that PAs are working in the
parts of the country where
they are most needed.
“PAs across the nation are
providing high quality
healthcare to patients in
both our largest cities and
in America’s most rural
areas,”said Bass, the only PA
ever elected to Congress.“In
the next decade the demand for PAs is only going
to increase and Congress needs to act today to
make sure that we have the qualified healthcare
professionals ready to meet the growing need.”
H.R. 3943, the Physician Assistant Education Public
Health Initiatives Act of 2015, would, according to
Bass’s website,“expand scholarships for PA students,
authorize a loan repayment program for PAs who
spend at least two years in the classroom educating
PA students or working in medically underserved
areas or community health centers [and] fund
research into PA education and help educational
institutions develop full-time PA faculty members.”
A companion bill, H.R. 3944, the Physician Assis-
tant Higher Education Modernization Act of
2015, will seek to“expand PA education programs
for institutions that serve rural areas, make Histori-
cally Black Colleges and Universities eligible to
receive additional grants for PA education programs,
and provide funding to colleges and universities to
improve the faculty and modernize technology at
institutions that are educating and training PAs.”
FLUOROSCOPY PERMIT NOW
AVAILABLE FOR OREGON PAs
On January 1, new rules went into effect to imple-
ment Oregon’s PA fluoroscopy bill (HB 2880), which
allows PAs to obtain a certificate to use fluoroscopy.
The rules, adopted by the Oregon Board of Medical
Imaging, require PAs who wish to obtain a fluoros-
copy permit to complete the AAPA/American Soci-
ety of Radiologic Technologists (ASRT) Fluoroscopy
Educational Framework for the PA course, which
includes 40 didactic hours and 40 clinical hours.
Upon completion of the course, PAs must submit
an application to the board and pass the American
Registry of Radiologic Technologists (ARRT) fluoros-
copy exam.
AAPA worked with the Oregon Society of PAs
(OSPA) and the state’s Board of Medical Imaging
throughout the drafting process and submitted
comments to the board on the proposal. AAPA
applauds OSPA on its hard work and success this
year with both the bill and the rules.
For more information, please contact Keisha Pitts,
JD, director of constituent organization outreach
and advocacy, at kpitts@aapa.org.
CALL FOR AAPA AWARDS NOMINATIONS
Do you know an exceptional PA? Has he or she demonstrated exemplary service
to the PA profession and the community they serve? Then nominate your peer
for Humanitarian PA of the Year or one of the other national awards that will be
presented at AAPA Conference 2016 in San Antonio in May.
Last year, PA Gina Brown (pictured) received the Humanitarian PA Award for
her work in Pakistan and Afghanistan. From 2007-2009, she was the only female
medical provider in a Kabul health center where she oversaw the medical care
of thousands of female patients. Along with creating a prenatal care clinic that
continues to see patients today, she established a training program to help her
Afghan peers keep up on medical developments.
AAPA Awards recognize PAs who have worked tirelessly on behalf of patients
and the profession. The other categories are the Eugene A. Stead Jr. Lifetime
Achievement Award, Military Service Award, Preceptor of the Year Award and
Publishing Award.
The deadline for all award applications is Feb. 15, 2016. Learn more at the AAPA
Awards page.
COURTESYOFTHEOFFICE
OFREP.KARENBASS

STAT | continued
EASING NAUSEA IN THE ER
A study authored by Kenneth Beadle, PA, DSc, and
published online in Annals of Emergency Medicine
in December found that nauseated patients in the
emergency department (ED) who sniffed pads satu-
rated with isopropyl alcohol were twice as
likely to get relief from their symptoms as
thosewhosniffedpadssaturatedonlywith
saline solution.
“We love it when we find a cheap, easy
and fast way to bring relief to our patients,”
said Beadle, with the San Antonio Uni-
formed Services Health Education Consor-
tium in San Antonio, Texas. “Nausea and
vomiting are the chief complaint for nearly
GOT LOANS?
Students and providers interested in careers in primary
care can find a variety of loan repayment and scholar-
ship programs through the Health Resources and Services
Administration (HRSA), Bureau of Health Workforce.
The Application Bulletin outlines the eligibility require-
ments, disciplines and estimated open dates for all of the
Bureau of Health Workforce programs. PAs can sign up to
receive email alerts when each of the 2016 application
cycles open.
Interested in what PAs have to say about HRSA loan
repayment and scholarship programs, such as the National
Health Service Corps? Read this PA Professional article or
watch this video.
CHLM QUALITY IMPROVEMENT SYMPOSIUM AT AAPA 2016
Earn 7.5 hours of AAPA Category 1 CME while learning how quality improvement measures enhance
clinical excellence, organizational success and personal leadership during a full-day symposium at
AAPA Conference 2016 in San Antonio.
Sponsored by the AAPA Center for Healthcare Leadership and Management (CHLM), the symposium
is designed to help you learn the latest in care delivery analysis and systematic efforts to improve care
while keeping costs down.
Engaging, interactive sessions with healthcare
executives, thought leaders and quality improve-
ment experts will help keep you on the leading
edge in this rapidly changing healthcare landscape.
Sign up for the CHLM symposium when you regis-
ter for AAPA 2016.

REGISTER FOR CHALLENGE BOWL 2016!
PA programs interested in competing in the Student
Academy’s National Medical Challenge Bowl can reg-
ister for the event starting February 1.
This year’s Challenge Bowl will be held on Sunday,
May 15, during AAPA Conference 2016 in San Anto-
nio. PA programs from around the country converge
on the Conference city to battle for a chance to earn
the coveted silver bowl and bragging rights to the
national title.
Founded by the Student Academy more than 20 years ago,
Challenge Bowl combines the suspense of a game show, the spirit
of a Big 10 football game and the raucousness of a rave.
Learn more about Challenge Bowl here or watch this video.
five million emergency patients every year, so this
remedy has the potential to help a lot of people.”
Beadle and his colleagues gave patients pads sat-
urated with either isopropyl alcohol or saline solu-
tion and instructed them to inhale deeply through
their noses from the pad every two min-
utes for four minutes, for a maximum of
three inhalations. Within 10 minutes, the
nausea score for the patients breathing
the alcohol was half that of the saline solu-
tion patients and the satisfaction score for
the alcohol patients was double the satis-
faction score for the saline solution
patients.
ADOBESTOCK.COM

STAT | continued
UTRGV PA PROGRAM EARNS SECOND
APPLE AWARD
For the second two-year cycle in a row, Apple has
recognized the PA program of the University of
Texas–Rio Grande Valley (UTRGV), formally UT–Pan
American, for its use of iPads in the classroom.
The program faculty use iPads in many differ-
ent ways, including to design online courses and
supplement live courses, grade video assessments,
communicate asynchronously with students and
other faculty, and project presentations in class
through Apple TV-equipped classrooms. Students
can use them to access a wealth of videos and
other learning tools. Each student receives an iPad
when they begin the program.
“This supports our belief in teaching methodolo-
gies that incorporate a modular curriculum com-
bined with technology, and the iPad has been a key
component of this success,”said Elias Villareal, MPAS,
PA-C, an associate professor with the program. The
program has seen noticeable improvements in its
students PANCE scores, Villarreal added.
The Apple designation highlights the success of
the PA program as an innovative and compelling
learning environment, he said.“Our faculty have
worked together, embracing this technology to
create curriculum programming that engages stu-
dents—actively involving students in their learning
process—and provides tangible evidence of aca-
demic accomplishment,”he said.
Villarreal was recognized as an Apple Distin-
guished Educator earlier this year.
STIs ON THE INCREASE
The prevalence of all three nationally notifiable
sexually transmitted diseases—chlamydia, gonor-
rhea and syphilis—has increased for the first time
since 2006, according to the latest STD Surveillance
Report from the U.S. Centers for Disease Control
and Prevention’s (CDC) Division of STD Prevention.
Trends in the 2014 STD Surveillance Report include
the following:
• The number of reported cases of chlamydia was
higher than for any other condition ever reported
to CDC.
• Primary and secondary syphilis cases were at a
level that has not been seen for 20 years with
alarming increases in men, particularly men who
have sex with men (MSM).
• The rate of gonorrhea in the population
increased to 110.7 per 100,000, the highest
point in many years. Moreover, resistance to
other antibiotics now leaves azithromycin as the
only CDC-recommended treatment regimen for
gonorrhea.
STDs continue to affect young people and
women most severely, according to the report.
Increasing rates among men, especially among gay,
bisexual, and other MSM, contributed to the overall
increases in 2014 across all three diseases.
TAKING A STAND FOR ADULT
IMMUNIZATION
PAs are encouraged to participate in Take A
Stand, a new national initiative that helps
medical practices implement standing orders
programs (SOP) for adult vaccines. Adult immunization rates in the U.S. are dreadfully
low, resulting in increased mortality and morbidity. Strong evidence supports the
use of Standing Orders Programs (SOPs) to improve immunization rates in the adult
population.
The heart of the Take A Stand initiative is a series of free half-day workshops provided
to medical practices around the country. The ongoing workshops are coordinated by
the Immunization Action Coalition (IAC) and sponsored by Pfizer. AAPA urges PAs to
participate in these free workshops.
Workshop speakers may vary, but the multidisciplinary team of presenters includes
national experts. IAC also offers medical practices a year of free, direct support to assist
in the implementation of SOPs following attendance at the workshop.
Learn more about upcoming Take A Stand workshops on the organization’s website.
INGIMAGE.COM

STAT | continued
ISTOCKPHOTO.COM
INTENSIVE BREASTFEEDING CUTS
DIABETES RISK IN HALF FOR HIGH-
RISK WOMEN
Breastfeeding exclusively or almost exclusively and
for at least two months is independently associ-
ated with decreased incidence of diabetes among
women with gestational diabetes, according to a
study published in Annals of Internal Medicine.
Women with gestational diabetes mellitus (GDM)
are seven times more likely to develop type 2 dia-
betes. Prevention strategies after birth include
diet and exercise. Lactation is another modifiable
postpartum behavior that improves glucose and
lipid metabolism and increases insulin sensitivity.
However, evidence that lactation prevents type 2
diabetes has been inconclusive.
The Study of Women, Infant Feeding and Type 2
Diabetes After GDM Pregnancy (SWIFT) enrolled
more than 1,000 women between 2008 and 2011
and classified them based on lactation intensity
and duration. Those who exclusively formula-fed
their babies at six to nine weeks of age were more
than twice as likely to develop diabetes as women
who exclusively breastfed their infants. Based on
these findings, the researchers recommend efforts
to promote and support exclusive and extended
breastfeeding among women at high risk for type
2 diabetes.
FIND THOUSANDS OF PAs WITH
ANSWERS TO CAREER AND PRACTICE
QUESTIONS
Since its official launch this summer, Huddle,
AAPA’s new online community for members, has
become the hub for PA talk—with more than 3,000
conversations happening right now. PAs and PA
students in all stages of their careers are discussing
everything from the pros and cons of working for a
solo-physician practice to the best apps for medical
reference.
Want to know what it’s like switching gears in
clinical practice from real PAs? Or see what roles are
out there for
PAs looking to
leave clinical
practice? Ask
on Huddle!
SCREENING FOR HEPATITIS C IN U.S.
PRISONS IS COST-EFFECTIVE, WOULD
BENEFIT THE GENERAL COMMUNITY
Screening for hepatitis C virus (HCV) in U.S. prisons
and treating infected people is highly cost-effective
and would reduce HCV transmission, the incidence
of advanced liver diseases and liver-related deaths
both inside prison and in the general community,
according to a study in Annals of Internal Medicine.
The study found that a prison-based screening and
treatment program could reduce overall health
costs as much as $760 million over 30 years, with
most of those savings in the general community.
The prevalence of HCV in the noninstitutional-
ized U.S. population is approximately 1 percent,
compared to 17.3 percent in prisons. Liver disease
is a frequent cause of death among inmates and in
the general society and HCV is the leading cause of
liver cancer and the most common indication for
liver transplantation. Recent research has shown
that treating HCV in prisons with newer, more
effective (and more expensive) agents is feasible
and cost-effective. However, cases of HCV must be
identified if they are to be treated.
The researchers found that implementing a
universal opt-out screening program of inmates
would reduce the burden of HCV society-wide
because a larger proportion of prisoners released
to the community would have been cured of
the disease.

STAT | continued
NO CLEAR CHOICE AMONG NEWLY
AVAILABLE ONCE-WEEKLY DIABETES
MEDICATIONS
A systematic evidence review and meta-analysis
fails to clarify which once-weekly glucagon-like
peptide-1 receptor agonist (GLP-1RAs) treatments
are best for treating type 2 diabetes, according to
a study in Annals of Internal Medicine. The newly
available medications vary in terms of cardio
metabolic efficacy and adverse effects and direct
comparisons are needed to better inform physician
prescribing, the study’s authors say.
The number of approved diabetes treatments
has increased significantly in the past decade. New
once-weekly GLP-1RAs have been recommended
for patients who are not achieving metabolic
targets taking metformin alone or with another
glucose-lowering agent.
To compare these therapies, researchers
reviewed published research to estimate the com-
parative efficacy and safety of the once-weekly
GLP-1RAs albiglutide, dulaglutide, exenatide,
semaglutide, and taspoglutide. They found that
the drugs shared similar outcomes for blood pres-
sure, blood lipids, and C-reactive protein. However,
a modest increase in heart rate was seen with
once-weekly exenatide versus albiglutide.
All of the medications significantly increased
the risk for nausea, with taspoglutide, 20 mg and
10mg and dulaglutide showing the greatest risk.
The risk for hypoglycemia did not differ among
once-weekly GLP-1RAs. The authors of an accom-
panying editorial expressed frustration over the
lack of head-to-head comparisons and suggested
that more research is needed to help patients
and physicians find the most tolerable and least-
expensive treatment.
GERONTOLOGICAL SOCIETY OF
AMERICA HELPS PROVIDERS BECOME
“IMMUNIZATION CHAMPIONS”
The Gerontological Society of America (GSA) has
announced an opportunity for healthcare profes-
sionals to become“immunization champions”in
their organizations. The ICAMP Academy—a multi-
disciplinary leadership component of GSA’s Immu-
nization Champions, Advocates, and Mentors Pro-
gram (ICAMP)—is offering four events in 2016:
• February 15-16 in Los Angeles, Calif.
• March 28-29 in Atlanta, Ga.
• May 16-17 in Washington, D.C.
• June (date TBD) in Phoenix, Ariz.
Participants in the program are taught how to
improve organizational performance on immuniza-
tion quality metrics and lead their organization’s
immunization efforts.
PAs who are committed to improving adult health
through vaccinations are invited to apply to this 1½-day
multidisciplinary program. Space is limited so apply soon.
For more information, and to apply, go to the National
Adult Vaccination Program website. This program is free to
attend; coach air travel, hotel room, travel expenses and
program fees for participants are fully covered by GSA.
Applications will be reviewed by the NAVP workgroup.
Participants will be chosen based upon their dedication
to improving adult health through immunizations and
their interest in quality healthcare delivery performance
outcomes.

STAT | continued
•
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SOCIETY OF DERMATOLOGY PAs AND AAPA ADDRESS THE DERMCARE TEAM
The leadership of the Society of Dermatology PAs (SDPA) and AAPA continue to communicate our
concerns about the DermCare Team program of the American Academy of Dermatology (AAD). The
DermCare Team, launched by AAD last spring, created an opportunity for dermatologists and other
practice members to access select AAD products. However, DermCare Team members would be
required to attest that a dermatologist would provide“direct on-site supervision.”The fact that this
requirement is inconsistent with state laws and with standard practice has been communicated to
AAD in writing and during meetings with AAD leaders.
In response to SDPA’s and AAPA’s reaction to the DermCare Team proposal, the AAD launched a
survey on specific aspects of team practice for its members who collaborate with PAs or nurse prac-
titioners (NPs) to evaluate how team members actually practice together. Survey results are now
being analyzed. The next step is discussion of the results and an in-person meeting with AAD lead-
ers and representatives from SDPA and AAPA that will take place in March.
Additional information on the DermCare Team and the ongoing SDPA and AAPA joint response
can be found on the associations’websites. For additional information contact Jennifer Winter,
SDPA Public Education Committee chair, or Rick Christiansen, AAPA director for constituent organi-
zation outreach and advocacy.

STRONGER. TOGETHER.
Today, we helped Marco find out
what to expect when switching to
the night shift.
We connected Paige with PAs who could answer
questions about what it’s like to work at a solo physician
practice. And helped Dan find PAs who use surgical
robotics.
BBeing an AAPA member means you’re part of a powerful
nationwide network of more than 50,000 PAs. You can
find them in our online member community and at live
local events and national conferences – ready to help you
practice strong.
Your network is just one of the ways AAPA is here for you
every single day.
EExplore it all. aapa.org/network

COVER STORY
DISCUSSIONS ABOUT THE TITLE OF THE PA PROFESSION ARE
ALMOST AS OLD AS THE PROFESSION ITSELF. In recent times, the
issue has been debated at the House of Delegates (HOD) at least three times
since 1998, including at the 2012 HOD, when a proposal to create a taskforce
to consider the issue was ultimately voted down, and again in 2015. Numer-
ous editorials have laid out arguments on all sides. But one thing that almost
all PAs have always been able to agree on is that they are, well,“PAs.”And over
the nearly 50-year course of the profession, the term PA has become widely
recognized in the healthcare community and by patients.
“The word‘assistant’simply does not do justice to what PAs do in their prac-
tices these days,”says AAPA President Jeffrey Katz, PA-C, DFAAPA.“In my prac-
tice I diagnose patients, treat illnesses and counsel patients on their path to
wellness. And tens of thousands of PAs around the country do the same.”
“My guess is that few people would choose to call the profession‘physician
assistant’if we were starting it today,”says AAPA CEO Jennifer L. Dorn.“But we
are fortunate that the term PA is so widely embraced by patients and provid-
ers alike. So let’s use it. There is no doubt that it would be highly complicated
to legally change the name in potentially hundreds of state and federal laws
and regulations.”
AAPA’s contract lobbyist Heather Meade, with Washington Council Ernst
& Young, agrees.“Pursuing legislative revisions can be very risky,”she says.
“Other healthcare groups, who may have agendas that conflict with what we
want for PAs, may seize the opportunity to capitalize on the process in ways
that could ultimately harm the practice of PAs. What’s more, for legislation to
be revised there typically has to be a public benefit in doing so, and it would
be difficult to make that case. Finally, the investment in time and political
capital required to pursue a title change could detract from AAPA’s ability to
achieve its larger goal of removing PA practice barriers.”
FromPhysician
AssistanttoPAGreat Progress Is Being Made on AAPA’s
Initiative to Use PA, the Name We All Trust
BY STEVEN LANE
PAs and PA students overwhelmingly supported
using“PA”as the profession’s title during a round-
table discussion at AAPA’s 2014 Leadership and
Advocacy Summit.

LEADING THE WAY
Over the past few years the AAPA Board of Directors and leadership have
built on this recognition of the widespread acceptance of PA. At the
November 2014 Board meeting, robust discussions led to a significant
rethinking of the language that AAPA uses to talk about PAs. The result was
the first-ever PA Communications Guide, which made PA the primary way
of referring to the profession in AAPA communications. At the Leadership
and Advocacy Summit (LAS) last March, constituent organization (CO)
leaders enthusiastically embraced this change, as well as the HOD-
approved language used to describe the relationship between PAs and
physicians—“collaboration”rather than“supervision.”
As then-AAPA President Larry Herman put it in his address to the 2014
HOD,“We are branding the hell out of PA!”
At the encouragement of some COs, AAPA recently took this initiative
one step further and decided to eliminate the use of“physician assistant”
altogether, in all but strictly legal contexts.
“We had a resounding consensus as a team that we need to be
clear, focused and more aggressive in encouraging use of PA,”said
Katz, who is also chair of the Board.“It is of utmost importance that
we apply efforts to generate widespread use of PA without‘physician
assistant’in all of our communications and initiatives to reinforce the
use of the abbreviated title. And we are doing that.”
AAPA Director-at-Large David Mittman, PA, DFAAPA, a longtime
advocate of reimagining the profession’s title, is supportive of the
change.“I see this as a good compromise that can bring the profes-
sion together,”he says.“The day will come when the patient will ask,
‘What does PA stand for?’and we’ll say,‘Well, it used to stand for phy-
sician assistant but we felt that term did not fully describe what we
PAs discuss the“PA”title, while an AAPA staffer
looks on, at AAPA’s 2014 Leadership and
Advocacy Summit.
Dave Mittman Elizabeth Prevou
PHOTOBYJOHNNELSON
PHOTOBYJOHNNELSON
PHOTOBYFREDGREAVES

do.’So we chose to just use our initials: PA. But the real answer is,‘I practice
medicine. I’m here to take care of you. How can I help you?’”
“If people ask me what PA means, I say it means I am a medical practitio-
ner,”says Elizabeth Prevou, PA-C, MPH, Student Academy of AAPA president
and a recent graduate of The George Washington University PA program.
She is working administratively in a clinical practice while she waits for her
license.“I am training our office staff to ask patients if they want an
appointment with a PA,”Prevou says.“No one ever says,‘What is a PA?’”
SPREADING THE WORD
The decisions by the Board and CO leaders at LAS set in motion a con-
certed campaign to establish the use of the PA initials everywhere, from
Twitter hashtags to the AAPA logo. The PA Communications Guide was
shared with all AAPA members, COs and PA program directors, as well as to
the leaders of sister PA organizations and other stakeholders. Over
the past year, AAPA has been working on removing all references to
“physician assistant”—except those in historical documents—from
its website and its media relations staff have been working with their
contacts and media outlets to encourage them to use PA exclusively.
AAPA no longer spells out“physician assistant (PA)”on first usage,
and encourages others, if they have to spell it out at all—for an audi-
ence not familiar with PAs, for example—to write“PA (physician assis-
tant).”AAPA staff have also been providing support to COs on replac-
ing“physician assistant”with PA on their websites and other
communications. More than 30 COs now use PA exclusively on their
websites, except in the official names of their organizations.
And this too is changing. The California Academy of PAs (CAPA)
recently became the first chapter to remove“Physician Assistants”
from its name and now uses its new name on its website and in other
communications. CAPA Immediate Past President Jeremy Adler, MS, PA-C,
DFAAPA, has long been a champion of using PA and has spoken on the
issue at several conferences (click on the video link above to see his recent
presentation at the 2015 CAPA meeting).“I’ve been talking about this for
years, that we own PA,”says Adler.“We have discussed among our leader-
ship:‘What does‘assistant’do for us? We realized it does not define what
we do.”
CAPA is not changing its name legally at this point, Adler noted, though
it is researching the process for doing so and this is a possibility in the future.
“Our articles of incorporation have not changed; it’s more about reposi-
tioning the PA profession. The perception is more important at this point.”
The Rhode Island Academy of PAs (RIAPA) is also making good progress
on using PA in its communications, says Jim Carney, PA, DFAAPA, RIAPA
immediate past president.“We sat down with a great designer from Rhode
Click to watch video.
COURTESYOFCAPA
Then California Academy of PAs President Jeremy Adler’s presented“Influencing
the Position of the PA Profession”at the 2015 CAPA meeting in Palm Springs.

Island School of Design, gave her the PA Communications Guide, and
asked her to come up with a new logo that uses‘PAs’and not“physician
assistants,”Carney said.“We’re looking forward to seeing what she
comes up with. And we’re chipping away at the website, looking at
everywhere we need to replace‘physician assistant.’It’s an ongoing
process, but we are headed in the right direction.”
BUILDING MOMENTUM
The move toward using PA will continue to gather steam as AAPA fur-
ther ramps up its communications and advocacy efforts. But the build-
ing blocks appear to be firmly in place.
“The most important consideration in whether to use an acronym or
initialism is whether it is already well recognized,”says Mike DiFrisco, a
marketing consultant who has written and spoken frequently on this
topic and is founder of the consulting firm BrandXcellence.“If there is
equity in those initials, there is a benefit there. Everybody knows what
IBM and BMW are even if they don’t know what the letters stand for.”
While the transition can take time, DiFrisco cautioned, perceptions
can change remarkably in a few years:“AARP [formerly the American
Association of Retired Persons] formally changed its name 12 years ago,
and now some people have no idea what AARP used to stand for. With
any rebranding it takes time to be inculcated in the consciousness. The
important thing is to infuse meaning into those initials. It will take some
time and work but it sounds like it’s the right thing to do.”
For AAPA, the next step is to focus attention on the next circle of
stakeholders and partners. AAPA communications and marketing staff
have developed a detailed plan for working with national organizations,
business partners, employers and media outlets to encourage the use
of PA and to change licensing agreements where needed.
But the most important work will probably be done at the grass roots
level, by PAs everywhere.
“This can work if we all do it,”says Mittman.“It’s really incumbent on
all state and specialty organizations and every PA to go on Facebook
and LinkedIn and their practice websites and change their profile infor-
mation to PA from‘physician assistant.’And we should all use PA when-
ever we talk about the profession or introduce ourselves to patients.”
“I’m willing to give it a shot,”he added.“I am 100 percent behind the
effort. Let’s really take it on as individuals and give it our best shot.”
STEVEN LANE is senior writer for AAPA
and managing editor of PA Professional.
Contact him via email or 571-319-4364.

Using the PA Communications Guide
The PA Communications Guide was developed in 2014 to provide ways of talking about the PA profession
that reflect the profession’s true place in the modern healthcare arena. The preface to the guide captures its
intent succinctly:
As the PA profession evolves, so does the language used to talk about it. The explosive growth of the profes-
sion, coupled with the continued modernization of PA laws, is rapidly changing the way PAs practice and the
language we use to describe what they do. This is a reference guide for how to communicate about the pro-
fession in a way that reflects the realities of modern PA practice.
The PA Communications Guide was sent to all AAPA members, constituent organizations (COs) and PA
programs in 2015. More than 70 COs have already replaced“physician assistant”with PA on their websites,
and many are using it to help educate all the stakeholders they work with. The California Academy of PAs,
which was one of the first COs to use“— Academy of PAs”on its website, letterhead, and newly printed
promotional materials has been one of the standard-bearers in using the guide.
“We are using it as an educational tool and it is really effective,”says CAPA Executive Director Gaye Brey-
man, CAE.“The fact that it comes from the national organization really helps. Recently, an advertiser was
using phrasing we did not love. I was able to forward the guide to them and let them know that CAPA has
adopted the guide. People are impressed with how consistent and intentional we are.”
Breyman is also on the Board of Trustees of Marshall B. Ketchum University in Fullerton, Calif., where a
new PA program was accredited this past year. The university has embraced the PA Communications Guide
as well, Breyman says, and is moving toward implementing its recommendations on all of its PA-related
communications:“People use it everywhere. All at MBKU are embracing CAPA’s name change and being
really conscientious in speaking and writing about the profession.”
“Our members, our board and stakeholders are excited to be part of a movement,”Breyman adds.“We
are very enthusiastic and they understand the need for the change. I hope it goes nationwide. It will take a
lot of people being passionate, consistent and patient but I see it happening. We consistently offer adver-
tisers, authors of articles and others an opportunity to change their written material [to“PA”] and they do.
Each incident is a learning opportunity. It will take time, but it will be those little things that will add up.”
“The fact that [the PA
Communications Guide] comes
from the national organization
really helps. Recently, an advertiser
was using phrasing we did not love.
I was able to forward the guide to
them and let them know that CAPA
has adopted the guide. People are
impressed with how consistent and
intentional we are.”
Gaye Breyman, CAE
CAPA executive director
COURTESYOFCAPA

T
here was a time when
PAs practiced medicine
exclusively. But as the
profession has matured, PAs are
taking on more executive and
administrative positions, such
as executive director of a large
surgical group practice, medical
center PA director and even chief
operating officer of a hospital.
When it comes to medical directorship posi-
tions, physicians have traditionally filled those
spots. However, PAs with the right background
and determination are making opportunities for
PA EXECUTIVE:
Javier Esquivel-Acosta
Increasing Access to Care From a Leadership Position
BY DAVE ANDREWS
PHOTOS BY FRED GREAVES
FEATURE STORY

themselves, like Javier Esquivel-Acosta, PA-C, MMS, assistant medical direc-
tor of a federally qualified health center in San Jose, Calif. The center over-
sees a number of local health clinics in the area.
Esquivel-Acosta moved to the United States in 2004 from his native
Mexico, where he worked as a physician. He was looking for new opportu-
nities to work in medicine and improve the health of those in need, and
quickly took an interest in the PA profession.
After graduating from the Stanford University PA pro-
gram, passing the PANCE and obtaining his PA license, he
worked in various healthcare roles in the Bay Area. His goal
was not to obtain a medical directorship, but when the
opportunity presented itself at Foothill Community Health
Center (FCHC) in San Jose, Calif., he knew he was the right
person for the job.
“When I applied for the [associate medical director] job,
our CEO and medical director initially questioned whether
or not it could be given to a PA,”Esquivel-Acosta says.“By
that time, I had already done some research and was able
to reference several other PAs in similar roles at hospitals
and clinics in the surrounding region. I knew it wasn’t
going to be easy, but I knew it was possible.”
According to Bindu Chandran, MD, medical director at
FCHC, what made Esquivel-Acosta the clear choice for the
job was his familiarity with the center—having already
worked there for more than three years—along with his
work ethic and dedication to helping improve the health of
the medically underserved.
“Javier was one of our most productive providers, and he
always had new ideas about how to make things better for
the patients and the staff,”Chandran says.“No matter what you asked of
him or what the issue was, he would do a thorough evaluation—research-
ing other clinics in the area and considering industry best practices—and
then bring his proposed solutions to the table.”
Immediately after accepting the position, he got to work. Esquivel-
Acosta created several departments that have redesigned processes and
improved quality. He heads up the innovation department, which impacts
PA EXECUTIVE | continued
PHOTOBYFREDGREAVES
Esquivel-Acosta graduated from the Stanford
University PA program.

several areas of the center’s operations, including optimizing medical
record data, identifying new clinical standards and improving patient
outreach.
Additional departments Esquivel-Acosta created include the health
education department, where nurses on staff help coordinate care for
patients with chronic conditions. A new referral department ensures spe-
cialist referrals are processed quickly and accurately. And an on-site call
center was established to alleviate the growing number of inbound calls
fielded by the front desk.
Esquivel-Acosta says that the leadership at FCHC has been largely sup-
portive of what he calls his“unorthodox”ideas.
“We’re continually focused on finding new ways and developing new
programs to help the staff work more easily and efficiently,”he says.“The
result is often improved quality, which eventually leads
to improved patient health.”
Though“unorthodox”may be a light-hearted descrip-
tion of some unique approaches adopted by FCHC, the
significant increase in revenue might indicate more inge-
nuity than lack of orthodoxy. Since 2011, annual revenue
has soared from less than $500,000 to nearly $12 million.
Chandran says the recent success at FCHC cannot be
attributed to just one person or program. Rather, credit
is due to the talented support team of clinicians and
administrators who all contribute to the overall goals
of the center.
What sets Esquivel-Acosta apart from many, according
to Chandran, is his willingness to take initiative and
inspire others to do the same. Each staff member knows
what his or her unique role is and has a better understanding of what
is expected.
“Javier is very compassionate with his patients, but he’s also passionate
about helping the employees,”says Jessica Pedder, quality assurance
director at FCHC, who has worked with Equivel-Acosta for more than
three years.
Pedder says that Esquivel-Acosta will challenge his co-workers and oth-
ers within the organization to work to their full potential, knowing it’s not
just about keeping the patients happy, but the staff as well.
“So often, I see people gravitate toward PAs because of the unique way
that they take the time to share what they know and to find the solution;
I see that with Javier,”Pedder says.“He is deeply respected by his patients
and peers here at Foothill. People truly listen when he offers his thoughts
PHOTOBYFREDGREAVES
Esquivel-Acosta has led a push to redesign
processes and improve quality at FCHC.

and opinions, and that comes not just from his expertise, but
also his approach to problem solving.”
As associate medical director at FCHC, Esquivel-Acosta has
to apply many of the skills he’s learned throughout his entire
career. In Mexico, he practiced family medicine in rural commu-
nities, supervising medical staff and educating patients with
chronic diseases about how to better manage their condition.
After moving to the U.S., he worked as a case manager
for the California Department of Developmental Disabilities
Services, evaluating client needs, coordinating care access
and advocating on behalf of his clients who needed govern-
ment assistance.
These skills have been essential to Esquivel-Acosta’s
advancement at FCHC, which as a federally qualified health
center provides services to anyone in need of healthcare,
regardless of his or her ability to pay. Its focus is on providing
primary care and preventive care, predominantly serving
underserved, underinsured and uninsured populations.
“My passion has always been helping low-income families,”
says Esquivel-Acosta.“There were other job offers with higher
salaries, but this was where I felt like I could have the most
impact.”
In recent years, Esquivel-Acosta and his colleagues at FCHC
have been dedicated to increasing access to care. Many within
the center’s patient population are without transportation, so
FCHC is creating more convenient ways to get care.
For example, FCHC continues to expand its school-based
clinics at public high schools throughout the San Jose area.
Over the past three years, the number of FCHC-managed clinics
“My passion has always been
helping low-income families,”
says Esquivel-Acosta. “There
were other job offers with
higher salaries, but this was
where I felt like I could have
the most impact.”
PHOTOBYFREDGREAVES

has increased from three to 13. It has also created extended hours of
operation to 10 p.m. seven days a week for most of its clinic locations.
Cultural competency is another significant factor for providers in this
region. For that reason, the number of providers at FCHC who speak
Spanish and/or Vietnamese continues to grow. Most are also aware of
and considerate to the unique cultures and customs within their diverse
patient population, which can often help put the patient at ease.
Esquivel-Acosta has also helped increase the number of PA students
doing their rotations at FCHC, not only from his alma mater, Stanford, but
from other programs in the region as well. He would like to give as many
PA students as possible the experience of working within the unique
atmosphere of FCHC.
To his fellow PAs who might be considering an administrative or lead-
ership role, Esquivel-Acosta advises that they should focus first on doing
whatever is necessary to become—or continue to be—a successful PA.
“Once you know what it takes to achieve success as a PA in your
unique environment, try to identify ways you can help your fellow staff
members,”Esquivel-Acosta says.“From there, take it a step further and
look for opportunities—big or small—to impact the specific needs of
your community.”
PHOTOBYFREDGREAVES
DAVE ANDREWS is a communications and
public relations professional specializing in the
improvement of healthcare delivery. He is a
regular contributor to PA Professional. Contact
him at dandrews@aapa.org.
Esquivel-Acosta knew it was not going to be easy to become an
assistant medical director, but he knew it was possible.

Retail Clinics: An Opportunity for PAs
and NPs to Work Together
Q&A With MinuteClinic Chief Nurse Practitioner Officer Angela Patterson
BY MATTHEW RUDBERG, MMS, PA-C
T
his past spring I attended AAPA Conference 2015 in San Francisco,
where I was an exhibitor with MinuteClinic, and was profoundly
struck by the interactions I had with many of my colleagues. I
started my career with MinuteClinic over three years ago after working in
family medicine, colorectal surgery and thoracic surgery. For me, coming
to work for MinuteClinic has been an excellent decision. I have been able
to provide high quality care in the retail setting and it has afforded me
opportunities to work in a variety of clinical leadership roles. When I
joined MinuteClinic we hired PAs in only four states (Minnesota, Texas,
Nevada and North Carolina) and we have subsequently increased this to
nine states, adding New Mexico, Rhode Island, Nebraska, South Carolina
and Maryland. We are continually looking to add states to increase our
interdisciplinary workforce.
The majority of interactions I had with my colleagues at AAPA were very
positive. I believe I inspired some to work with their state PA organizations
to get legislation modernized. Some of the interactions I had were hostile
toward the retail concept. But many of my colleagues felt that we as PAs
were getting left out of this innovative approach to medicine; their percep-
tion was that many
retail clinics only
hire nurse practi-
tioners (NPs). The
NP/PA rivalry was
palpable during
some of these
conversations. I
found myself in a
position to remind
them: the main
issue is not NPs
versus PAs; rather,
the focus should
be on PAs aligning their energy towards changing outdated state regula-
tions for PAs. Outdated regulations are the primary reason that hiring of
PAs in certain states is cost-prohibitive in a retail setting. When I returned
from the conference, I had the opportunity to sit down with Angela Patter-
FEATURE STORY
Angela Patterson Matthew Rudberg
To read a longer version of this Q&A, go
to the Constituent Organization Resources
page of the AAPA website.

son, MS, FNP-BC, chief nurse practitioner officer with MinuteClinic, to gain
further insight into some of the challenges she sees for PAs in retail medi-
cine from her vantage point as a member of leadership in a company with
more than 1,000 clinics run by PAs and NPs.
Matthew Rudberg (MR): Angela, how long have you worked for Minute-
Clinic and in retail medicine?
Angela Patterson (AP): I have worked with MinuteClinic for nine years.
I have been a nurse practitioner since 1988—27 years. Prior to MinuteClinic
I worked in primary care.
MR: What originally drew you to retail medicine?
AP: As a primary care clinician in family practice, it was very apparent to
me for at least 10 years before joining MinuteClinic that the structure of
primary care at the time was not sustainable. In my mind, it was important
that I start to do work that was about strengthening primary care in our
communities because I always understood and embraced the fact that
comprehensive, wholistic primary care that focuses on health and wellbe-
ing, health promotion, disease prevention, condition assessment and man-
agement, was really foundational to achieving the country’s agenda for
health and healthcare reform. When I was contacted by MinuteClinic I did
my due diligence to research what the company was trying to do with
healthcare. I was really moved by the commitment that the leadership of
the organization had with regards to wanting to fulfill a purpose of increas-
ing access to quality, affordable healthcare in the communities they
served. So, I left my practice to be part of a company that was trying to do
something different in healthcare for what I saw was all the right reasons.
MR: How have you seen the landscape change for PAs in your tenure with
this company compared with how the landscape has changed for NPs?
AP: In the very first few years working as part of this organization and
working across many different states, I was seeing more organized and
targeted activity through NP organizations to modernize practice. In the
past five years, PAs have increased their organized activity to become
strong, really start to move current practice laws and pick up speed in a
way that NPs have been trying to do. The amount of activity I have seen by
the PAs has come to the level I have seen previously with NPs, and I really
appreciate that. There are unfounded regulations or restrictions put into
place that are not based on evidence—for PAs and NPs. I am excited to see
how these laws have modernized to increase access to quality care. It’s
really what our patients ultimately need. Minute Clinic’s collaboration with
AAPA has also increased over the past few years to help advance the prac-
tice of PAs. As the landscape has changed in healthcare, the PA profession
has evolved and more resources were moved from hospitals or specialists
to primary care, PAs have really stepped up to say:“We can fill that void.”
RETAIL CLINIC Q&A | continued
COURTESYOFMINUTECLINIC

MR: I am very excited we have been able to hire PAs in nine states now.
What regulations do you typically see that prevent us from hiring PAs in
different states?
AP: The biggest issues in our setting as a retail clinic are physician ratios
and on-site requirements for supervision. MinuteClinic is not a traditional
model—we have clinics across the entire country (which is novel in and of
itself, to have a national practice). The biggest issues are around scope of
practice regulations, regulations that require on-site supervision and tight
PA-to-physician ratios. These regulations add expense for our practice set-
ting and are unnecessary given that the services provided at MinuteClinic
are well within the scope and training of PAs. These regulations require
additional work hours from physicians that are not required for the type of
patients we see and thereby limits access to care. There is no evidence that
demonstrates these tight ratios or geographic restrictions improve quality,
safety or outcomes.
The other piece that is important is on the payer side. Payers can choose
to supersede state regulations and the payer can refuse to credential PAs.
Hawaii for example, has good regulations for PAs but the PAs can’t inde-
pendently enroll in Medicaid and have to bill under physicians. Payers
need to modernize and credential PAs independently.
MR: How is MinuteClinic collaborating with AAPA to advance the
PA profession?
AP: We believe, as does AAPA, that PAs positively impact patient outcomes
in the ambulatory care setting. We believe PAs are educated and trained to
deliver quality, safe care in our setting and we want to continue to be able
to hire PAs in our clinics. Also, being an organization that hires a large num-
ber of PAs, we recognize it is important to our workforce to be a good part-
ner with their national professional organization.
MR: What do you see as the most significant challenge facing retail clini-
cians (excluding NP/PA differences)?
AP: The biggest challenge is to support clinicians over the long term in our
organization; that’s purely because of two things. First, primary care that is
at the heart of the community is hard work. The other thing that makes it
really tough is we commit to care for the majority of our patients on off-
hours, weekends and holidays. As the CNPO, my key role is to make a satis-
fying job experience for our NPs and PAs, as well as support their profes-
sional and talent development. The biggest challenge is keeping folks
engaged when the work is really tough. Our professionals need to know
how to assess every patient and determine the next step for the patient—
doing that when your friends and family are not working is tough work.
MR: Specifically for PAs, what are some barriers we, as a profession,
should be focusing on in regards to retail medicine?
AP: There is a lack of knowledge regarding what we are doing in retail
health. Better education across the profession in general is needed to focus
on the fact that retail health is a legitimate part of PA practice. Part of the
reason we haven’t been doing PA preceptorship is because schools didn’t
want their students to rotate with us because they believed we were lim-
ited—which is untrue. This has limited the perception of PAs regarding
what retail health is.

MR: Tell me where you see PAs and NPs collaborating to help fix the
admittedly broken healthcare system.
AP: The most powerful thing we can do is work together to demonstrate
how we impact access and patient outcomes. PAs and NPs are caring for
probably the majority of patients in ambulatory and primary care settings.
What’s needed is data that shows we positively impact access and patient
outcomes. That’s how we are going to fix it: showing what you are doing
and exceeding benchmarks. Those that are lobbying and working on legis-
lation need the data to move the laws.
MR: In states where we don’t currently employ PAs, what action would
you recommend PAs take?
AP: Support AAPA and your state PA association. You don’t have to be out
there lobbying because they are out there supporting you. You have an
amazing group of professionals that are supporting you. They need to be
funded. As clinicians, we have a responsibility to be aware of what’s going
on nationally in healthcare and how we can make a difference. We need to
remember our patients are at the center of everything we do.
MinuteClinic now hires PAs in nine states and is looking to add more states to that number.
COURTESYOFMINUTECLINICVIAFACEBOOK

CLINICALALERT
GUILLERMO V. SANCHEZ,
PA-C, MPH, is a public health
scientist with CDC’s Office of
Antibiotic Stewardship, and is PA in
emergency medicine with Emory
University at Grady Memorial
Hospital in Atlanta, Ga. Contact
him by email at or by phone at
404-718-4619.
Promoting Antibiotic Stewardship
PAs Must Do Their Part
B Y G U I L L E R M O V . S A N C H E Z , PA - C , M P H , A N D L A U R I A . H I C K S , D O
M
ore than 2 million antibiotic-resistant infections
and at least 23,000 associated deaths occur
annually in the U.S, highlighting the need to
practice and promote judicious antibiotic use across all
healthcare settings.1
PAs must be engaged in the effort to
improve both antibiotic resistance and antibiotic prescrib-
ing. In 2011, PAs in the U.S. wrote an average of 276 antibi-
otic prescriptions per provider, totaling over 17.5 million
courses of antibiotics.2
Since about one third of PAs prac-
tice in primary care,3
and many more of us prescribe anti-
biotics regularly, PAs are a critical part of improving antibi-
otic use in the U.S. today.
The syndromes for which inappropriate antibiotic pre-
scribing is most common are acute respiratory tract infec-
tions (ARTIs), most of which do not benefit from antibiot-
ics.4
For example, acute bronchitis is caused by viruses in
more than 90 percent of cases and does not benefit from
antibiotic treatment even when it is caused by bacteria
(pertussis is one exception).5
Only 15-30 percent of chil-
dren and 5-10 percent of adults with sore throat will have
Group A streptococcal (GAS) pharyngitis, the only routine
indication to prescribe an antibiotic for sore throat.6
According to the Infectious Diseases Society of America,
acute rhinosinusitis among adults is caused by a virus in
over 90 percent of cases.7
Recent evidence suggests that
refraining from antibiotic prescribing often leads to equiv-
alent outcomes in the management of ARTIs while avoid-
ing the risks of harm from antibiotics, a finding empha-
sized by recent clinical guideline changes. For example,
the 2015 American Academy of Otolaryngology–Head
and Neck Surgery guidelines recommend watchful wait-
ing as an evidence-based approach to the management
of acute uncomplicated bacterial rhinosinusitis.8
Antibiot-
ics are commonly prescribed for ARTIs due to a perceived
net benefit, however, the harms of antibiotic therapy often
outweigh the benefits.
Perhaps the most underappreciated fact about antibiot-
ics concerns the risks involved with their use. Antibiotics
account for about half of the top 15 most common caus-
ative agents leading to an adverse drug event (ADE)
related emergency department visit in the United States,
totaling over 142,000 visits every year.9
Among children,

CLINICAL ALERT | continued
antibiotics are the most frequent cause of ADE-related ED visits.10
In addi-
tion to the common side effects of antibiotics such as abdominal pain,
nausea, diarrhea and rash, it’s important to remember that there are less
common severe ADEs associated with antibiotic use, including Clostridium
difficile infection (CDI), anaphylaxis and severe skin reactions such as Ste-
vens-Johnson syndrome or toxic epidermal necrolysis. Surprising to many,
CDI is more frequently acquired in community settings than in hospitals,
accounting for about 71 percent of CDI in children and 41 percent of CDI
among adults.11,12
A recent study estimated that there were over 159,000
community-associated CDI cases in 2011, with 82 percent of these patients
reporting visits to an outpatient clinic in the three months before onset of
symptoms.13
Antibiotics have well-established risks associated with their
use, and PAs should only expose our patients to these risks when there is a
clear and significant benefit.
Patient satisfaction is a chief concern among providers when deciding
whether to prescribe an antibiotic. However, provider communication with
patients is a more important driver of visit satisfaction than whether or not
they receive antibiotics.14
Ways to improve patient satisfaction include
providing recommendations for symptomatic relief, discussing the poten-
tial harms of antibiotic therapy and sharing normal findings during the
physical examination. If a diagnosis is unclear, it can help to be honest
about your findings and provide a contingency plan if an infection doesn’t
improve. Delayed prescribing strategies have been shown to both
decrease antibiotic use and increase patient satisfaction. These include
practices such as contacting patients after their visit, having the patient
return to the clinic in two or three days if symptoms worsen or writing
postdated antibiotic prescriptions. Finally, antibiotics should never be used
as a placebo or as a means to increase patient satisfaction.
The most crucial step PAs can take to alleviate the widespread problem of
antibiotic resistance is to practice and promote judicious antibiotic prescrib-
ing in our own hospitals and clinics. For more information about the latest
clinical practice guideline recommendations, visit the provider’s section of
the Get Smart website, where you can find summarized practice guidelines,
patient education resources and antibiotic stewardship information to help
you practice and promote judicious prescribing where you work.
By working together to improve antibiotic prescribing, PAs can help turn
the tide on antibiotic resistance, to benefit of patients and communities
alike. Get Smart: Know when antibiotics work.
COURTESYOFCDC

CLINICAL ALERT | continued
REFERENCES
1. Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United
States, 2013.
2. Hicks LA, Bartoces MG, Roberts RM, et al. US outpatient antibiotic prescribing variation
according to geography, patient population, and provider specialty in 2011. Clinical
Infectious Diseases. 2015;60(9):1308-1316.
3. U.S. Department of Health & Human Services, Agency for Healthcare Research and Qual-
ity. Primary Care Workforce Facts and Stats: Overview., Rockville, MD:DHHS; January 2012.
4. Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United
States, 2013.
5. Smith SM, Smucny J, Fahey T. Antibiotics for acute bronchitis. JAMA.
2014;312(24):2678-2679.
6. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and
management of group A streptococcal pharyngitis: 2012 update by the Infectious Dis-
eases Society of America. Clinical Infectious Diseases. 2012;55(10):1279-1282.
7. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial
rhinosinusitis in children and adults. Clinical Infectious Diseases. 2012;54(8):e72-e112.
8. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update):
adult sinusitis. Otolaryngology-Head and Neck Surgery. 2015;152(2 Suppl):S1-S39.
9. Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-
associated adverse events. Clinical Infectious Diseases. 2008;47(6):735-743.
10. Bourgeois FT, Mandl KD, Valim C, Shannon MW. Pediatric adverse drug events in the
outpatient setting: an 11-year national analysis. Pediatrics. 2009;124(4):e744-750.
11. Wendt JM, Cohen JA, Mu Y, et al. Clostridium difficile infection among children across
diverse US geographic locations. Pediatrics. 2014;133(4):651-658.
12. Langford IH BG, McDonald AL. Multi-level modeling of geographically aggregated health
data: a case study on malignant melanoma mortality and UV exposure in the European
Community. Statistics in Medicine. 1998;17(1):41-57.
13. Lessa FC, Mu Y, Bamberg WM, et al. Burden of clostridium difficile infection in the United
States. New England Journal of Medicine. 2015;372(9):825-834.
14. Mangione-Smith R, McGlynn EA, Elliott MN, Krogstad P, Brook RH. The relationship
between perceived parental expectations and pediatrician antimicrobial prescribing
behavior. Pediatrics. 1999;103(4 Pt 1):711-718.

PROFESSIONALPRACTICE
Assessing an Offer:
Key Questions to Consider
Advice From the PA Career Coach
B Y J E N N I F E R A N N E H O H M A N
C
ongratulations—you’ve been offered the job! Now
you need to assess the offer and build a negotia-
tion strategy. I suggest using this article as a work-
sheet, writing out your answers and rating each category
on a scale of 1-4, with 1 representing the highest level of
satisfaction and 4 representing an area most in need of
improvement through negotiation. Unless you’ve discov-
ered a majority of 4s, in which case you’ll likely want to pass
on the offer, highlight the areas for improvement you’ve
identified as you move forward to the negotiation stage.
Clinical Role and Responsibilities, Appropriate
and Interesting Scope of Practice
What will be your clinical role and responsibilities in this
position? What is the employer’s vision of your role in this
practice/institution? Do they (and you) see it expanding
over time? Are there specific procedures and/or areas of
responsibility you would like to negotiate into this job?
What are the areas for negotiation/improvement?
Partnering Physician(s)
Do the physician(s) seem to listen and communicate well?
What are their clinical expectations of you (and for team
practice)? Do those expectations fit with what you’d like to
do in this position? Will there be opportunities for your
growth and development?
Is there a commitment to appropriate mentorship by
partnering physicians if you are in a new practice area? If
you are a seasoned clinician, do you sense they will give
you appropriate autonomy? Are there any physicians who
do not want to work with PAs? (This could signal trouble
ahead—a consensus about working with PAs is important
in group practice settings.) What are the areas for negotia-
tion/improvement?
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.

PROFESSIONAL PRACTICE | continued
Salary
A number of factors should determine your salary target and acceptable
salary range (as well as walk-away point!) in order to assess the compensa-
tion package you’ll be offered. They include:
■ Specialty
■ Your years of experience (in a specialty and as a practicing PA)
■ The regional and local economy where the position is offered
■ The financial value/quality of life value of your fringe benefits package
The AAPA Salary Report is an invaluable resource for assessing salary and
benefits by state and specialty. Think about areas for negotiation/
improvement.
Fringe Benefits
Benefits are an essential aspect of your compensation and have a huge
impact on the quality of your professional and personal life. In this section,
consider the fringe benefits being offered by the employer and assess
them, particularly in the areas of your highest priority. Are they sufficient?
Are certain benefits offered that you consider less important that might be
traded off in favor of higher priority ones?
NEGOTIATION NOTES FOR SPECIFIC BENEFITS
■ Paid vacation
■ CME funding
■ Paid CME leave
■ Liability coverage
■ Loan repayment (if applicable)
■ Paid sick leave
■ Health insurance
■ Retirement programs
■ Maternity/paternity leave
■ Other benefits—specify and assess
■ Areas for negotiation/improvement

PROFESSIONAL PRACTICE | continued
Schedule/Location(s)/Commute
A schedule that allows for healthy work-life balance and includes a man-
ageable commute is key to quality of life. What will your typical schedule
be? If you are to provide services at more than what location, where are
they, and what will be your typical schedule be at each location? Do you
have call duties, and if so will they be compensated in addition to salary
and what is your call schedule? Is there an option for adjusting the sched-
ule so that you can meet family obligations? What are the areas for nego-
tiation/improvement?
Patient-centered Philosophy of Care
How many patients a day will you be expected to see/treat? What is the
employer’s philosophy of patient care? What seems to drive the mission of
this organization/practice and is it in line with your professional ethos?
Leadership and Ownership Opportunities
How does the employer see this position evolving over time? Are there
opportunities for PA participation in committees, management, and lead-
ership in this organization? Would they consider making a PA a partner/
co-owner of this organization? What are the areas for negotiation/
improvement?
Stability of Employer, History With PA Employees
Has the employer employed PAs in the past? Do they currently? Is there a
high PA turnover rate? Do they anticipate any major changes in the busi-
ness model/ownership of the practice/institution in the next year or down
the road?
My hope is that this assessment process will help you evaluate the
potential of a given position to advance your career professionally and
financially as well as in terms of rewarding, meaningful practice. Having
identified areas for negotiation, my advice is to go forward with your con-
cerns, and engage in a discussion aimed at making an acceptable offer into
a great one!

PA_Pro_Jan_2016_FINAL

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