The Goal is to Get More PAs Practicing in Rural Areas
Just 15 percent of physician assistants (PAs) practice in rural areas – a situation that has contributed to acute shortfalls in the delivery of primary care for 20 percent of the population. Moreover, not enough PAs are helping meet the demand among rural residents for close-to-home specialized care in such critical areas as mental health, rheumatology, urology, and neurology.
The new Master of Science in Physician Assistant Studies (MS-PAS) program at Pfeiffer University, which begins teaching its inaugural students this semester, aims to address these issues by “providing the kind of advanced instruction that will enable more physician assistants to go into remote rural areas to practice medicine and feel confident in those settings,” said Brenda Diaz, the program’s founding director. “The intentionality of our program is what sets us apart.”
Or, to put it another way, Diaz wants to give her students the tools in medicine and advocacy that will equip and inspire them to follow in the footsteps of the country’s first PAs. These people were once Navy corpsmen who, having learned many medical skills during the Vietnam War, completed the country’s first training program for physician assistants at Duke University in the 1960s – then began working in Appalachia.
Nathan Woodward, 38, is among Pfeiffer’s first PA students. He finds the focus of the program appealing, having served the rural communities near Wilmington as a paramedic for six years.
“When I found out that this program was starting and that they were going to have a concentration offered in rural medicine, that spoke to me,” he said. “I’m also looking forward to getting to know the people in this area and giving back in any way I can.”
Sheryl Steele, also among Pfeiffer’s first PA students, shares Woodward’s enthusiasm for what the MS-PAS program aspires to achieve. Before coming to Pfeiffer, she worked for 31 years as a paramedic in rural areas, first in Kansas and later in North Carolina, in addition to raising three now-grown children. Along the way, she also earned a BS in emergency medical care from Western Carolina University and became an EMT instructor.
“Rural medical work was already my forte,” Steele said. “It was already what I was used to. It was rewarding. I’ve always enjoyed my medical experience. I left my last job of 17 years (as a senior paramedic for FirstHealth of the Carolinas in Chatham County) to come to this school. The day that I left I was in tears because there was not a day when I could say that I didn’t love what I do. I’m excited to be here because I get to grow that even higher than I ever have.”
The MS-PAS program at Pfeiffer has been about four years in the making. This past November, it received provisional accreditation from the Accreditation Review Commission on Education for the Physician Assistant, Inc. This paved the way for the first cohort of students to begin taking classes on Pfeiffer’s Misenheimer campus; 22 will do so on a temporary basis until summer 2020. At that point their permanent home will become Pfeiffer’s Health Sciences Center in nearby Albemarle, the construction of which is nearing completion.
Diaz said that another 36 students will make up the MS-PAS program’s second cohort, enrolling in January 2021. After that, 45 new students will enroll each January, capitalizing on the high demand for PAs that Diaz expects to continue for many years.
Steele wanted to be part of an inaugural program.
“No new program is going to have young people starting it,” she said. “It’s going to be people with a huge amount of experience, and I was absolutely right with that. And, of course, this is a smaller school, so I knew there was going to be more one-on-one training.”
Ultimately, as several studies have shown, the likelihood of PA students practicing in rural areas after they graduate increases when they receive the right kind of clinical exposure as part of their training. Thanks to the efforts of Dr. Tom Earnhardt, the director of clinical education for Pfeiffer’s MS-PSA program, Pfeiffer has affiliation agreements with all the major hospital systems serving rural patients in its area, including (but not limited to) Atrium Health, Novant Health and FirstHealth of the Carolinas. Moreover, the clinical rotations that Pfeiffer’s PA students undertake at various hospitals and clinics will be enhanced by the training that they receive at the Health Sciences Center.
The MS-PAS program, then, has all the ingredients for success. Still, Diaz allows that several obstacles stand in the way of keeping Pfeiffer-educated PAs in rural areas after they complete the 27-month program: lower pay than that offered in urban areas; isolation that can limit interaction with colleagues; settings that may not be conducive to the needs of a family.
At the same time, there are many possible rewards, both financial and personal, which Pfeiffer’s MS-PAS program will promote. The financial ones come in the form of loan repayment programs that some rural clinics offer. Pfeiffer’s PA students can expect to hear plenty about them, either from the university’s financial aid office or from visiting representatives of the clinics themselves.
As for the personal rewards: “You know you are making a difference,” Diaz said. “The patients are so thankful for you being there, which certainly compensates for the lower salary you may make.”
Advocacy to Be a Key Part of What Students Learn in Pfeiffer’s New Physician Assistant Studies Program
The mission of Pfeiffer University’s new Master of Science in Physician Assistant Studies (MS-PAS) program is clear, and it goes far beyond educating exceptional clinicians.
“Our students will also be effective advocates for their community,” said Brenda Diaz, the MS-PAS director.
This advocacy will rest not only on raising awareness of problems in rural areas (and beyond) but also coming up with solutions to them. It will be integrated into the MS-PAS curriculum in a variety of ways.
Diaz spoke, for example, of teaching each of several smaller groups of students how to advocate effectively for a cause. One cause might be keeping a hospital open. In recent years, many rural hospitals have closed, having been unable to operate because of low reimbursement rates from the federal government.
“It’s through effective advocacy that we can get policy changed so that (higher) reimbursement rates and federal money can come to rural communities and support those hospitals that provide much-needed care for these communities,” Diaz said. “The return on such investments is tremendous. Functional hospitals and clinics mean healthier communities; you don’t have people losing time from work or becoming disabled because of preventable disease.”
This kind of thing should appeal to Meghan Norris, who is among the first PA students at Pfeiffer. Norris, who hails from Burlington, earned a BS in biology/psychology from UNC-Chapel Hill in 2014 and, later, an MS in physiology from NC State. Before coming to Pfeiffer, she worked as a certified medical assistant for UNC Health Care.
During her undergraduate years, Norris served as the vice president of a student rural health initiative that aided a free health clinic in Fremont. The work entailed designing and distributing brochures, raising money and asking community members what they needed in terms of healthcare. Norris also worked as a volunteer in Panama and Honduras for Global Brigades, which works to implement sustainable health systems in the rural areas of those countries as well as in Nicaragua and Ghana.
“I’m ready for classes to start,” Norris said last week. “I’m jumping at the gate.”
There are several other ways that advocacy will emerge in Pfeiffer’s MS-PAS program.
For example, an entire class of students will learn to identify a healthcare-related need or disparity in their backyard – then, using the Project SEED model that numerous other institutions have established, develop an initiative to address it.
The “SEED” in Project SEED stands for Serving Everyone, Embracing Diversity. Diaz helped establish a project several years ago when she was teaching PA students and serving as their faculty advisor at Nova Southeastern University (NSU) in Fort Myers, Fla.
The inaugural Project SEED at NSU began when students learned that workers in orange groves were injuring their eyes. In response, they secured a donation of 600 pairs of protective glasses along with ties to secure the eyewear. They distributed the eyewear at a local Catholic church, along with instructions on what to do in the event of an eye injury, which was translated into Spanish and Creole with the assistance of NSU nursing students.
In subsequent years, this effort expanded to include not only the distribution of eyewear but also blood pressure and glucose screenings, mammograms, immunizations, nutrition education, and child physicals.
But that’s just the beginning. The Project SEED at NSU, as the one at Pfeiffer will be, is a multi-pronged effort.
For example, Project SEED Global Health gets students to think beyond the boundaries of their classrooms to identify needs in areas abroad that have been affected by natural disasters, war or famine. Diaz spoke of NSU’s PA students sending books and stethoscopes to their counterparts at a school in St. Croix after these items were lost in a hurricane there.
“The things I’ve seen the students at Nova Southeastern University do over the years are pretty amazing,” she said. “I really can’t wait to see what our students at Pfeiffer University will do.”
Another example: A mentorship program called Project SEED Next Generation connects PA students with high school and college students from underrepresented minority and disadvantaged populations who are interested in becoming PAs. The mentorship works this way:
Each semester, a PA student calls a mentee and asks several questions. How are you doing? How are your classes going? Are you ready to start applying to PA school?
In Diaz’s eyes, such an effort is critically important. “The No. 1 reason why a minority student or a student from a disadvantaged population leaves college or drops out of medical school is because of lack of support from home,” she said. “They have no mentorship outside of the university.
So, if we can be that mentor, if we can be that voice of encouragement, if that’s all it takes, then why not? It means a lot that this PA student took the time to call me and asked me how things are going.”
Darwin Ramirez, who is among Pfeiffer’s first PA students, would agree.
He earned a BS from Pfeiffer in health and exercise science, graduating in 2018. During his junior year at Pfeiffer, he met Diaz and, after the two discussed his interest in pursuing a master’s degree in PA studies, she “became my No. 1 fanatic,” Ramirez said.
“She reached out regularly to see how I was doing in and out of my classes,” he added. “When I faced adversity over things I had no control over, I reached out to her. She gave me advice and helped me to see things more clearly.
“She also pointed out why being a PA was such a rewarding career to go into. She shared experiences of her journey through PA school, and also of her time as a clinician. Everything she told me further empowered my desire to pursue PA school.”
Training of Students in Pfeiffer’s New Physician Assistant Studies Program Includes Ways of Addressing Personal Challenges of Rural Patients
Students in Pfeiffer University’s new Master of Science in Physician Assistant Studies (MS-PAS)
program “need to demonstrate skills at the highest level,” said Brenda Diaz, the program’s director. “But can they apply them effectively in a rural setting?”
The training that the students will receive in Pfeiffer’s Health Sciences Center will help ensure that the answer is yes.
The center, which will open this summer in downtown Albemarle, will feature the Center for Advanced Clinical Simulation Education, one side of which will include a “clinic” with six fully equipped exam rooms. Each room will be wired for audio and visuals. This will enable instructors to evaluate recordings of the PA students engaging with patient actors in what are known as Objective Structured Clinical Examinations, which each student will do at least once a week, so that “when they go out on clinical rotations, they’re comfortable around patients and they’re comfortable in the clinical environment,” Diaz said. (The clinical phase of Pfeiffer’s MS-PAS program lasts 12 months, with each clinical rotation lasting five weeks. It begins after students successfully complete a 15-month didactic phase of the program.)
The recordings will facilitate the assessment of a student’s ability to establish a rapport with a patient along with the quality of their physical exam technique. Is the student looking at the patient in the eye? Is the student speaking clearly? Is the student establishing a therapeutic type of relationship with the patient?
Is the student holding the stethoscope correctly? When they order labs, are they ordering the right ones and, if so, interpreting them correctly? Are they formulating the right diagnosis and treatment plans?
Most important – and this is what will make Pfeiffer’s MS-PAS program unique – the recordings will reveal how well students are responding to the personal challenges of the patient actors they are examining. The challenges in question reflect real-life experiences that Diaz and other faculty in the MS-PAS program have had working decades as PAs in rural settings.
“We want our students to be exposed to that so that they think critically,” Diaz said. “It’s not just rote memory. They need to think and keep everything in context.”
One of the most common challenges is the patient who has lost their job and has no insurance. When such a scenario emerges, a PA wouldn’t order a medication that costs $200. Nor would they order labs that cost $1K. Instead, they’d come up with an appropriate treatment plan that the patient can afford, while adhering to standards of care.
She stressed that there is “always an alternative” to, say, the listed price for a medication. “You pick up the phone and call the pharmaceutical company. They have patient-assistance programs. You (the PA) have to be the advocate.”
First Row (L-R) - Sheryl Steele, Rachel Nance, Ngoc Nguyen, Morgan Sox, Emily Daniecki, David DeBerry, Elizabeth Wimmer, Kayla Miles
Second Row (L-R) - Laurel Barnett, Samantha Gulledge, Elizabeth Saucedo, Hunter Rogers, Rachel Kiker, Faith Pressley, Meghan Norris, Nathan Woodward
Third Row (L-R) - Kayla Donnalley, Robert Schwartz, Darwin Ramirez, Mario Tawadrous, Dalton Helm
not pictured – Marisa Cook)
Ken Keuffel, who authored this article, has served as Pfeiffer’s Assistant Director of Communications since December 2019. He welcomes story ideas from Pfeiffer’s faculty, staff, students, alumni and friends. The form for submitting story ideas is at www.pfeiffer.edu/newsform