In this issue:
Provider wellness includes the health of your mind, body and spirit. Unfortunately, many PAs are unwell. Our jobs can be very stressful. Most practices these days are trying to maximize patient visits in minimal time. Then there are the quality measures, much of which depend more on patient adherence than provider competence. Provider stress can lead to substance abuse, trouble with relationships, depression, and even suicide. Provider Burnout has become a popular term and many PAs, MDs, and NPs are leaving the practice of medicine years before retirement age.
Unfortunately, medical providers are generally not good at seeking help from others. We are less likely to seek help for physical, mental, or substance abuse problems. Often, providers may fear that asking for help might affect their medical license. Fortunately, in NC, if you do ask for help, avenues have been created to protect your medical license.
So, where do we go from here? Obviously, 7 to 8 hours of sleep, 5 days of moderate intensity exercise weekly, and a well-balanced diet can’t hurt. But, beyond that, surrounding yourself with good friends and family as well as tending to your spiritual health are crucial. Work-life balance can be a challenge in our current medical environment but will lead to a more fulfilled and happy life.
The NCAPA recognizes the importance of PA Wellness. Our current strategic plan includes promotion of wellness and we collaborate with the NC Physician’s Health Program (NCPHP). Medical providers have a notoriously poor history of confronting or even reporting impaired colleagues. NCPHP offers compassion, support, and respect for confidentiality and privacy. If you or a PA colleague is dealing with provider burnout, substance abuse, or mental health issues, NCPHP offers evaluation, monitoring, and a treatment referral program. For more information, go to https://ncphp.org.
The NCAPA is pleased to have Dr. Clark Gaither, NCPHP Medical Director, present a session on Provider Burnout at our upcoming Summer Conference. I hope you find the session enlightening and look forward to seeing you on the beach at the Fun Run promoting PA wellness!
Truett Smith, MPAS, PA-C, DFAAPA
by Sarah Wolfe, Assistant Vice-President, McGuire Woods Consulting
SB 160: Handicap Parking Privilege Certification was signed into law by Governor Cooper on July 12, 2017. Effective immediately upon signature into law, the law was clarified to explicitly state that PAs may sign for handicap placards. Once signed into law, NCAPA sent a letter to the DMV, notifying them of this change.
We appreciate our bill sponsors, in both the House and Senate, for backing this proposal. Thank you, Sens. Andrew Brock (R-Davie), Wesley Meredith (R-Cumberland), and Ralph Hise (R-Mitchell), as well as the HB 11 bill sponsors, Reps. Gale Adcock (D-Wake), Josh Dobson (R-McDowell), Jon Hardister (R-Guilford), and Carla Cunningham (D-Mecklenburg)!
NCAPA is asking YOU to send a prepared email to your House and Senate members, thanking them for passing this important legislation.
Governor Cooper signed the STOP Act into law on June 29, 2017. The final version of the STOP Act was amended to limit the language requiring PAs and NPs to personally consult with their supervising physicians ONLY when a “patient is being treated by a facility that primarily engages in the treatment of pain by prescribing narcotic medications or advertises in any medium for any type of pain management services.” Check with your practice to see if your place of employment falls under this description of facilities where PAs and NPs must personally consult.
NCAPA plans to work with the North Carolina Medical Board (NCMB) on any rules established to regulate the personal consultation requirement for PAs practicing in pain clinics. The NCMB has released information to all licensees that it has not determined how it will define “consultation” in regulation, and that “an important consideration is whether a meaningful consultation about the patient and the recommended treatment occurs and is documented in the patient record. The Board might ultimately leave it to the discretion of PAs, NPs and their supervising physicians to determine how consultations occur (e.g. in person, via telephone or other electronic means).”
by Cliff Daub, PA-C
As PAs practicing in North Carolina, we have one of the best scopes of practice in the country. Most patients are familiar with PAs and appreciate our role in the health care system. However, every now and then, we all encounter a patient who says, “I only want to see the doctor.”
Recently, I entered an exam room to see a new patient and introduced myself as the PA with the spine team at our orthopedic group. Immediately, her facial expression hardened and I could tell she was not happy. She said, “I don’t know why I am here because I don’t think you can help me. I have already seen two other doctors including a spine specialist and have tried lots of medication and injections and have now been told I need back surgery. I don’t want surgery, but wanted a second opinion, and this was the only available appointment.” Having practiced for 15 years as a chiropractor before beginning my PA career, I have seen tens of thousands of patients; this was not the first time I had a patient skeptical of my skill and knowledge.
I sat down next to her and asked her to tell me what she thought was going on with her back and what she thought needed to be done. After several minutes of listening to her story, I told her I had already reviewed her voluminous medical record and prior testing, but wanted to do my own exam before giving her my treatment recommendation. Upon completing the exam, I could tell her demeanor had changed and she was much less tense. She said, “That is the first time in more than two months that anyone listened to my concerns and actually touched my back to try and determine what was wrong.” We then went on to discuss her treatment options and, in the end, she said, “I don’t care if you are a surgeon, PA or chiropractor, I trust you.”
There is a saying that patients do not care how much you know until they know how much you care. Every day in practice, I am reminded that it is truly a privilege and honor to have patients trust me with their health. I am thankful for the opportunity.
Embassy Suites, Kingston Plantation
Myrtle Beach, SC
August 20-25, 2017
The NCAPA combines the best CME conference for PAs with a family-friendly beach vacation. We start our sessions early and end early so you can have the best of both worlds!
Our full agenda is announced and we are proud to present a variety of interesting topics. There is truly something for any provider. Each lecture hour on the agenda will include case studies and clinical pearls that will be useful in YOUR clinical practice. In addition, we offer the 2 hours of Opioid Prescribing CME now required by the NC Medical Board included in your full conference registration or Wednesday daily registration.
by Sandra Alexander, PA-C
You’ve seen it in the news, in your communities, and in your practices…the opioid epidemic. On July 22, 2016, President Obama signed the Comprehensive Addiction and Recovery Act (CARA) into law to increase access to providers, including PAs and NPs, for evidence-based treatment for opioid dependence. But as PAs, are we doing our part? Are we providing non-narcotic therapies before trying prescription opioids for pain, using our state Controlled Substance Reporting System to help monitor our patients’ safety, and having discussions with our patients to recognize the symptoms of physical dependence that can lead to full-blown opioid dependence? Are we consulting with our medical peers on tapering opioid medications safely and effectively on an individualized patient basis when we see signs or symptoms that make it prudent to do so? Are we taking the next step to provide naloxone to those using opioid prescriptions as a safety precaution, and offering naloxone to patients and family members of those with identified opioid dependence?
Here in North Carolina, Governor Roy Cooper recently signed into law the Strengthen Opioid Misuse Prevention (STOP) Act of 2017, which aims to reduce the supply of unused, misused and diverted prescription opioids in the state as well as decrease resulting patient harm and deaths. If we aren’t in pain management clinics, how are we as PAs responding to the fight against the opioid epidemic? As of June 30, the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment reported that 496 PAs and 1721 NPs across the U.S. have received their waiver for a DEA-X license to provide buprenorphine as an evidence-based treatment for opioid dependence. In North Carolina, 34 PAs and 62 NPs have received their DEA-X license. Why so little participation by PAs?
In 2016 the Surgeon General reported only 10 percent of the 2.2 million Americans with an opioid use disorder may have received treatment. On June 27, 2017, the Stat Forecast estimated that 500,000 Americans may die from opioid misuse in the next decade. The need is apparent, but perhaps the process on how to proceed needs clarification.
The Providers’ Clinical Support System for Medication Assisted Treatment (PCSS-MAT) is a federally funded coalition of major healthcare organizations that provides training, resources and mentoring with no cost to clinicians. It is now working in conjunction with AAPA to offer a FREE 24-hour MAT waiver course that allows PAs to treat opioid use disorder, thereby increasing the number of PAs in the fight against the opioid epidemic. Go to here to see PCSS-MAT’s information on MAT waiver training for PAs.
The American Society of Addiction Medicine (ASAM) is collaborating with AAPA and AANP to provide the 24-hour waiver training for PAs and nurse practitioners. The NP/PA 24-Hour Waiver Training is available for free through 2017, made possible in part by an unrestricted educational grant from Indivior. To take advantage of the opportunity to receive your training from the author of the National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use, follow this link.
My patients combat stigma on a daily basis in the process of receiving treatment for their disease. I serve all races, ethnicities and classes of patients with no difference to be found in their behavior in the waiting room, whether being treated for addiction or not. In my office I find my buprenorphine patients to be more appreciative of the accountability and service I provide as well as more compliant than other patients. Consider adding yourself to the army against the opioid epidemic and join me in the fight!
NCAPA Health Committee member Sandra Alexander, PA-C, is the 2016 recipient of the PA Foundation NIDA Mentored Outreach Award in Substance Use Disorders (SUD) Treatment Dissemination. She is also a member of AAPA and founder of RDU PA/NP psychiatry & addiction medicine group/web forum, a consultant for NC Physicians Health Program, and founder and owner of Collegial Behavioral Health, PLLC Raleigh, NC.
Buddy Treadwell worked in North Carolina between 1940 -1975 and became the prototype for modern day Physician Assistant. NCAPA Board member April Stouder, MHS, PA-C, has written an article on the man and his legacy, which was published in the March 2017 issue of JAAPA. As we celebrate the 50th year of the PA profession, AAPA has generously agreed to allow us to share the article with our members this month. Discover the legacy of Buddy Treadwell and read the article in its entirety here.
by Emily Adams, Executive Director
NCAPA is looking for members who would like to serve on one of our standing committees in 2018. Committees gather information, study issues, reach consensus, and make recommendations to the Board of Directors. Read more about our standing committees here and how active committee involvement makes NCAPA a successful organization.
Based on individual interest, Committee Chairs are appointed by the President-Elect and voted on by the Board of Directors in September. Once Committee Chairs are notified of their appointments in early October, we hope they will plan to attend the NCAPA Board meeting on November 4th, which will also include an orientation to board and committee involvement. Committee Chairs, while working with staff, will confirm and notify accepted committee members. To move this process forward, we would like your application by August 31st.
If you currently Chair or serve on a committee and would like to continue to do so in 2018, please complete the renewal application. If you are new to NCAPA committees and would like to be considered for a position, please complete the form found here. All appointments are for one year terms and begin on January 1, 2018. Please contact NCAPA’s Executive Director, Emily Adams at email@example.com if you have any questions. We appreciate your interest and look forward to working with you!
Joint Injection Workshop
Wake Forest University Department of PA Studies
Appalachian State University Campus
September 16, 2017
Registration will open in early August!
PAPA 2017 Fall Seminar
Forsyth Medical Conference Center
3333 Silas Creek Parkway, Winston Salem, NC 27103
October 14, 2017 | 7:30am – 4:00pm
Piedmont Association of Physician Assistants is holding their Annual Fall Seminar in Winston-Salem again this October. For more information and to register, go here.
FWNCPEA 2017 Fall Conference
Harrell Center Auditorium
Lake Junaluska Conference and Retreat Center
October 14th, 2017 | 8:00am – 4:00pm
Far West NC Physician Extender Associates is holding their Annual Free Fall Conference in Lake Junaluska in October. 6 hours of Category 1 CME (AAPA approval pending). For more information, visit www.fwncpea.com or email firstname.lastname@example.org.
The 2017 NCAPA Student Leadership Retreat will be held on Saturday, November 11th. This event will be open to all students in NC PA programs and will focus on focus what to expect in the initial years following PA school, how to become a leader and advocate for the profession, and what lies in the future for PA practice. The event will begin at 9am with light breakfast and socializing and wrap up around 3pm. Lunch will be provided.
Registration will be done through NCAPA Student Representatives and will begin in September.
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Welcome to our renewing and our brand new members!
The following members have joined or renewed their membership since our last issue. Thank you all for your support of NCAPA and all PAs in North Carolina!
Jose Alcala, Durham
Tyler Allen, Granite Falls
Allison Almeida, Raleigh
Brandon Alspaugh, Charlotte
Lauren Ambrose, Jacksonville
Jennifer Atwater, Cary
Jonathan Baltzell, Mooresville
Taneisha Barnett, CHERRYVILLE
Tabitha Bednarczyk, Raleigh
Inga Benson, Winston Salem
Angela Bethea, Raleigh
Nicole Blohm, Charlotte
Garrett Bostwick, Charlotte
Angela Bowman, Fancy Gap, VA
Kathleen Bradley, Charlotte
Lindsey Brun, Durham
Christina Burton, Fuquay-Varina
Vanessa Cain, Wilmington
Amie Collins, Salisbury
Julienne Connor, High Point
Jennifer Couillard, Greensboro
Gregory Creel, New Bern
Anthony Davis, Conyers, GA
Christopher Donovin, Wilmington
Connie Dorfner, Charleston, WV
Allyson Dupay, Huntersville
Mary Egbuniwe, High Point
Sallie Elliott, Fuquay Varina
Brooke English, Cary
Donna Forsee, Statesville
Kirsten Goolsby, Greensboro
Heather Gragg, Lenoir
Darci Grochowski, Charlotte
Christian Gurley, Winston Salem
Jami Hagler, Wilmington
Diann Hedrick, Vale
Jennifer Hellinger, Cary
Geoffrey Holland, Summerfield
Ryan Hollifield, Kings Mountain
Laurena Jackson, Raleigh
Jane Johnson, Fayetteville
Emily Keefer, Durham
David Kerr, Cooperstown, NY
Braxton Kinsey, Durham
Theodore Kistemaker, Winston Salem
Justin Loomis, Owego, NY
Richard Lovenberg, Chocowinity
Jennifer Martin, Pfafftown
Julie Martin, Williamsburg, VA
Joanna May, Savannah, GA
Margaret McConnell, Stevensville, MD
Ryan McDonald, Lewisville
Laura Medlin, Whitakers
Nadine Minani, Raleigh
Lindsay Morgan, Spencer
Karen Myers, Huntersville
Alison Neal, Elizabeth City
Christopher Oliver, Stem
Megan Pavlovic, Holly Ridge
Ijeoma Perkins, Durham
Josie Prabhakar, Raleigh
Tarsha Rivens, Raleigh
Leigh Roth, Hickory
John Schoonmaker, Oak Island
Gene Serpe, Greensboro
Christopher Shatley, Morganton
Kevin Shelby, Plymouth Meeting, PA
Paul Silvi, Cary
Heatherly Simmons, Cary
Deborah Smith, Murphy
Jason Sonnenschein, Durham
Krista Stark, Indian Trail
Garon Strong, Biscoe
Leisa Tapia, Elon
Lisa Thomas, Summerfield
Mary Tolle, Asheville
Maria Velaz-Faircloth, Chapel Hill
Marlene Wallace, Greenville
Alan Watt, Greensboro
Erin Wetherill, Raleigh
Allison Williams, Winterville
Steve Winn, Chesapeake, VA
Amanda Zimmerman, Winston Salem