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Certified PAs are changing the face of healthcare today. They practice medicine, manage acute and chronic patients, perform complex procedures, prescribe medications and assist in surgery.

The PAs on this page have maintained certification by completing a substantial amount of continuing medical education and passing a rigorous national exam. Some of them have additional credentials as well. They are all skilled providers who share a common goal: to deliver the highest quality care possible to optimize each patient’s outcome and satisfaction.

If you are a patient or an employer, you will enjoy meeting each of them and reading their story.

Click here to read about more PAs and the exciting work they are doing!

If you are a PA and would like to share your information for this site, submit your profile here.

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Caring for Women's Health

Hema Majeno

Adventist Health Community Care
Certified Physician Assistant (PA-C)
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As a PA in a rural area, Hema works with many undocumented immigrants and especially women to build relationships so they trust her to provide necessary healthcare and wellness counseling.

EMPLOYER:

Adventist Health Community Care in Parlier, California

NCCPA CERTIFICATION:

Certified physician assistant (PA-C)

Hema’s blog (below) was previously published in Physicians Practice.

© Physicians Practice 2016

Physician's Quote

“I have worked with Hema for almost three years at Adventist Health Community Care in Parlier, California. She is a very bright, knowledgeable and experienced physician assistant who has a great deal of responsibility in managing a wide diversity of patients from newborns to geriatric patients with multiple medical problems. I am very impressed by her compassion for our patients, her integrity and professionalism. She is a highly committed individual with a good sense of clinical judgment and priorities.” --Rogelio Fernandez, M.D.

PAs Providing Women's Health: More than OB/GYN

By Hema Majeno, PA-C

Having emigrated from India in 2003, I have always been interested in the healthcare of women in rural areas. Today, I am fortunate to work as a certified PA in a family medicine practice, which provides care to many women in the San Joaquin Valley of California.

Women PAs can help to meet the needs of women in rural areas by providing access to needed health programs and services, and offering the opportunity to be seen by a female provider. I think this also increases patient satisfaction as women may be more candid with another woman.

Many of my patients are undocumented farm workers, who are dealing with language and cultural barriers as well as raising their children and trying to keep them in school. While the demographic base of my practice may be different than yours, by and large women's health needs are universal. It is important to treat the whole woman, not just today's problem. This includes not only preventative physical exams, but also screening for mental health.

Most of my patients come to me through word-of-mouth referrals and I usually see 20 patients a day. Typically, a woman will come in because of symptoms, like a cough or cold. While I handle the acute problem, I also use the opportunity to ask if they have had a Pap smear or a mammogram and try to schedule a physical. I want to have more time to do a total assessment: check for cholesterol, diabetes, hypertension, and more. Many of my patients put their families first and have neglected their own health for years. Of the 45 minutes I schedule for an exam, I spend at least 20 of those minutes on preventative education.

However, my goal isn't to just to provide acute care, I want to build relationships so these women will continue to come back for preventative and wellness services. I've found there are four primary reasons patients will schedule follow-up visits:

1. Family planning. Family planning is a big part of my practice. Teenagers and young women tend to be timid, and my priority is to be sensitive and find a personal connection. I smile, make eye contact, and sometimes hold their hand when I speak to them, so that I can gain their confidence. I explain birth control options and discuss STD prevention.

2. Depression and/or anxiety. During routine physicals, I frequently uncover symptoms of depression and anxiety. If patients are mildly depressed, I explain meditation techniques and may prescribe antidepressants and therapy. I have found that, often, even a short course of treatment can bring them back to feeling normal. For more serious issues, I refer to a psychiatrist or a psychologist. I also check to see if they may be in an abusive relationship, and if so, we look for community resources that can assist.

3. Weight loss. Female patients often ask about weight loss. The diet in this rural area seems to be high in fat and carbs. I provide basic nutrition counseling and explain carb and calorie counting. I also prescribe medication in the case of morbid obesity, but then I also refer to a nutritional or diabetes educator. Again, I stress prevention and educate patients about how they can take control of their weight and their health.

4. Menopause. For middle age and older women, I perform breast examinations and Pap smears and order mammograms. I ask about menopausal symptoms such as hot flashes and mood changes. I also educate them about natural alternatives to hormones, which have fewer or no side effects. At this point in their lives, they may have comorbidities that contribute to their symptoms. I help them understand menopause changes and manage any medications they are taking.

My goal is to treat patients the way I want to be treated — as if they were a family member. I'm fortunate to love what I do, and every day I thank my patients for the privilege of providing their care.

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Stabilizing Trauma Patients

Sarah Cawley

Team Health at Southwest Hospital Emergency Roon
Certified Physician Assistant (PA-C)
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Sarah Cawley practices clinically in emergency medicine. She volunteers at a pregnancy center, is a family engagement adviser, a member of several patient advocacy committees, and speaks regularly on patient experience and family engagement.

EDUCATION:

BS, Liberal Studies, Excelsior College

MPAS, Physician Assistant Studies, University of Nebraska

NCCPA CERTIFICATIONS & CREDENTIALS:

Certified physician assistant (PA-C)

Sarah’s blog (below) was previously published in Physicians Practice. © Physicians Practice 2016

Being a Patient Makes Us Better Providers

It is not enough to simply practice medicine. As providers, the way we care for our patients is as important as the knowledge we possess.

Each of us has our own method of engaging with and managing patients; an approach that is individualized yet influenced by training and experience. However, it was only after a life-changing diagnosis for myself and my youngest daughter that I came to realize both the power of the diagnosis and the importance of the empathy we provide to our patients.

When my daughter was born in 2012, she was diagnosed with hydrocephalus, along with several other serious medical conditions that required countless medical appointments, tests and treatments. Then, in 2014, I was diagnosed with breast cancer and required multiple surgeries, chemotherapy and radiation. Those events changed our lives dramatically. Just as important they changed my perspective as a health care provider.

Some experiences with doctors over the last few years have been incredible, providing the emotional support, education and treatment quality we needed. Other interactions fell short. These experiences allowed me an opportunity to re-evaluate the way I practice medicine. Was I giving my patients the information, treatment, and emotional support they needed to overcome their situation?

As a certified PA in emergency medicine, my interaction with patients is critical, and I have the opportunity to make an immediate impact on their lives. My patients in the emergency room need someone who looks out for them and ensures they receive the best care possible. All healthcare providers are called to be patient advocates, not just medical practitioners. The challenge is, with our many other responsibilities, how can we step up and fill this role?

These are the takeaways from my own experience as a patient that have changed the way I practice:

1. Remember what it’s like to be the patient. Even though we have the knowledge and skills to treat medical conditions, being a patient is different. You may be overwhelmed with fear of the unknown or can’t collect your thoughts long enough to ask questions. It’s helpful to have the provider in your corner trying to anticipate those questions for you.

2. The patients need to matter to us. They’re more than a medical case; they’re real people with their own lives, families and struggles. Until we humanize them, we won’t be able to treat them to our fullest potential.

3. How care is provided is as important as what care is provided. Treating all patients with respect is key. When examining and treating my patients, I ask questions to get to know them, not just what has brought them into the emergency room. I explain any testing that needs to be done, discuss the results and carefully review treatment plans. I try to remember to talk with my patients and not to them. It’s my job to educate them so they comprehend their situation and can get better.

4. Understand that different patients may have the exact same diagnosis, but how they experience it is influenced by their life situation. We need to meet patients where they are and customize the manner of treatment to those needs. This requires us to listen.

5. A strong support system for patients can make a tremendous difference in their health. Get the families engaged and involved in your patients’ healthcare. 6. Join – or start – a committee aimed at improving quality, patient safety, patient interaction and patient experience. Whether you practice in a large hospital system or in a private practice, meeting with fellow practitioners, colleagues, and families to discuss how the delivery of healthcare can be improved for your patients can only benefit your practice. 7. It’s OK to get to know your patients. In fact, it’s critical. Listen to their story. Share your story. They can learn from you; and you can learn from them. This will change the way you practice. Be brave enough to connect! Ultimately, patient advocacy grows out of empathy. We all have a story and hardships. Allow that experience to connect you with your patients. When you can build that bridge, it will result in effortless empathy and better care for your patients. At that point, you stop just doing your job and start really caring for people.

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Caring for the Mentally ill

Kristi Kincheloe

Shannon Clinic
Certified Physician Assistant (PA-C)
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Kristi Kincheloe has been a PA for four years and took a job in psychiatry immediately after graduating her PA program. Before becoming a PA, she was a school psychologist for 10 years.

EDUCATION:

Masters in Physician Assistant Studies, Texas Tech University Health Science Center

Masters of Science, Abilene Christian University

NCCPA CERTIFICATIONS & CREDENTIALS:

Certified physician assistant (PA-C)

Kristi’s blog (below) was previously published in Physicians Practice. © Physicians Practice 2016

Bridging the Gap: How Certified PAs Serve Mental Health Patients

States across the country are dealing with the challenge of a shortage of psychiatrists and the impact it has on caring for patients with mental illness. In my home state where “everything is bigger in Texas,” it’s certainly a problem. With 200 of the state’s 254 counties designated as lacking enough psychiatrists, Texas stands out as one of the most severely affected.

To help solve the problem, Certified Physician Assistants (PA-Cs) are being tapped to fulfill an important role in caring for mentally ill patients.

As a Certified PA working with psychiatrists, I enable additional patients to be seen, diagnosed and managed. I see patients as young as 5 and as old as 100 for a range of mental disorders including ADHD, depression, anxiety, bipolar disorder and schizophrenia. Most referrals come from primary care, neurology or infectious disease specialists, and many of my patients also have chronic conditions such as obesity, diabetes or AIDS.

Currently, 1.3% of the nation’s 108,500 Certified PAs practice in the field of psychiatry, and we are well prepared to step up and specialize in this growing field. PAs are educated at the master’s degree level to practice in medical and surgical specialties. Plus, all PAs are certified by passing a national exam, and we maintain certification through substantive Continuing Medical Education and by passing rigorous exams at regular intervals throughout our career.

Certified PAs provide mental health care by:

1) Performing initial psychiatric evaluations. I see new patients, usually referrals, formulate a diagnosis and develop a treatment plan. It can be challenging, as some patients are forthcoming and eager for treatment, while others omit information they are uncomfortable sharing.

2) Educating patients about mental illness. I usually begin with a family history, trying to understand how that may influence current dynamics and the patient’s and family’s perception of the illness. We discuss the journey ahead, and I connect them with community resources. Unfortunately, we have a high suicide rate in this area, so I often refer them to counselors on suicide prevention. Educating the families on what they can expect and how to support the patient is also part of my mandate.

3) Managing patient medications. Of course, many of these patients are on long-term medications. I want to treat each patient with the same high standards and compassion I would treat a family member, so I try not to prescribe medication unless it is absolutely warranted. For example, I try not to automatically prescribe ADHD medication without considering early interventions first, such as cognitive behavioral therapy or behavior modification therapy. However, when I do prescribe medication for any mental illness, I explain the importance of compliance and also monitor the patient’s prognosis. I review labs to make sure they are not elevated, monitor thyroid and liver function and manage patient treatment plans.

4) Teaching a healthy lifestyle. I talk to my patients at length about lifestyle, and modifications they can make to feel better both mentally and physically. This may include a discussion about moderation and substance abuse, including abstaining from smoking and alcohol. This is particularly important if they are abusing a controlled substance, for which we regularly do drug screens and refer to support groups. I discuss stress management as well as the importance of exercise and encourage them to start a simple routine like walking or joining an exercise group. Patients tell me this does make them feel better.

5) Collaborating with other providers. Many PAs choose this profession because we like working on a team. Daily, I collaborate with physicians in many specialties. For example, I consult with a rheumatologist if the patient is asking for early refills of pain medication for arthritis or fibromyalgia. I have a great deal of crossover communication with primary care physicians. Together we stabilize and improve patient health.

Certified PAs can make a big difference to any practice, particularly in the area of mental health—where there is a significant and growing need.

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Treating Diabetes

Ji Chun

Optum Medical Partners
Certified Physician Assistant (PA-C)
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Ji Hyun (CJ) Chun, PA-C, BC-ADM, has been practicing endocrinology in southern California at Optum Medical Partners for 6 years. He works closely with patients who are resistant to certain therapies due to fear or misconceptions and tries to get them to modify their lifestyle to improve their overall health.

EDUCATION:

Masters of Physician Assistant Studies at A.T. Still University / Arizona School of Health Sciences B.S. in Kinesiology: Exercise Science, Arizona State University

NCCPA CERTIFICATIONS & CREDENTIALS:

Certified physician assistant (PA-C)

Board Certified-Advanced Diabetes Management (BC-ADM)

Physician’s Quote:

“Due to the epidemic of diabetes, there is an increasing number of patients needing access to the specialty of Endocrinology. Therefore, we've expanded our department to meet these needs. CJ is a valuable addition to our team. We consistently receive complimentary feedback from our patients regarding the excellent care he provides. They appreciate the time he takes to teach them and make them active participants in their care. In addition to his outstanding clinical and interpersonal skills, he is motivated to continually expanding his knowledge. He also dedicates his time to share this knowledge with the medical community by giving lectures across the country.”

--Amitpal Kohli, M.D.

Read CJ’s blog on managing diabetic patients below. His blog was previously published in Physicians Practice.

The Diabetes Crisis and How PAs Can Help Manage It

Diabetes is becoming epidemic. A 2014 Centers for Disease Control and Prevention report estimated that 29 million Americans have diabetes, 25% of whom don't yet know they have it. Another 86 million have pre-diabetes, with 90% of them unaware of their condition. An estimated 15-30% of those pre-diabetics will progress to full blown diabetics within five years without intervention.

There is also a critical shortage of endocrinologists, with three-month wait times for an appointment not at all unusual. That leaves primary care physicians to shoulder much of the burden of the increasing diabetic population. The good news is that certified PAs can help.

Certified PAs are well-suited to managing diabetic patients because they are highly educated, skilled in patient communications (critical to chronic disease management) and must pass a rigorous exam administered by the National Commission on Certification of Physician Assistants to be licensed in any state. They can provide vital assistance in this area in a number of ways.

Enable Additional Appointments

Certified PAs will increase access for the burgeoning number of patients. In addition, PAs can manage those uncontrolled diabetic patients who often require frequent visits and several days of follow-up, which is very difficult for already overscheduled physicians. Having PAs follow up on unstable diabetic patients is a big safety net for both the practice and patients.

Schedule Sufficient Time

Diabetes management is very time consuming, and most physicians struggle with lack of time. Each appointment requires a thorough review of the glucose log, adherence to lifestyle intervention and medication, and discussion of polypharmacy including cost and side effects. We need to do foot exam and manage lipids and blood pressure as well. Having a PA dedicated to diabetic management can ease the physician’s mind that this time consuming review is completed during each visit.

Focus on Disease Complexity

The field of diabetes is constantly changing. There were only two available drug classes (insulin and sulfonylureas) in the 1970s, and we now have 11 different classes of medications. As much as we are excited about the flexibility of different options, it is easy to get overwhelmed with "too many" and fall behind with the updates, especially with so many other things PCPs have to follow.

A PA designated for diabetes management can focus on staying up-to-date with evidence-based management by attending conferences and CME sessions, and then applying it to patient care. PAs can keep the physician current with the most clinically relevant updates.

Play to Their Strengths

We cultivate a team approach that includes the physician, PA and patient setting goals for outcomes. Everyone contributes to improve the patient’s care. As a PA in endocrinology, my strength is talking to patients who are resistant to certain therapies due to fear or misconceptions. Often the endocrinologist I work with specifically asks me to talk to a patient who has been refusing necessary treatments, whether it is insulin therapy, injectable therapy, statin therapy or something else. I take the time to explain the science, the rationale, and why changes need to be made now. I also try to add some humor to ease the tension.

For example if a patient shows worry or frustration with injectable therapy, I say: "I am actually relieved that you feel this way. I would be more concerned if you were excited to start injections." This usually makes them laugh and opens up the discussion.

Offer Perspective

There are now multiple options in treating diabetes, and each provider has preferences. A PA adds a different perspective in treatment approach. It's another benefit of working as a team — like having a second set of eyes on the same patient.

I became enamored with endocrinology during a clinical rotation during my PA education. I saw the joy in my preceptor who worked to motivate patients to change their lifestyle so they could reduce medications, come off insulin and improve their overall health. I realized then that drugs are only a part of medicine. Patient rapport, trust and relationships are medicine too.

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Providing Urgent Care Services

Jessie Dorne

PhysicianOne Urgent Care, ProHealth Physicians Inc., and Norwalk Hospital
Certified Physician Assistant (PA-C)
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Jesse is president of the Association of Family Practice Physician Assistants. She currently delivers urgent care through expanded hours at the patient’s primary care office which also increases safety because the patient’s complete electronic health record is available.

EMPLOYER:

PhysicianOne Urgent Care, ProHealth Physicians Inc., and Norwalk Hospital.

EDUCATION:

Master of Health Science Physician Assistant, Quinnipiac University

NCCPA CERTIFICATION:

Certified physician assistant (PA-C)

Jesse’s blog (below) was previously published in Physicians Practice.

© Physicians Practice 2016

Expanding Practice Scope with Urgent Care Services

By Jessie Dorne, PA-C

We live in an era of immediate gratification where everything is available at our fingertips. We expect services to be available early, late, and on the weekends, as evidenced by the rapid growth of urgent care centers around the country. I have noticed this trend firsthand while working as a PA in urgent care, obstetrics and gynecology, and emergency medicine.

I often ask patients with non-emergent complaints why they came to the emergency department. I've heard "My primary provider doesn't have an opening for two days" or "I can't make appointments with my hectic schedule." Just yesterday I was doing a sports physical on a teenager and the mother told me, "I usually bring him to his pediatrician for this, but I just forgot to make an appointment this year and tryouts are tomorrow." Patients expect access to care when they want it and where they want it.

Adding urgent care hours to your existing practice isn't just about patient convenience and practice revenue: It is actually a patient safety issue. Consider how the quality and safety of care are improved when providers have access to patients' entire electronic health records. Providers can perform medication reconciliation and have access to the past medical history. In addition, there is built-in follow up as the primary-care physician is copied on every note, and a follow-up appointment can be scheduled if needed.

One group of primary-care practices in Connecticut has addressed this demand by opening their practices on evenings and weekends for "extended hours." Patients can make an appointment, call ahead, or just walk-in for care. They can be an established patient of the practice or a new patient looking for a medical home. These extended hours are mainly staffed by PAs.

Why PAs? PAs are well-suited to help practices extend into the urgent care arena because of their education, certification, and experience. For example, PAs:

• Are educated as medical generalists and therefore able to provide a full range of care as they have training in all areas of practice, including pediatrics, internal medicine, and surgery.

• Work autonomously and have a collaborative relationship with physicians. They know when to seek another opinion and are comfortable working on a clinical team. • Are cost-effective — PAs provide most of what a physician can at about 50 percent of the cost.

• Maintain certification through a rigorous process that includes completing substantive CME every two years and passing a secure, proctored certification exam every 10 years.

• Transition easily among different specialties. In fact, over half of PAs change specialties during their career. Our wide range of clinical experience from multiple fields enriches the urgent care experience for our patients.

Urgent care is an emerging discipline that is here to stay. Primary-care providers should re-evaluate their practice and establish ways to provide extended hours and urgent care walk-in access to their patients. Certified PAs will help physicians meet this demand.

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Fighting Childhood Obesity

Justin Latino

Sheridan Healthcare at JFK Medical Center
Certified Physician Assistant (PA-C)
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As a PA in the emergency department, Justin too often sees the results of a sedentary lifestyle. In his spare time, he has turned his passion for health and fitness into a community resource to help children avoid and fight obesity.

EMPLOYER:

Employed by Sheridan Healthcare at JFK Medical Center in West Palm Beach, Florida

EDUCATION:

Master’s Degree in PA Studies, Nova Southeastern University

Fellowship in emergency medicine, Eastern Virginia Medical School.

NCCPA CERTIFICATIONS & CREDENTIALS:

Certified physician assistant (PA-C)

Certificate of Added Qualifications (CAQ) in Emergency Medicine

Justin’s blog (below) was previously published in Physicians Practice.

© Physicians Practice 2016

Certified PAs Can Help Fight Child/Adolescent Obesity

By Justin Latino, PA-C

As physicians know all too well, obesity is a major health issue, particularly when it starts in childhood. The statistics are startling when you consider that 17 percent of children and adolescents age 2 years old to 19 years old are considered obese, according to the CDC. Another fact physicians recognize is that obesity sets patients up for a lifetime of healthcare problems including cardiovascular disease, type 2 diabetes, and certain cancers.

As a certified PA working in emergency medicine, I sometimes see 13- and 14-year-old kids who weigh 200 pounds to 300 pounds and are already in need of medication for high blood pressure and diabetes. That is a concern to healthcare professionals as habits formed in childhood are hard to reverse later in life.

Because I am passionate about health and fitness, I decided to bring awareness to this issue and am planning the Kids Wellness Expo in West Palm Beach, Oct. 9, collaborating with Healthcorps, a national charity.

This is a free health fair for the whole family that include classes in fitness, nutrition, stress relief, and medical screenings for blood pressure and diabetes. We are raising sponsorship funds and the money will be used to implement a model in local high schools that directly impacts students'' overall wellness.

My point is, PAs in your office can impact this epidemic on a local scale by leading change in your private practice. A certified PA can be charged with developing simple screening protocols, basic nutrition and exercise information, and a list of community resources. If you have a significant number of patients with this condition, the PA could hold group educational appointments and bring in outside speakers.

Certified PAs routinely take histories and perform physicals during which they can assess the child or adolescent's current or potential obesity and his predisposition to diabetes and hypertension, based on family history.

In addition, they are educated in communications skills, which allows them to approach and discuss what can often be a sensitive subject, not only to the young patient but to parents as well.

What can we do to address the issue and begin to change behaviors?

• Educate both the patient and parent. Certified PAs in primary care are often in a position to discuss why it is important to have a healthy BMI not only while young but throughout life. Patients and parents are often not aware of the basic nutrition and exercise facts that we as medical professionals take for granted.

• Inspire the patient. Children need to see the value of changing eating and exercise patterns. For example, do they want to feel better by reducing or eliminating knee pain? Do they want to be faster in gym class or on the track? Do they want to play a sport that is leaving them behind? Are they self-conscious about their weight and want to look better? PAs are skilled at asking probing questions that can make kids realize they have the power to make changes in their lives.

• Discuss reducing screen time. As a population we are getting more sedentary. Everything is at our fingertips with remote controls and mobile devices. We all know these devices can be addictive. Explain why it is important to turn them off, walk away and spend time outdoors.

• Cover the basics of nutrition and exercise. Eat in moderation, keep healthy snacks in the home, and move more. Walking, swimming, and riding a bike are things kids can easily do in the summer to keep active. Encourage parents to look for opportunities for their children to play on community sports teams. Tennis, baseball/softball and soccer are standard offerings in many towns and usually affordable on a recreational level.

Like most PAs, I chose this career because it affords a good work/life balance. I realize it's not the money that is most important — it is the impact I make and the legacy that I leave behind. The childhood obesity epidemic is a national challenge and physicians and PAs have the opportunity to empower change and make a real difference.

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Patients Benefit from Continuing Medical Education

Patients Benefit from Continuing Medical Education

Focused on Performance Improvement

Certified PAs at the University of Michigan Health System are developing performance improvement studies as part of their continuing medical education (CME) requirements for recertification.

PAs want to improve patient care and their practice environment and allowing them to customize their CME activities to their practice maximizes the benefits to their patient population.

For example, in the otolaryngology department, certified PAs Brian Kilbarger, Alexandra Tiefel and Janet Urban designed a study to see if they could improve patient outcomes by better directing patients to the follow-up care they need.

This team measured current referrals, implemented a plan to increase referrals where indicated and compared the results.

1) First, they identified a problem. Many patients who came to them for evaluation for ear pain often had another condition such as problems with the jaw (TMJ), grinding/crunching of teeth, muscle spasms in neck area etc. The goal was to find a way to improve referrals to the providers who could actually treat these conditions.

2) In September 2015, the PAs generated a baseline measurement. Through the department’s Electronic Health Records, they identified 41 patients who came in with one of those conditions as a primary or secondary diagnosis. They discovered only 52 percent of these patients were referred to a dentist, physical therapy or a combination of both for treatment.

“We had to ask ourselves why only half of these patients were being seen by someone who could help them,” said Kilbarger. “Whether it was long wait times, lack of access or provider education, we had to find ways to eliminate these barriers.”

3) The result was an increase in referrals from 52 percent to 88 percent within three months -- a direct impact on patient outcomes in terms of treatment and symptom relief. What did the team do to achieve these results?

• They met with the Director of the TMJ Program to discuss seeing patients on an expedited basis since wait times for the TMJ clinic were up to one year. The team created “Smart Orders” with the name of therapists who see TMJ patients and copied the director. The Smart Orders were a flag that his person needs prompt attention.

• They created a “Smart Phrase” in the orders that said “prescribed soft diet and anti-inflammatory.” This Smart Phrase was a trigger for providers to realize there was a Smart Order for this patient.

• In addition to educating providers, they asked who else they could meet with to be effective and began engaging and educating residents and scribes on Smart Orders and Smart Phrases.

“This shows that with focus and simple interventions, significant changes can be made,” concludes Kilbarger. “As PAs we like to do these things because we are natural problem solvers and caring for patients is our calling.”

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Managing HIV

Sam Wijesinghe

Adventist Health Central Valley Network
Certified Physician Assistant (PA-C)
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Sam practices Family Medicine at Adventist Health Central Valley Network in California in a small, rural community. He is the HIV specialist in the office and has been an advocate for HIV testing throughout hospitals in his region. He is also a faculty member at Pacific AIDS Education & Training Center.

EDUCATION:

HIV/AIDS Clinical Fellowship UCSF, Fresno, Master of Physician Assistant Studies (MPAS), Union College, M.S. in Management Information Systems, U. of Nebraska, B.S. in Health Care Management, Bellevue University

NCCPA CERTIFICATIONS & CREDENTIALS:

Certified physician assistant (PA-C)

AAHIVS - American Academy of HIV Specialist

Physician’s Quote:

“There is a lack of providers in Central California, particularly in rural areas, that are able to effectively manage HIV in a primary care setting and the PA is a viable solution to fill this gap in service. Under the supervision of a Physician, the Physician Assistant examines patients, orders and interprets tests, diagnoses and treats illnesses, prescribes medications, and counsels patients on preventive health care. The addition of an HIV specialty certification contributes to PAs’ ability to adequately provide this same scope of disease management and preventive care access to a group of patients that are in need of and have historically been marginalized in receiving quality primary care services.”

--Ivan Gomez M.D., AAHIVS

Read Sam’s blog below about making a difference in the fight against HIV. This blog was previously published in Physicians Practice.

Certified PAs Make a Difference in the Fight against HIV

About a year after I started practicing family medicine at Adventist Health in California, the medical director invited me to work with local counties as the HIV testing coordinator. The first patient I met was a little girl about my daughter's age who was born with HIV. This unwitting victim touched my heart, and that connection helped me realize that someone had to step up and get involved to help these patients.

At the end of my first year as the HIV testing coordinator, I was invited to do one-year HIV clinical fellowship at UCSF, Fresno, in the family medicine department. After completing the fellowship, I took a national exam and become credentialed as a Practicing HIV Specialist (AAHIVS). This is the same exam that physicians and nurse practitioners must pass to also earn the AAHIVS credential.

That being said, there is tremendous opportunity to make a positive impact on the fight against HIV within family practice without become a full-time specialist in this area. In fact, 90 percent of my own patients are still in family medicine, and I have a loyal patient panel typical of that specialty. Managing HIV patients is just 10 percent of my practice. All certified PAs in family medicine can make a big difference in reducing the spread of HIV/AIDS. There are simple steps that can bring positive change to all communities.

• It starts with testing. The CDC recommends opt-out HIV screening for all patients 13 years old to 64 years old. That means the provider makes HIV testing routine along with other necessary screening labs unless the patient opts out. The U.S. Preventive Service Task Force recommends HIV screening for all patients 15 years old to 65 years old. This is a "grade A" recommendation. That means the net benefit is substantial with routine HIV testing. If the age seems too young, consider this: There are about 50,000 new cases every year and one-third of them are in the 13-year-old to 29-year-old age group. Many patients don't know they have HIV, and this age group is more likely to engage in risky behavior.

• It continues with education. Certified PAs are educated in communication skills. They know how to ask questions and deliver information about the disease, how to reduce the spread of infection and how to maximize the patient's own health and maintain wellness. Education leads to patient understanding about why treatment is important. Currently, only 30 percent of patients have viral suppression because the others are still undiagnosed, not linked to care, not taking medicine or not going to appointments. When patients are treated and the disease is controlled, there is a 96 percent reduction rate in transmission.

• It challenges all providers. There is still a stigma around this disease. Yet, you may already have HIV patients and don't know it. Estimates show 13 percent of the HIV population remains undiagnosed. If testing becomes routine, people talk about it, learn about it and stop fearing it. You just have to treat HIV patients like all other patients. Confidentiality is important and is already covered by HIPPA.

• In family medicine, treat it as just another chronic condition like diabetes or hypertension. Treatments have advanced greatly for HIV. Patients used to have to take three to four medications a day. Now it is just one pill and there are six choices for that pill based on patient history, kidney function, etc.

I encourage PAs to work with a physician already treating HIV patients. Once they have experience, they can manage medications and patients' long-term care on their own. Also, PAs can connect with the American Academy of HIV Medicine for tools and information, and make it point to direct some of the ongoing CME credits required to maintain PA-C certification in the area of infectious disease and HIV.

There is big shortage of HIV providers. A 2012 survey showed there were 4,500 HIV providers, and about 50 percent of them planned to retire in the next 10 years. The expectation is that primary-care providers will fill the void and care for HIV patients.

However, primary-care physicians are also in short supply and overburdened. We must remain vigilant and considerate about this disease. Certified PAs have always stepped up to the plate to fill the void in family medicine and underserved areas, whether it be caring for the homeless or Medicaid patients. Managing HIV patients is one more area where we can make a big difference.

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Performing Annual Wellness Checkups

Valery DeSimone

Certified Physician Assistant (PA-C)
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Valery routinely sees Medicare patients for their Annual Wellness Visit at OptumCare Medical Group, an internal medicine practice in South Orange County, California. She also worked as a dermatology PA for eight years, and uses that experience in her day-to-day work in internal medicine.

EDUCATION:

Masters of Physician Assistant Studies, Yale University B.S. in Biology, University of California, Davis

NCCPA CERTIFICATIONS & CREDENTIALS:

Certified physician assistant (PA-C)

Physician's Quote

“As healthcare evolves, a provider’s role becomes more complex. Valery provides and augments the ongoing access to keep continuity of care flowing. She broadens office services, decreases the need for certain referrals and captures data and metrics which health plans now require for quality. The complexion of the office would be compromised by her absence.” --Vincent Duda, M.D.

Read Valery’s blog below on providing the Annual Wellness Visit for Medicare patients here. This blog was previously published in Physicians Practice.

Annual Wellness Visit is a Win-Win for Patient and Practice

By Valery DeSimone, PA-C

The annual wellness visit (AWV), funded by Medicare, is a special opportunity to communicate to your senior patient population and understand their needs at a deeper level, providing them a free opportunity to assess and advocate for their own health going forward.

I work in an internal medicine practice where over half of our patients have Medicare as their primary insurance. As a certified physician assistant (PA-C), I see several patients every week for this type of visit.

The AWV is not intended to be a typical appointment aimed at treating acute illness or chronic conditions. Rather, it is more of a discussion than an exam, focused on assessing the patient’s current health baseline and helping them understand how health maintenance and prevention will keep them out of the doctor’s office.

Building on this discussion, I can then coordinate care with specialists and provide continuity of care going forward. This visit solidifies this patient in your practice as they begin to understand it is their “medical home.” This is a visit that all seniors should have, even those who feel good and are not in need of health care at the moment – but they may need your encouragement to understand its availability and importance.

To make the most out of this visit, here are four questions to ask your patients when scheduling the AWV appointment:

1. Can you create a health history folder and bring it to your appointment? The appointment will go more quickly and be less stressful if the patient has already made a list of vaccinations, prior surgeries and dates. Your records probably don’t include that flu or shingles vaccine the patient got at the local pharmacy.

2. Can you bring a list of all specialists you have seen in the past few years? Many patients self-refer and may be seeing seeing a cardiologist, an ob/gyn, urologist etc. This list may bring to light medical issues that the patient hasn’t mentioned.

3. Can you bring in all prescriptions, supplements and over the counter medications in their original containers? This ensures you have the correct information on dosage and frequency and allows you to discuss any concerns about drug interactions or duplication.

4. Do you have an advanced directive? The AWV is a unique opportunity to discuss end-of-life issues. If they have one, scan it into their chart for use should the need arise. If they don’t have an advanced directive, you can give them one to fill out or take home to discuss with family. You are doing them a great service by provoking this discussion.

The AWV can be a vehicle to ensure early detection. It allows you to screen for early identification tests based on risk factors. However, it is important in this population especially to prioritize scheduling so the patient is not overwhelmed with a battery of follow up tests.

The AWV collects a significant amount of baseline data, so the first appointment can take an hour. As the name implies, it is an annual visit, and in subsequent years the appointment should be shorter.

Some physicians feel the reimbursement is too low for this comprehensive visit. However, if your practice markets the annual wellness visit effectively, it can provide additional revenue from new patients and cement your relationship with existing ones.

Certified PAs are highly-qualified to manage the annual wellness program in your office. We are highly educated, nationally certified and licensed by state medical boards. Studies show we provide high value as we deliver cost-effective, quality care.

Consider making the AWV a “best practice” for your office, and reach out to your senior population to offer them this Medicare-paid opportunity for better health.

About NCCPA

NCCPA is dedicated to serving the interest of the public. We do so with a passionate belief that certified PAs are essential members of the health care delivery team who provide millions access to more affordable, high quality health care.
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