In this issue:
By Charlene M. Morris, DFAAPA, MPAS, PA-C
2014 has arrived, and with it another roadmap of opportunities for NCAPA and the practicing and student PAs of our state.
What more needs to be done in an established, active organization such as NCAPA, you the member may ask? First and foremost, PAs are here and doing well in the medical system because of many hardworking folks who preceded us. Although most have moved on, the foundation built by those visionaries continues to make our paths more comfortable and expansive.
The Legacy of the Past
NCAPA owns its own building. Constructed with an eye to future development and uses, if you have not yet visited, please do. It IS your building as well. The exterior landscaping gently but firmly reminds us of PA origins with a meditative design. This includes a pond that supports local wildlife, gardens of impressive variety, and a solemn statue of a Viet Nam era medic. Inside the building, there is the wall commemorating the founders of the PA movement. Many of you may have met, read about, or been told of these visionaries–and here their portraits are gloriously sunlit in the atrium. A replica of the office of Dr. Eugene Stead, Duke PA program founder, heralds to a century past of his hard work, passion for his profession, and a dream he made reality with the first PAs who graduated 6 October 1967, almost 47 years ago.
The Promise of the Future
There is still more to be accomplished for NCAPA. North Carolina does not yet allow PAs to care for hospice patients. As we and our patients all get older, hospice is a natural extension of what we already do. If you too, have interest in pursuing hospice practice, please join me in writing letters to our legislators and get legislation accepted!
Are PAs supervised or do we collaborate? That question has burned in our minds for over four decades. This very important nuance to our definition as PAs changed in the VA system as of 12/24/13. As per VA Directive 1063, PAs now collaborate with physicians and are no longer “supervised”. What does that mean for North Carolina, let alone the 100,000 practicing PAs in the U.S.? At this juncture, we must wait and see what occurs within AAPA and with state medical boards and organizations. Personally, I value my role in the rural family practice where I work. Still, I know we must continue to be PAdvocates as well as PAtient advocates to blaze the trail into the future. Those steps forward include accurately reflecting what we do, rather than clinging to obsolete notions that may hinder progress of the physician assistant profession.
Annual NCAPA Recertification Exam Review Conference
February 24-28, 2014
Sheraton Imperial Hotel, Durham, NC
The conference agenda will mirror the PANRE Exam blueprint, and will also be an excellent review of all organ systems for any medical professional. This conference offers 35+ hours CME* for PAs, NPs, and ATCs. Register now at https://ncapaoldsite.wpengine.com/index.php/conferences/
*This program has been reviewed and is approved for a maximum of 48.00 hours of AAPA Category I CME Credit by the Physician Assistant Review Panel. Physician Assistants should claim only those hours actually spent participating in the CME activity.
The Sheraton Imperial Hotel and Convention Center is offering NCAPA conference attendees a special room rate. Click here for hotel information and reservations
Commercial Driver Medical Examiner Training
NEW DATE ADDED!
Saturday, March 22, 2014
9 a.m.-4 p.m.
Eugene Stead Center for Physician Assistants, Durham, NC
Ready to get certified? The Federal Motor Carrier Safety Administration (FMCSA) requires all medical examiners who wish to provide DOT/CDL exams to be trained and certified by May 21, 2014. The NCAPA training course is designed to follow FMCSA training guidelines and will prepare the medical examiner to pass the national certification exam. This course will offer 6 hours of Category 1 CME.* Register now!
*This program has been reviewed and is approved for a maximum of 6.00 hours of AAPA Category I CME credit by the Physician Assistant Review Panel. Physician Assistants should claim only those hours actually spent participating in the CME activity.
SOLD OUT Friday, February 28, 2014 (accepting wait-list registrations only)
9 a.m.-4 p.m.
Sheraton Imperial Hotel, Durham, NC
The NCAPA Nominating Committee is soliciting candidates for open positions on the Board of Directors and Nominating Committee in 2015. Serving on the NCAPA Board is an important way to contribute to your profession and a wonderful leadership experience for you. North Carolina is often cited as a great state in which to practice as a PA. It got that way through the vision, leadership, and volunteer work of PAs just like you!
If you know a PA who cares deeply about the profession, who wants to contribute to the future of the profession, who is a good listener, collaborator, and decision maker—or if you are that person—please nominate her/him for a position on the NCAPA Board of Directors.
The following positions for elected offices are open for nominees: President-Elect, Vice President, Secretary, Director-At-Large (two positions), and Nominating Committee Member. To read more about these positions and to nominate yourself or a colleague, click here. While the deadline for submitting nominations is not until May 30, 2014, the Committee will actually do much of the work to create a ballot before then, so get your nominations in early!
All terms begin January 1, 2015. Nominees for officer positions (President-Elect, Vice President, and Secretary) must have been a Fellow member in good standing of the NCAPA for the calendar year prior to election. All other nominees must have been a Fellow or Associate member.
By Lee Busselman, Director of Membership and Marketing
Thank you and welcome to all of our new and renewing members for 2014! Membership cards are in the mail for the 1000+ individuals who joined prior to January 1 (please contact me if you don’t receive your card by the end of January). And if you have not yet renewed your membership, NOW is the time to take action–otherwise, your NCAPA benefits (including the next issue of The Pulse) will no longer be coming your way. Renew online now!
By Cathie Feild, Executive Director
It has been my pleasure to work with Lee Busselman and Carin Head since May when I was hired to serve as NCAPA’s Interim Executive Director. I am pleased to announce that they both received promotions as of January 1, 2014 in recognition of their excellent work and increasing responsibilities. Lee Busselman is now Director of Membership and Marketing. You can reach him at email@example.com. Carin Head’s new title is Director of Conferences and CME and she can be reached at firstname.lastname@example.org.
I am also pleased to announce that a new Administrative Assistant has joined our team. Kat Nicholas started working for NCAPA on January 6. As the only administrative support person for Carin, Lee, and me, in addition to serving as the receptionist, Kat is a welcome addition and will stay quite busy. You can reach Kat at email@example.com.
Please know that you are well served at the NCAPA office and let us know how we can assist you. The office is open Monday through Friday from 9:00 a.m. to 5:00 p.m. We look forward to helping NCAPA achieve its mission and goals in the coming year!
NCAPA Board and Committee members met in November to set goals for 2014. The main purposes of the Government Affairs Committee are to 1) advocate on behalf of PAs to local, state, and national legislators and policy makers, 2) educate NCAPA members regarding local, state, and national health policy, and 3) build relationships with other medical organizations, legislators, and regulatory agencies.
In support of these purposes, the Committee has established the following goals for 2014:
- Survey our members to identify their primary concerns regarding issues that impact PA practice.
- Respond to member questions about legislation, policy, regulations, and reimbursement.
- Include an article about legislative, regulatory, or practice issues in each issue of The Pulse.
- Utilize an online legislative action center on the NCAPA website to make it easy for PAs to communicate with legislators and regulatory agencies.
- Advocate to the North Carolina Medical Board on behalf of PAs.
- Advocate for PA regulatory and legislative issues.
- Promote NCAPA’s Political Action and Education Committee (PAEC).
- Work to get PAs included as allowed providers in mental health clinic regulations.
- Document what NCAPA has done for PAs in NC over the years on issues such as scope of practice.
- Determine how the Patient Protection and Affordable Care Act will impact PAs.
- Conduct outreach to PA students.
We would like to hear from you. How do our goals match up with your needs? What is the most important issue that you would like to see the Government Affairs Committee tackle this year or what is a service that would really help you advance your practice as a PA? Please let us know by clicking here, putting Government Affairs in the subject line, and sending us your message.
- In the final weeks of 2013, Congress took steps to reform Medicare’s payment system. All three congressional committees of jurisdiction have specifically included PAs in their proposals for Medicare reform. This is a significant victory for PAs to be treated exactly the same as physicians and nurse practitioners.
- Additionally, the Senate Finance Committee bill would allow PAs to provide and manage hospice care for Medicare beneficiaries, and to directly supervise cardiac and pulmonary rehabilitation services in critical access hospitals. This legislation is poised for full congressional action in 2014.
- After vigorous efforts supported by PA colleagues from across the nation, the Centers for Medicare & Medicaid Services clarified murky regulations to authorize PAs to write orders and perform the history and physicals for hospital admissions, and affirmed PAs as providers at community mental health centers.
During the roll-out of the Affordable Care Act in the last few months of 2013, AAPA’s President and President-Elect reached out to the media to publicize the important role of PAs in health care reform, garnering great news coverage including pieces by CBS News, NBC, the Wall Street Journal, Forbes, and others. While most coverage was accurate, AAPA’s President Lawrence Herman, PA-C, MPA, stated, “even though we still find irritating errors and oversights in media coverage, often these issues prove to be opportunities to work with reporters and inform their future healthcare coverage.”
Make 2014 the year you play an active role in advancing the PA profession. If you see something wrong in the media, say something—but not just to NCAPA, AAPA, or your colleagues. Take the time to write a letter to the editor to correct any errors or misperceptions about what PAs do and how they are trained. If you would like some help composing a letter to the editor, contact NCAPA and we’ll be glad to help. Be sure to share your efforts with us by emailing Lee Busselman, NCAPA Director of Membership and Marketing at firstname.lastname@example.org. Other actions you can take are: Print and share a PA poster in your clinic, hospital, program or elsewhere. Encourage your colleagues to become members of NCAPA. Your dues help NCAPA promote the profession on your behalf. Make it your New Year’s resolution to stay involved in NCAPA and volunteer your time to advance YOUR profession to help us become a stronger workforce.
Update to Physician Assistant Taxonomy Codes
During the transition into NCTracks, some physician assistants’ claims were denied because of taxonomy codes. The system has now been updated to accept Level II taxonomy code 363A00000X. Physician assistants can now resubmit denied claims with this taxonomy code to be reimbursed for services on their fee schedule. Level III taxonomy codes 363AM0700X and 363AS0400X are not yet implemented in NCTracks.
Fayetteville area PAs, put this date on your calendar! January 28, 2014. A new group is forming in the Fayetteville area to provide professional and personal support to area PAs. Our first meeting will be at 6 p.m. at Sherefe’s downtown. Contact Sandra Keavey, PAC at email@example.com if you have questions or to RSVP that you are coming. Look forward to seeing you there.
By Charlene M. Morris, DFAAPA, MPAS, PA-C
Family Medicine Physician Assistants—Who We Are
Family medicine physician assistants are historically the cornerstone of the PA profession. Dr. Eugene Stead conceptualized physician assistants as primary care clinicians. Dr. Stead’s philosophy, innovative spirit, and adaptability nicely reflect what family medicine PAs do and what they continue to represent.
Deciding upon family medicine is a career choice, and it is ultimately based upon several variables in the educational and clinical rotation years. As patient advocates by design, many PAs find their allegiance to family medicine developing via two distinct, yet complementary ways.
First, exposure to a physician assistant in a family medicine practice is an incredibly powerful motivator. To observe someone whose passion is to see patients, care for them and their families, earn a competitive living wage, and maintain a high quality lifestyle is attractive to new or aspiring PAs.
Second, the rigorous PA training schedule demands that PAs rotate within all the major disciplines of medicine. As long-time Pamlico County family physician Dr. Richard Hudson once confided1, he completed his ob/gyn rotation and said “I really loved that”. Next came rotations in internal medicine, pediatrics, surgery, and the other practice specialties. Ultimately, Dr. Hudson—and family medicine PAs—realize that they can do it all and have it all by practicing family medicine in their own communities. The eclectic yet humanitarian choice of family practice is of benefit to all concerned: patient, clinician, and community.
Family medicine practice is as varied as the many aspects it entails. PAs work in rural, urban, and suburban settings. Physician assistants have the flexibility to participate in diverse practices such as the White House PA, communities in Canada and the UK, and military facilities worldwide. There is no typical day for a family medicine PA. Whether the setting is academic, office, nursing home, or mobile unit, the mission is the same: to provide quality care and remain in a continuously changing and expanding profession. 2
Many PA educators, authors, and leaders who have diversified to their chosen endeavor continue to acknowledge their origins as family medicine PAs. The PA career path may branch in many directions, yet remain deeply rooted in its original directive. As J. Michael Jones writes in his book A Kernel in the Pod, “As a kernel in the pod, a so-called midlevel clinician in top-level world, I have finally found a place of rest, where the pod of peas is big enough for a kernel or two.” 3
Where Are We Going?
The original definition of physician assistants in family medicine dictated that PAs work under direct supervision of a doctor. The American Academy of Family Physicians (AAFP) supports the concept of team practice utilizing physician assistants. AAFP’s position is that the term physician assistant be specifically reserved for those trained in an accredited PA program. The capacity in which a PA may work should reflect and enhance the physician’s own scope of practice. 4
As practice types develop and evolve to mirror the needs of the contemporary family practice, many physician assistants and the doctors with whom they work concur that expansion of the PA role is crucial for future growth. The word “supervision” was recently changed to “collaboration” for PAs within the VA system. With this distinction, perhaps a broader vision of what we do is being considered.
As competency-based clinicians in a 21st century world of advanced degrees and titles, PAs have likewise embraced the necessity of at least master’s-degree education. Many have achieved a PhD and this is a step many health care professionals have determined to be necessary. Newer PAs want and are demanding more recognition in the challenging and changing workplace. Lifelong learning has become a watchword for PAs, and in family medicine there is no room for complacency. While PAs continue to provide care in traditional family practices in the U.S. and abroad, it is now recognized that family medicine PAs can and do perform well in more diverse, specialized environments such as emergency departments, urgent care, and hospitals, while maintaining the original vision of being a family medicine physician assistant.
1. Dr.Richard Hudson, founder of Pamlico Medical Center, PA and Hope Clinic, Bayboro, NC. Permission received 12/28/07.
2. AFPPA Mission Statement. http://www.aafp.org/about/policies/all/mission.html
3. Jones, J. Michal, A Kernel in the Pod, 2002, p. 394
4. American Academy of Family Physicians website. http://www.aafp.org/about/policies/all/physician-assistants.html
Charlene M. Morris, DFAAPA, MPAS, PA-C, is a physician assistant at Pamlico Medical Center, Bayboro, N.C., past president of the Association of Family Practice Physician Assistants, past CME manager for the Society for PAs in Pediatrics, and the current President of NCAPA.
The Agency for Healthcare Research and Quality’s (AHRQ) National Partnership Network is raising awareness and encouraging use of evidence that compares the effectiveness, benefits, and risks of treatment options for common conditions. The goal is better quality health care and improved patient outcomes. The Network is now more than 500 organizations strong. AHRQ offers newsletter articles, social media posts, Web buttons, and more to help. In addition, NCAPA members can order free printed copies of clinician and patient resources to support education and outreach efforts.
NCAPA has promoted and supported the work of Project Lazarus throughout the past year. Community Care of North Carolina is holding Project Lazarus Training: A Guide to Rational Opioid Prescribing for Chronic Pain in January. The training sessions will help prescribers of pain medications to understand the multi-dimensional character of chronic pain as a distinct clinical entity; identify the role of opioids in the safe and effective management of chronic pain; use rational prescribing to provide adequate pain management while minimizing the risk of abuse of controlled medications and intervene effectively when misuse or abuse of medications occur. Training sessions will be held in Pinehurst on January 23rd and Concord on January 30th. To register, click here.
Physician Assistants for Global Health (PAGH) is a group of PAs who are seeking to promote cross-cultural awareness and serve as a resource for PAs to serve in both domestic and international health professional shortage areas. It is the only PA organization designated by the AAPA to organize and centralize the PA profession and support individual PAs in their efforts working or volunteering abroad. PAGH is contacting state chapters as well as several organizations that utilize PAs in their international work, in the hope of working cooperatively to raise awareness about global health and also help increase the number of PAs serving in the global health setting. PAGH offers online resources for PAs who are interested in global health. If you have questions relating to PA opportunities in global health, or inquiries from PAs within your organization, email PAGH.
Melissa Murfin, PA-C, PharmD and Jaclyn Stevens, PA-S from Elon University are working on a research project and would love some input from the members of NCAPA. The purpose of this survey is to see if the introduction of free and reduced-cost antibiotics has influenced the prescribing habits of North Carolina health care practitioners. The data gathered from this survey will be analyzed on whether prescribing habits have changed as well as explore any potential difference in prescribing habits amongst specific types of prescribers (NPs, Pas, MDs, DOs). The information gathered will also be analyzed and compared with current resistance rates of the antibiotics on free/reduced medication lists. Participation is completely voluntary and anonymous. Take the survey
If you would like to help make a difference in your community as a Red Cross volunteer, please contact the Western Carolinas Red Cross at 828-258-3888 or go to www.redcross.org/westerncarolinas for more information.