News
Official Publication of the California Academy of Physician Assistants
May/June 2015
\The Magazine
SB 337: Successful PA Legislation Depends on All of Us by Jeremy A. Adler, MS, PA-C; President
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very day brings new adventure, twists, turns and opportunity as CAPA navigates moving SB 337 forward through the legislative process. We find ourselves continually educating so many parties, such as lawmakers, other health professions and regulatory boards. One thing has emerged that we must all recognize, our profession is still maturing and each of us are its daily representatives. I have now heard again and again, the power of anecdotal experiences “I have repeatedly with PAs, many not firsthand and some advocated that PAs are theoretical, that go professionals and I know something like “…I heard about a PA with the professional who….” We should services we provide every each strive to have day, together, we will make this sentence finish with the words “… needed advances that will was exceptional!”
serve to improve the health and well-being of patients everywhere. “
You are a PA Ambassador. Every
PA you know is a PA Ambassador. Think of the best PA you have encountered, and then every other PA in California, and recognize that what they do every day reflects every other PA in the State. Despite our profession reaching the 40 year milestone, we are not over the hill. Every encounter with a patient, policymaker, lawmaker, physician, pharmacist, nurse, attorney, etc., matters. The
bar must be set high and PAs must exceed expectations each and every time. We are making head way, but the starting line is visible behind us and the finish line is still beyond the horizon. It has been a privilege to serve as President of CAPA, especially at a time when getting the word out about who we are and what we do is so needed. I have felt honored to speak on behalf of PAs at the Capitol, meet with many other health profession leaders and present in front of the Medical Board. Our sponsored bill, SB 337, highlights
the heart of our professional core, our fundamental relationship with physicians. Despite all the amazing work our current and past leaders at CAPA continue to produce and the incredible expertise of our staff and consultants, the responsibility for our profession remains on each of us, in every setting in which we find ourselves. I have repeatedly advocated that PAs are professionals and I know with the professional services we provide every day, together, we will make needed advances that will serve to improve the health and well-being of patients everywhere.
Fighting For California PAs by Teresa Anderson, MPH; Public Policy Director
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e have all heard the quote “anything worth having is worth fighting for” and without a doubt Senate Bill 337 is no exception. Improvements to the PA Practice Act based on solid health care policy, are definitely worth having. Countless hours of working to craft language that ref lects the unique relationship between a PA and supervising physician, meeting with stakeholders
and interested parties to address regulatory requirements, conferring with legal counsel, researching state and national policy, preparing for regulatory board meetings, committee hearings and floor votes is just the beginning of what it takes to fight for improvements to the PA Practice Act. Why is SB 337 worth fighting for? PAs are essential, and have been for decades, to meeting the health care demands of people in California. We Continued on page 5
News
At The Table
Editor Gaye Breyman, CAE
Managing Editor Denise Werner Proofreaders Kimberly Dickerson Coryn Henderson Jonathan Kulesza Rachel O’Connell Editorial Board Jeremy A. Adler, MS, PA-C Roy Guizado, MS, PA-C Ana Maldonado, MPH, DHSc, PA-C Bob Miller, PA CAPA Board of Directors President Jeremy A. Adler, MS, PA-C president@capanet.org President Elect Roy Guizado, MS, PA-C presidentelect@capanet.org Vice President Ana Maldonado, MPH, DHSc, PA-C vicepresident@capanet.org Secretary Christy Eskes, DHSc, MPA, PA-C secretary@capanet.org Treasurer Bob Miller, PA treasurer@capanet.org
Special thanks to Richard Granese, MD and Greg Mennie, MS, PA-C for their well-presented and informative comments relating to SB 337 before the Medical Board of California on May 7, 2015. Jeremy Adler, PA-C also presented compelling comments. Pictured here Richard Granese, Gaye Breyman, Jeremy Adler, Teresa Anderson and Greg Mennie.
CAPA again exhibited at Pri-Med West in Anaheim on April 8-11, 2015. It is always such a pleasure to connect with CAPA members there and to reach out to physicians who may be looking to ulitize PAs in their practice. Pictured here: Eric Glassman, PA-C and Jamie McCoy, PA-C
Incoming 2015-2016 CAPA Board of Directors Term: July 1, 2015 – June 30, 2016 President Roy Guizado, MS, PA-C
Director-At-Large Susan Gilroy, PA-C
Immediate Past President Jeremy A. Adler, MS, PA-C
Director-At-Large Cherri L. Penne-Myers, PA-C
Vice President Ana Maldonado, MPH, DHSc, PA-C
Director-At-Large Kevin Robertson, PA-C
Saloni Swarup, PA-C dirsaloni@capanet.org
Secretary Christy Eskes, DHSc, MPA, PA-C
Director-At-Large Saloni Swarup, PA-C
Student Representative Jamie McCoy, PA-C studentrep@capanet.org
Treasurer Bob Miller, PA
Student Representative Emily McCoy, PA-S
Directors-At-Large Sue Gilroy, PA-C dirsue@capanet.org Cherri L. Penne-Myers, PA-C dircherri@capanet.org Kevin Robertson, MPH, PA-C dirkevin@capanet.org
The CAPA News is the official publication of the California Academy of Physician Assistants. This publication is devoted to informing physician assistants to enable them to better serve the public health and welfare. The publisher assumes no responsibility for unsolicited material. Letters to the editor are encouraged; the publisher reserves the right to publish, in whole or in part, all letters received. Byline articles express the opinion of the author and do not necessarily reflect the views or policies of the California Academy of Physician Assistants.
The CAPA office is located at: 2318 S. Fairview St. Santa Ana, CA 92704-4938 Office: (714) 427-0321 Fax: (714) 427-0324 Email: CAPA@capanet.org Internet: www.capanet.org ©2015 California Academy of Physician Assistants
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CAPA NEWS
2016 AAPA House of Delegates San Antonio, Texas
Departing CAPA Leader
Term: July 15, 2015 – July 14, 2016 Tracey DelNero, PA-C, MSPAS Joy Dugan, MPH, PA-C Grace Landel, MEd, PA-C Ana Maldonado, MPH, DHSc, PA-C Cherri L. Penne-Myers, PA-C Julie Theriault, PA-C
Jamie McCoy, PA-C; Student Representative
Err in the Direction of Kindness by Sue Gilroy, PA-C; Director-At-Large
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was working at a satellite clinic location one afternoon in February which is surrounded by many senior living facilities. We have two elder female patients, J. and F., who met at their facility and have become the best of friends, often scheduling their appointments at our office together. As I was hurrying through the lobby after an appointment with F., her buddy J. was sitting in the lobby. Her face brightened when we made eye contact and my heart sank—there goes my monthly timeliness review, out the window again, I thought. A mental chastisement followed and I veered over to say hello. J. was so excited to tell me her friend’s news—the niece of F. was going to compete in the Miss Wheelchair California 2015 competition and they were going to the pageant. Like two little girls, they excitedly told me there was a formal event to follow and they had gone shopping for long dresses and had made hotel reservations. When you are almost 90 years old this is a big change in the routine of life
and they were bubbling over with enthusiasm. J. is quite savvy with a computer and asked for my email address—she wanted to send me some photos of their dresses. Again, I am reluctant to give out my email to patients—another quick mental chastisement followed—and I gave her my work address. As F. was finishing her story she quietly told me this will probably be the last long formal dress she will ever purchase in her life; not said for sympathy but relayed in a straightforward manner as a fact of senior life.
Two days later I had filed that conversation far away until I received an email from F. Inside were a few photos of each of them in their long and lovely dresses, grinning at the camera in a self-conscious happiness. They were brave choices, with one being sleeveless and slightly V-necked and the other with a matching jacket and showing a little ankle. I don’t think I have ever seen a more beautiful choice for the last formal. I veered in the right direction that day.
Inside This Issue At The Table............................................................................................................ 2 Incoming 2015-2016 CAPA Board of Directors.......................................................... 2 2016 AAPA House of Delegates................................................................................ 2 Departing CAPA Leader............................................................................................ 2 Needs Title.............................................................................................................. 3 Supervising Physician Letter for SB 337 Support....................................................... 4 Someone Asked….................................................................................................. 6 A Legacy of Excellence, Professionalism and Integrity............................................... 8 The Determinants of the PA Scope of Practice.......................................................... 10 Congratulations SJVC - Winners of the 2015 National Student Challenge Bowl!......... 11 2015 CAPA Annual Conference - Palm Springs........................................................ 12 CAPA Palm Springs Conference – What Makes It Such a Great Event?...................... 14
What is a Practice Analysis and Why Should I Participate?....................................... 15 Medicare Reform Law Is Good News for America’s PAs and their Patients................. 16 Controlled Sustances Education Course for PAs........................................................ 17 Renew Your CAPA Membership Today!.................................................................... 17 Aspiring PA Students.............................................................................................. 18 Medical Malpractice Claims and Physician Assistants................................................ 20 PA Students Making an Impact Throughout California.............................................. 21 Congratulations Graduates..................................................................................... 21 Needs Title............................................................................................................ 22 Welcome New Members......................................................................................... 23 Local Groups......................................................................................................... 23
MAY/JUNE 2015
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Date:
Spring 2015
To:
California Medical Association Physician Assistant Board Medical Board of California California Legislators Governor Jerry Brown
From:
Physician Supervisor of Physician Assistants (PAs)
Subject: Senate Bill 337- Physician Assistants Access to patient care continues to be a prime concern as more and more patients enter the health care system. There are simply not enough hours in my schedule to accommodate the growing need and I rely on the professional excellence and high-quality health care provided by the physician assistant (PA) on my clinical team. As licensed health care professionals who practice medicine as members of a physician-led team, PAs are widely recognized as an effective solution to access to care issues in all settings. I believe it is essential to safeguard the relationship between physicians and PAs through legislation. Eliminating barriers to high-quality, cost-effective and efficient team-based care is a necessity in order to increase timely access and availability of medical care to all Californians. As the supervising physician, I hold the ultimate responsibility for the patient and therefore must ensure and provide for optimal supervision of the PA(s) I supervise in meeting the unique needs of my practice. The level of supervision and documentation of such varies based on the experience and training of the PA I am supervising. Increasing options for documenting supervision would allow for flexibility at my practice and reflect current models of team-based care. I join thousands of my physician colleagues who work in team-based practice with PAs and each day ensure that patient and consumer safety are of the utmost concern. ____________________________________ Licensed California Physician’s Printed Name
_______________________________ Signature
Stamp or Print Address______________________________________________________ City______________________________________State_________ Zip_______________
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CAPA NEWS
Fighting For California PAs Continued from page 1
ACT NOW –
Photocopy the letter on the opposite page and ask your supervising physician(s) to sign it. If you have more than one supervising physician, ask them all to sign one of their own. Then make it your mission to fax these letters to (714) 427-0324, or scan and email CAPA at capa@capanet. org. Or, visit the CAPA home page, download and print the PDF of the letter and ask your supervising physician(s) to sign one and you return it to us! CAPA is gathering hard copies of these letters from California physicians – thousands of them from physicians who work in team practices with PAs. A huge stack of letters provided to legislators during legislative visits when lobbying for SB 337, shows tremendous physician support. Much more powerful than a list of email addresses. A really compelling visual. SB 337 – Physician/PA Team Practice will modernize supervision documentation. Make it very clear to the supervising physician that he or she remains the leader of the health care team! SB 337 will make you more valuable to the team and your patients. ACT NOW! Don’t wait. Have your supervising physician(s) sign the letter and be sure you send it to CAPA.
know from the recent survey we did with the Office of Statewide Health Planning and Development (OSHPD) that PAs practice in virtually all of the recognized areas of medicine, provide a substantial amount of care in underserved areas of the state, contribute significantly to meeting the cultural and linguist needs in diverse communities and have a unique scope-of-practice that provides for the opportunity to fill many of the gaps in health care. Given the strength and flexibility of the profession as well as the ability to adapt to systemic changes in health care it becomes evident why it is so important to fight for SB 337 and make overdue improvements to the PA Practice Act. The bill made it out of the Senate Business and Professions Committee without any ”NO” votes, off the Senate Floor and is now at the mid-point of the legislative process. Next it is on its way to the Assembly policy committee where we will continue to advocate and educate about the importance of team-based care highlighting the value of the PA profession. In order to encourage and increase the utilization of PAs in California, the state needs a Practice Act that reflects current models of team-based practice, patient care and innovation in practice management. As health care policies and systems of care change over the years, professions and practice acts need to evolve as well to reflect the scope and skill of the professions. For example, PAs are highly skilled, highly trained, licensed health care providers that provide care to hundreds of thousands of patients each year across the state, yet when compared to similar practitioners they are the only practitioner with a stringent one-size-fits-all cosignature mandate related to documenting supervision and physician co-signing 100% of medical records for patients seen by a PA when Schedule II medications have been prescribed. IT’S TIME… It’s time to improve the PA Practice Act by increasing options for documenting supervision, streamlining requirements among practitioners and reducing overly burdensome administrative requirements thereby promoting greater utilization of PAs. As we head to the Assembly with SB 337 we will be asking for your help in advocating and asking for support from your legislators.
MAY/JUNE 2015
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Someone Asked … by Bob Miller, PA; Professional Practice Committee Chair interviewing for a job Q: I’m where my duties will include
seeing hospitalized patients. How do I get privileges at a hospital?
should be credentialed A: PAs through the hospital Medical
Staff Office similar to physicians. Most hospitals have modified their physician credentialing packet to use for PAs. Credentialing is a process to obtain documentation of education, licensing, past experience and prior employment among other historical information. It will also include background checks for disciplinary actions or convictions.
Credentialing is approved for PAs by the Executive Committee of the Medical Staff [see “The credentialing process CCR 70706.1 (b)]. Once credentialed, is lengthy - sometimes the PA is granted taking 5 to 6+ months for privileges appropriate to the PA’s training formal approval.” and experience and that of the supervising physician. The hospital Medical Staff Office may choose to restrict privileges as they determine appropriate. A PA is not a “member” of the hospital medical staff in California. The following is excerpted from the California Code of Regulations. Note that registered nurses fall under the Committee on Interdisciplinary Practice while PAs are approved by the Executive Committee of the Medical Staff. 22 CCR § 70706.1 § 70706.1. Granting of Nonphysician Privileges. (a) Registered Nurses. The Committee on Interdisciplinary Practice shall 6
CAPA NEWS
be responsible for recommending policies and procedures for the granting of expanded role privileges to registered nurses, whether or not employed by the facility, to provide for the assessment, planning, and direction of the diagnostic and therapeutic care of a patient in a licensed health facility. These policies and procedures will be administered by the Committee on Interdisciplinary Practice which shall be responsible for reviewing credentials and making recommendations for the granting and/or rescinding of such privileges. (b) Physician’s Assistant. A physician’s assistant who practices in a licensed facility shall be supervised by a physician approved by the Division of Allied Health Professions of the Medical Board of California who is a member of the active medical staff of that facility. Physician’s assistants shall apply to and be approved by the Executive Committee of the medical staff of the facility in which the physician’s assistant wishes to practice. is the CIDP that I’ve Q: What heard about? Committee on A: The Interdisciplinary Practice
(CIDP) is a committee typically with more focus on non-medical professionals who are also nonmembers of the Medical Staff, including nurses and clinical psychologists for example. Other licensed or certified health professionals may also be allowed to perform functions in the hospital or be granted privileges by this committee. The CCR section 70706 below defines those to be included in the CIDP and also states there will be an equal number of registered nurses and physicians included in the committee. The physicians are
appointed by the Executive Committee of the Medical Staff. 22 CCR § 70706 § 70706. Interdisciplinary Practice and Responsibility for Patient Care. (a) In any facility where registered nurses will perform functions requiring standardized procedures pursuant to Section 2725 of the Business and Professions Code, or in which licensed or certified healing arts professionals who are not members of the medical staff will be granted privileges pursuant to Section 70706.1 there shall be a Committee on Interdisciplinary Practice established by and accountable to the Governing Body, for establishing policies and procedures for interdisciplinary medical practice. (b) The Committee on Interdisciplinary Practice shall include, as a minimum, the director of nursing, the administrator or designee, and an equal number of physicians appointed by the Executive Committee of the medical staff, and registered nurses appointed by the director of nursing. When the hospital has a psychiatric unit and one or more clinical psychologists on its medical staff, one or more clinical psychologists shall be appointed to the Committee on Interdisciplinary Practice by the Executive Committee of the medical staff. Licensed or certified health professionals other than registered nurses who are performing or will perform functions as in (a) above shall be included in the Committee. (c) The Committee on Interdisciplinary Practice shall establish written policies and procedures for the conduct of its business. Policies and
procedures shall include but not be limited to: (1) Provision for securing recommendations from members of the medical staff in the medical specialty, or clinical field of practice under review, and from persons in the appropriate nonmedical category who practice in the clinical field or specialty under review. (2) Method for the approval of standardized procedures in accordance with Sections 2725 of the Business and Professions Code in which affirmative approval of the administrator or designee and a majority of the physician members and a majority of the registered nurse members would be required and that prior to such approval, consultation shall be obtained from facility staff in the medical and nursing specialties under review. (3) Providing for maintaining clear lines of responsibility of the nursing service for nursing care of patients and of the medical staff for medical services in the facility.
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(4) Intended line of approval for each recommendation of the Committee. heard the credentialing and Q: I’ve privileging process takes a long time - how long?
credentialing process is A: The lengthy - sometimes taking 5 to 6+ months for formal approval. When I was hiring PAs at a hospital, I would typically get “temporary” privileges granted within 4-5 weeks if I asked the Medical Staff Office to expedite the process. They usually just needed a subset of crucial, required information documented to allow temporary status. Also, before implementing full privileges, the PA may need to be proctored while on the job for procedures, etc.
I was able to obtain temporary privileges for a new-hire because I got to know the Medical Staff leaders AND the staff who actually did the work - who handles PAs, who sends letters for documentation, who logs in the returned letters and who assembles the credentialing packet, etc. So, it would likely be an advantage if there is an advocate to keep you informed of missing items to try to track down. The new-hire PA is usually not as effective if seen
as “pestering” the credentialing staff with repeated phone calls. Also on my end, I would encourage the new-hire to personally contact (and re-contact) each reference to let them know a letter is being sent by the hospital for documentation of information. A question came up about possibly legislating a mandate to complete this process in a limited (short) period of time. Although formal credentialing typically takes a long time, I don’t believe a mandate should require a hospital to grant privileges if they don’t have the documentation necessary to be confident that the new-hire is safe to work on patients. There are many potential barriers that prolong the process including slow (or no) response when information is requested from educational programs, other organizations, previous employers or references. Sometimes a Medical Staff Office may be inefficient or overworked. Tracking items and following up on requested documentation seems to offer some probability of shortening the lengthy process.
Fourth Edition of the California Physician Assistant’s and Supervising Physician’s Legal Handbook*
NEW 4th Edition
M
ichael Scarano, Jr., Esq. authored the California Physician Assistant’s and Supervising Physician’s Legal Handbook. Newly updated, it answers scores of questions in a concise, clear fashion, with citations and appendices that will permit practitioners to read the operative statutes and regulations for themselves. A must have for all California practices employing PAs. Visit the CAPA website at www.capanet.org for more information or to order the book online. *CAPA Member Price - $34.95 Non Member Price - $54.95
MAY/JUNE 2015
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A Legacy of Excellence, Professionalism and Integrity by Gaye Breyman, CAE; Executive Director
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une 30, 2015 is the last day of Jeremy Adler’s CAPA presidency. To say that he “served you well” is truly an understatement. I am struggling to find the words that will describe the impact he has made, the legacy he leaves and the profound and consistent leadership he exudes. I have been doing this a long time and it has been my distinct honor and pleasure to serve with some terrific CAPA Presidents. Jeremy is
among the very best. His conviction and commitment to the PA profession, to CAPA and to doing that which is right - not necessarily easy or convenient - inspires us all to do better and be better people. I will forever be personally grateful to him for the difference he has made in my career and in the CAPA I love. You should all be so lucky to work for someone like Jeremy. It is challenging, he is a bit of a perfectionist and his mind never
stops. Working with him is so much fun! We are all fortunate he remains on the CAPA board as Immediate Past President beginning July 1. There is a very long list of people offering thanks and good wishes to Jeremy and here are just a handful of them. If you would like to connect with Jeremy you may do so at president@capanet.org.
Jeremy is a visionary and progressive in the advancement of our profession. He was one of the pioneers in the social organization of the San Diego Society of Physician Assistants. He has instilled the mission to promote the PA profession, encourage networking and community outreach, and improve the quality of medicine. He has an unbelievable work ethic where his passion for medicine and the community most brightly shines. He has been not only a role model, but an inspiration for me and I am honored to have him as a friend. Bernard Casillan, MS, PA-C; President, San Diego Society of PAs 8
CAPA NEWS
Jeremy has shown to us all his remarkable leadership skills. He has impressed me again and again during his presidency by stepping in to face issues head on and by using the skills of his leadership team to draw out the best in each person. Bob Miller, PA Treasurer and Past President
The great leaders are the ones that seem to not only weather a great storm, but also bring along their constituency unscathed. It’s Jeremy’s calm and consistent presence that seems to always instill a sense of all is ok and all can and will be better. Thank you, Jeremy, for being a great CAPA leader.
Jeremy’s bold and effective leadership has led CAPA through perhaps the most difficult challenges it has ever faced. Indeed, without him I’m not sure we would still have the incredibly productive and well-respected CAPA we have today!
Greg Mennie, MS, PA-C Former CAPA Board Member
R. Mike Scarano, Jr. CAPA Legal Councel - Retired
The PA profession is lucky to have Jeremy Adler! He uses his passion and skills, sometimes for hours on end to craft language, to “wordsmith” and to push the envelope in advocating for California PAs. Jeremy is such a gem. He is so keen, smart and an incredibly kind soul. I have watched his leadership skills grow in leaps and bounds. Jeremy is an incredible asset to our profession and the patients we serve. I am so proud of him. Thank you, Jeremy, for all you have done and all I know you will do in the future. Julie A. Theriault, PA-C, DFAAPA; Former CAPA and AAPA President
Teresa Anderson, MPH CAPA Public Policy Director
Thank You, You Served the PAs of California Well! MAY/JUNE 2015
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The Determinants of the PA Scope of Practice by Roy Guizado, MS, PA-C; President Elect
T
he Winter 2015 publication of the Annals of Health Law published by Loyola University Chicago School of Law features an article titled, “Access and Innovation in a Time of Rapid Change: Physician Assistant Scope of Practice”. The authors are known throughout the PA community and they include: Ann Davis, MS, PA-C; Stephanie M. Radiz, JD; James F. Cawley, MPH, PA-C, DHL (Hon); Roderick S. Hooker, PhD, MBA, PA and Carson S. Walker, JD.
“CAPA makes it a priority to
The authors provided a comprehensive review of the PA educate physicians about profession from who PAs are and what PAs inception, through the growing pangs can do for them and their of law and scope of practice, to what the patients.” future might hold for the profession. The authors were able to identify four characteristics, or as they referred to them, determinants that define the PA scope of practice. The purpose of this CAPA News article is to review the four determinants of the PA scope of practice found in the article authored by Ann Davis, et al. Davis, et al., make a distinction between a professional scope of practice and a legal scope of practice. “The professional scope of practice is the profession’s description of the services its members are trained and competent to perform.” The legal scope of practice is what state regulatory bodies define as acceptable practices and activities of a licensed health provider. These two scope of practice definitions define some of 10
CAPA NEWS
the parameters of the overall PA scope. Davis, et al., find that the PA scope of practice is formed by four determinants. The first determinant is PA education, experience and preference. The second determinant is physician delegation. The third determinant is facility credentialing and privileging. The final determinant is state law and regulation. Determinant 1 - PA education, experience and preference is best summarized in that the PA scope of practice is relative to the classroom, clinical education and experiences received while in PA school. The education received by PAs has been somewhat standardized through the Accreditation Review Commission on Education for Physician Assistants (ARC-PA) accreditation process. Although the bulk of PA education adheres to ARCPA standards, Title VII, federal funding for PA education has provided a number of innovative academic and clinical approaches to the delivery of PA education. Physician delegation is the second determinant discussed by Davis, et al. The PA profession was founded on the premise that the PA scope of practice is physician delegated. PAs learn skills similar to what a physician has learned, such as performing routine examinations, utilization of labs to aid in diagnosis and initiating patient plans that include prescribing medication. In essence, a PA practices medicine with a physician or group of physicians and the PA has duties and responsibilities of practicing medicine delegated to him/her by the physician or physician group. The question is: are there limits as
to what the physician or group can delegate for PA scope of practice? The answer is a definitive maybe. The supervising physician(s) must be sure that anything delegated to the PA must be within the scope of the supervising physician and that it does not overstep the training received by the PA. Determinant 3 is facility credentialing and privileging. While PAs may find it burdensome to apply to different facilities in order to obtain privileges and credentials, the reality is that this process is designed to keep the facility safe for patients while providing due diligence for the safety of the institution. Once privileges are granted, the PAs are allowed to perform their duties such as rounding on patients, assisting in surgery or completion of other specific responsibilities delegated by the physician or physician group. Interestingly enough, the hospital accreditation commission contains standards in which PAs should be credentialed in a manner similar to physician credentialing. State law and regulation is the fourth determinant of the PA scope of practice. State medical boards are responsible for reviewing health care provider behaviors and the impact they may have on public safety, which may result in provider disciplinary actions. Most states’ medical boards license and regulate PA practice. California is one of eight states that have a regulatory body dedicated solely to PAs (PA Board). These regulatory organizations set parameters for PAs to follow in order for PAs to practice in that state. All PA regulatory bodies require graduation from an accredited PA Program and an initial passing
score on the Physician Assistant National Certification Examination (PANCE). Considering this fourth determinant, most states do not regulate PA competencies for specific tasks. Most states require that the scope of practice for specific tasks fall upon the supervising physician. A minority of states do require state board approval for specific tasks in the PA scope of practice, such as specialized procedures. This is not the case in California. Davis, et al., point out that all states require PAs practice with physician supervision however, the supervising physician does not always need to be onsite. In California, the supervising physician does not need to be onsite, while other states require the supervising physician to be onsite at least one day of the work week. The real struggle is defining the term “supervision.” According to Davis, “An increasing number of states authorize the specific elements of supervision to be determined at the practice site, based on the complexity of patient problems common to the practice, the training and experience of the
PA and the setting in which care is rendered.” Most often more technical skills or an increased risk potential for patients results in supervision that is more explicit and defined.
CAPA’s role is more in the realm of monitoring. If CAPA sees a disparity in the hiring of PAs, it can educate facilities about the benefits of hiring a PA as well as the PA scope of practice.
CAPA does play a role in these determinants as they seek to protect and expand the scope of PA practice in California. In regard to Determinant 1, PA education, experience and preference, CAPA has an elected student representative on the Board of Directors. One responsibility of the student representative is to maintain communication with all California PA Programs to see if CAPA, in some way, can assist in the education of students.
CAPA’s strength is with Determinant 4, state law and regulation. CAPA attends all California PA Board meetings to monitor trends and address potential future issues. CAPA employs a dedicated staff person who monitors old and newly proposed legislation that may peripherally or directly affect PA representation or scope of practice. Davis, et al., pointed out that PA supervision in many states is being determined at the level of the practice site. CAPA is attempting to add this type of supervision to the other existing forms of supervision deemed acceptable in California.
Regarding the second determinant, physician delegation, CAPA makes it a priority to educate physicians about who PAs are and what PAs can do for them and their patients. With more education about PAs, there will be increased utilization of PA knowledge and skills for patients. Considering Determinant 3, facility credentialing and privileging,
The research by Davis, et al., was interesting to read, but the more interesting part is that throughout the article it was evident that CAPA has always played an important role in the protection, development, refinement and expansion of the PA scope of practice in California.
Congratulations SJVC - Winners of the 2015 National Student Challenge Bowl!
Students: Alyssa Miller, Chris Sietz, and Gill Gilliam had trained for this for several months and held fundraisers to pay their way to the conference.
SJVC PA students were victorious at the 25th Annual SAAPA Student Challenge Bowl held at the AAPA conference in San Francisco on Memorial Day. They fought against 72 other programs from all across the nation. SJVC has claimed the CAPA challenge bowl on several occasions including last year, while this is their first victory at the national competition. This win has special meaning for these students because they will be the final class to graduate from SJVC which is closing its PA program this year. Program Director, Jed Grant, PA-C states, “faculty and staff could not be more proud of this team which worked tirelessly to prepare for the competition. Well done!” MAY/JUNE 2015
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California Academy of Physician Assistants
Annual Conference Inspiring PAs October 8-11 Palm Springs, CA CAPA Conference – Inspiring PAs Each year hundreds of PAs gather in Palm Springs for the CAPA Conference. A much anticipated yearly trek for many driving through (or flying over) the towering windmills, down Highway 111 to beautiful downtown Palm Springs. Pulling into the Renaissance Palm Springs brings excitement in returning to a place of camaraderie, fantastic energy and professional renewal. Getting together with PAs who exude passion for the profession is inspiring. Taking time to get away to “sharpen the saw” is an investment in you. We have developed an educational program filled with exciting topics and presented by many of your favorite speakers. There are also many new speakers this year that we know you will want to hear again and again. The CAPA Conference Experience is one filled with opportunities to grow, make connections that matter, discuss topics of interest, find solutions to common problems and learn new and innovative ways to grow in your career. You will be inspired and return to your practice remembering why you love being a PA!
range of presentations from PA practice issues to PANCE review topics to current advances in medicine. Here are a handful of just some of the events we have planned for you: ~~ Still confused about Performance Improvement CME and how we are supposed to get it to fulfill NCCPA requirements? PA Greg Thomas, the Director of External Relations for NCCPA, will be joining us on Friday to help sort it out as well as provide updates from the NCCPA. ~~ Perennial favorite Jennifer Carlquist, PA-C, will be opening the session on Saturday with an in-depth discussion of a cardiology case and will also be presenting a fascinating discussion on how to mitigate risk in your practice on Friday. ~~ Unsure of what’s next after a positive ANA test? Rheumatologist, Dr. Robin Dore, will be sharing the latest advances in Lupus diagnosis and treatment on Thursday afternoon. ~~ NEW THIS YEAR! We are hosting a workshop on IUD Insertion on Saturday morning with Dr. Anita Nelson to provide training for each type of IUD currently available. Space is limited, so sign up today! ~~ Need to recertify for ACLS? We will be offering ACLS Recertification again this year on Thursday.
Each of you brings something special to the conference. We hope to see you in Palm Springs.
~~ The ever-popular Student Medical Challenge Bowl will take place once again Saturday evening. Will YOUR school take home the trophy this year?
CME Highlights
~~ Our 4-hour Conference agenda on Sunday features an array of topics from skin lesions to insomnia. Stay until the end, and you will be entered into a special drawing!
This is our 39th year offering a multi-day course of CME, and this year, we are hosting the conference once again in beautiful Palm Springs from October 8-11, 2015. We are thrilled to offer a diverse
More details on other exciting presentations and workshops are coming – stay tuned!
Call: 760-322-6000* You will want to reserve your hotel room early. We have a block of rooms at the Renaissance Palm Springs and the Palm Springs Hilton. Hotel rooms will sell out. Special parking and in-room internet fees at the Renaissance for CAPA. $5 parking and $5 Internet each day! *Renaissance Palm Springs 12
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2015
Student Medical Challenge Bowl The Student Medical Challenge Bowl is back again this year. On Saturday afternoon, just as the sun begins to set behind the mountains, the game begins. You won’t want to miss this fun, light-hearted, Jeopardystyle game show format event. PA students answer SJVC, 2014 C APA Stude nt Challen questions in order to vie for ge Bowl W inner the championship title, the coveted Student Challenge Bowl Trophy and cash prize for winning program’s Student Society. It has become a highlight of the CAPA Conference and so much fun to watch (and learn). So, have a beer or soft drink (which we supply), grab a chair and see who will win this year’s CAPA Student Medical Challenge Bowl.
Returning Saturday afternoon, Greg Mennie and the CAPA All-Star Band
DOT Medical Examiner Training Course Saturday, October 10, 2015 9:30 a.m. to 12:30 p.m. $250 Members $350 Non-members The Federal Motor Carrier Safety Administration (FMCSA) has established a National Registry of Certified Medical Examiners with requirements that all medical examiners who conduct physical examinations for interstate commercial motor vehicle drivers must complete a training course and pass a certification examination. We are pleased to offer this course at the CAPA Conference. The Medical Examiners Department of Transportation training program is a 2.5 hour optional course. Participation in this workshop does not guarantee successful passage of the certification exam. This is an advanced level fast-paced course for PAs, NPs and physicians, which assumes a prior mastery and skillset in the basics of history and physical examination techniques. In addition, this course includes extensive resources materials that the learner will need to review and study prior to taking the certification exam.
IUD Insertion Optional Workshop Saturday, October 10, 2015 9:30 a.m. to 11:30 a.m.
Fun times
nie, Greg Men
MS, PA-C
- CAPA Da
nce 2014
on drums
Enjoy the incredible concert before, during and after the Student Challenge Bowl. In case you don’t get enough dancing and music on Friday night at the CAPA Dance, we have more fun in store Saturday afternoon – a live band with PA, Greg Mennie on drums! So, you won’t want to miss the CAPA All-Star Band on Saturday, October 10, 2015 at 5:00 p.m.
Learn about each of the intrauterine devices (IUDs) currently available in the United States, and practice placing them using anatomical models in this hands-on clinical skills workshop. Training for the insertion of Paragard, Mirena, and Skyla will be provided by Anita Nelson, MD. Dr. Nelson is a member of the Harbor UCLA Division of Gynecology, Medical Director of the Women’s Health Care Programs at Harbor and in the Coastal County Clinics. She is the site Director of third year UCLA medical students, head of Harbor’s CME, Departmental quality improvement, and Departmental resident research for OB/GYN as well as the chair for the second IRB for LA Biomedical Research Institute. She has published nearly 200 articles for professional journals, 12 books, and 62 book chapters. MAY/JUNE 2015
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CAPA Palm Springs Conference – What Makes It Such a Great Event? by Ana Maldonado, MPH, DHSc, PA-C; Vice President
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s a relatively recent returnee to the California PA world I have had the great honor and pleasure of reuniting with my home state’s PA professional organization, CAPA. It has been proven to be a homecoming with many rich benefits. One of the benefits I hold with the highest regard is the CAPA Palm Springs Conference. It has proven to be one of the best professional, political and social events of the year for me as a practicing PA and educator of PA students. Granted, as a member of the American Academy of Physician Assistants (AAPA), the Physician Assistant Education Association (PAEA) and having been bi-coastal, I have attended many of the larger PA conferences and workshops across the country. I have also had the privilege of speaking at the Pennsylvania and Massachusetts state PA conferences. These have been enriching experiences as well, yet they do not hold the same importance to me as my current involvement with CAPA and its annual Palm Springs Conference. Why is that you may ask? Truthfully, it is mostly about the pride and the “connectedness” I feel with CAPA and the organization’s proven capability 14
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to provide a well-organized, informative and just-pure-fun conference that matters to me as a local PA in CA. Let me just outline a few of the highlights that make it “the best conference of the year.” # 1 – It is a proven time and place that one can count on. Now entering its 39th year in 2015, it highlights the end of summer in a place where summer never ends. #2- It brings together the north and the south of one of the largest states in the country and the California PA professionals that rank second highest in numbers (outside of New York State). #3 – In a short 4 days of ongoing events, it encompasses skills training workshops and lectures educating PAs on some of the most recent and important medical updates encompassing the specialty practices of PAs. #4 – The Conference provides a forum for updates from our national organization, AAPA, as well as from our governing national organization, the NCCPA. Many of these updates are salient to our knowledge of licensing, scope of practice, changing requirements and opportunities in our profession. #5 – The Controlled Substances Education Course, which is partnered with the Conference, provides PAs with the opportunity to join the ranks of those providers that are updated on prescribing Schedule II – V medications. For many of us, it is an essential component of our daily practices.
#6 – For many of us who have attended PA education programs in California, we are provided the space and time to join with our fellow alumni, many of whom are now scattered across the state. #7 – Students from the multiple California PA programs are provided the opportunity to meet each other in a networking and service capacity. They are assured a sense of welcoming into the ranks of the profession and provided a forum to explore their futures in the profession. Additionally, they are offered a competitive, academic event, the Student Medical Challenge Bowl that inevitably results in some excellent entertainment for all. #8 – The CAPA Conference provides us with local legislative updates which are invaluable to our practice, our medical communities and our professional futures. We also obtain updates on insurance and billing information that affects us all, to some degree, in our practices. All in all CAPA’s Palm Springs Conference is the jewel of the organization. I hope each of you has it on your calendar for October 8-11, 2015. We, the CAPA staff, leadership team and committees promise to make it another memorable and inspiring event for all of us. I look forward to seeing you there!
What is a Practice Analysis and Why Should I Participate? by Mark Christiansen, Ph.D., PA-C; PA Program Relations Committee Chair
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ecently you probably received a request from NCCPA to participate in a survey for their periodic practice analysis. If you are like me, you looked at the expected time to fill the survey out – about 90 minutes – and in your mind you weighed the value of your time against the value of doing the survey. Am I right?
Well, before you completely delete the request and choose not to participate, let me help you understand what a practice analysis is, why it is essential and what it can do for you and your chosen profession of PA. Hopefully, this will convince you the survey is worth an “Take the time to complete hour and a half of your time. the survey and think of it
as an investment in your
Practice analysis is the systematic study future and in the future of a profession to describe the job of the profession you have responsibilities of chosen.” those employed in the profession and to identify the knowledge and skills required to effectively carry out those responsibilities. Practice analysis is widely recognized as an essential component of any certification program. Certifying organizations like the NCCPA are required to conduct periodic practice analyses (every 5 – 7) years to have their certification programs recognized by the National Commission of Certifying Agencies (NCCA) of which NCCPA is a member. The practice analysis questionnaire focuses on the knowledge, skills and abilities needed for safe and effective practice within the field. The survey solicits information
from practicing professionals in the field concerning what they need to know, the tasks they perform and the relative frequency or importance of each. The general format provides a list of tasks followed by Likert scale responses designed to measure the frequency or importance of each for the professional in the field. Health care in general, and PA practice specifically, evolves over time. Think about changes in your own practice over the past few years and you can begin to imagine how much responsibilities, knowledge and skills change for PAs over a 5 to 7 year period of time. The primary purpose of certification exams is to distinguish individuals capable of practicing safely and effectively in the current health care environment from those who can’t. It is essential to ensure these high stakes examinations are based upon current practice patterns and that they are valid, reliable and objective measures of candidate ability. The final step in the process is the analysis of the data and the structuring of a usable test blueprint that is created to the specification of current work in the field. The blueprint of the exam should mirror practice in the field not only in terms of the knowledge and skill sampled, but also in the proportion, depth and breadth of coverage. The test blueprint supports the construct and content validity and is the basis for selecting items to be included on an exam. A strong argument for content validity can be achieved by conducting a practice analysis. The validity of any exam is really the accurate or valid interpretation of exam scores. These interpretations depend upon the content and constructs measured in the exam. The
appropriate knowledge and skill must be tested to achieve valid scores. In order to make valid interpretations of scores, examinations should have 1) face validity, 2) content validity and 3) construct validity. Face validity simply implies that the test appears to cover appropriate areas of practice. Content and construct validity suggest that the test measures the knowledge and skills pertinent to the field of practice. It can be difficult to encourage any busy professional to take the time to answer surveys. I get way too many of them and I do have to pick and choose which ones are most important. So what are the benefits of participating in this survey that we hope will produce an accurate and current picture of PA practice? This information is taken directly from the NCCPA survey request. The results of this survey will: • Have a direct bearing on NCCPA exams (i.e. content blueprint and examination strategies). If you want PANCE, PANRE and the CAQ Specialty Exams to measure relevant knowledge, please fill out this survey. •
Equip us to educate physicians, employers and the public about the current state of PA practice. When I talk to these groups, I am still surprised about all the things they don’t know about certified PAs.
•
Help NCCPA and others quantify the national impact of certified PAs to the media, policy makers, state medical boards and insurers those groups who make decisions that affect what we can do and how we are paid. Continued on page 19
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Medicare Reform Law Is Good News for America’s PAs and their Reprinted with permission from the American Academy of Physician Assistants Intro by Bob Miller, PA: Professional Practice Chair As you know, CAPA focuses primarily on California issues to improve PA practice and advocate for PAs across the state. CAPA also supports the efforts of the AAPA as they work on improvements on a national level. The article below discusses new Medicare changes which will be of benefit to PAs, not only in California, but across the nation. Alexandria, VA – April 27, 2015 PAs won a significant victory in the bipartisan Medicare reauthorization legislation that was signed into law by President Obama on April 16, 2015. The statute includes an increase in Medicare payment rates for PAs and other providers for each of the next five years, reduces a number of barriers to effective PA practice under the Medicare program, and elevates the profile of PAs as vital healthcare providers to America’s seniors. Importantly, changes in the Medicare program are a bellwether for changes in private insurance practices, as well. AAPA and its members played an active role in supporting the legislation, which represents the most significant Medicare reform in decades. “Through AAPA-organized meetings with lawmakers and key committee staff in Congress, as well as a significant grassroots effort, hundreds of PAs from across the nation urged Congress to make these long overdue changes. Their advocacy really helped make a difference for PAs,” said AAPA CEO Jenna Dorn. AAPA President, John McGinnity, MS, PA-C, DFAAPA, applauded several specific provisions of the law. “This legislation matters – a lot. It means we can expect to see greater stability in Medicare provider payment rates, which affects not only 16
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practitioners, but patients, as well” he said. “Plus, we’ve too often seen legislative and regulatory roadblocks that prevent PAs from delivering the medical care that they have been trained and licensed to provide. In this case, PAs worked with lawmakers to seize this opportunity to eliminate some important barriers to better patient care.” The statute repealed the “sustainable growth rate” (SGR) policy, which was enacted by Congress in 1997 in a failed attempt to control Medicare spending growth by establishing annual spending targets. Over the past 12 years, Congress has passed 17 “payment patches” to prevent SGR-mandated cuts in payment rates to all healthcare professionals, including PAs, who provide Medicare-covered services. By repealing the SGR payment policy, the statute not only avoided a 21 percent reduction in payment rates for PAs and physicians that would have taken effect immediately, but also guaranteed a .5 percent increase in payment rates for each of the next five years. The new payment rates will not directly affect the salaries of PAs. However, they will increase the revenue that hospitals and medical practices who employ PAs (including those owned by PAs) receive from Medicare, which could translate into higher PA salaries and/or have a positive impact on productivity-based pay. McGinnity also singled out the bill’s provision that authorizes PAs to provide care to patients with
complex, chronic conditions, which he called “a real step forward” that recognizes the value, education and skills of PAs. “The chronic medical care provision is excellent news for patients, especially those who rely on a PA as their primary healthcare provider,” he noted. Additionally, the measure authorizes PAs to document face-to-face encounters for durable medical equipment (DME), providing a remedy to an ongoing regulatory debate that could have placed additional burdens on PAs ordering DME. “We believe this provision will eliminate unnecessary delays for patients, reduce red tape for healthcare systems and provider practices, and allow PAs to practice at a level that is consistent with their license and education,” McGinnity emphasized. It is expected that Medicare will continue to move, over time, from paying providers on a fee-for-service basis to value-based payments. Under value-based payment systems (also known as value-based reimbursement), providers will increasingly be paid based on their contribution to patients’ health outcomes (value), rather than the number of patients they see or how many tests they order (volume). These payment changes are expected to drive changes in the practice of medicine, as well. The new law creates a program called the Merit-Based Incentive Payment System (MIPS), which will provide for additional payments to participating healthcare providers beginning in 2025. The implementation of MIPS, combined with the elimination of the SGR,
Patients moves Medicare another step closer to paying providers based on value, rather than volume. “We’re supportive of PAs being included in the new value-based systems. However, we are also keenly aware that the medical care provided by PAs under the Medicare program – and the value of that care – is not readily transparent,” noted Tillie Fowler, senior vice president of advocacy and government relations at AAPA. “We urge lawmakers to go a step further in seeing that
Medicare ensures transparency of the medical care provided by PAs and the value of that care, and look forward to working with them in the days ahead on this key issue.” The statute also provides continued healthcare coverage for America’s most vulnerable populations by reauthorizing the Children’s Health Insurance Program for two years, and continuing funding of the Community Health Center and National Health Service Corps programs for two years.
6 Hours Cat. I CME
Controlled Substances Education Course for PAs Saturday, July 25, 2015 Marshall B. Ketchum University Fullerton, CA Saturday, August 8, 2015 UC Davis Sacramento, CA Wednesday, October 7, 2015 Renaissance Palm Springs Palm Springs, CA
Renew Your CAPA Membership Today! There are many reasons to support CAPA. The number one reason for most of us is that we want to see things change for PAs in California. Change for the better! CAPA is here to promote and protect California PAs. Remember, there are those who want to change things to limit PAs’ ability to practice. Each and every day we are your eyes and ears. We have the best in the business working to make PA practice here in California better for you. Your membership dues are what make this possible. SB 337 is a huge and important undertaking for California PAs! Remain a member and help to make it happen. The more members we have, the greater our ability to Move California PAs Forward! Together we are stronger!! Our numbers and our strength must continually grow to stay on a level playing field with other health care providers in California.
Remember – Momentum Is Key To Our Success We Need Your Support Year After Year You may renew your CAPA membership online if you wish: www.capanet.org
Select auto renewal and save $15
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Aspiring PA Students by Cherri Penne-Myers, PA-C; Director-At-Large
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f you are mentoring someone who aspires to enter PA school, below is some helpful information to share. On April 22, 2015 the Central Application Service for Physician Assistants (CASPA) opened up. Are you ready for the daunting and tedious work that lies ahead? This year, if you used CASPA before and are applying again…there will be some changes! The following was posted on the CASPA website in September “Next on your list is working 2014, “The CASPA application platform on your personal statement will be updated with this new cycle, essay which can be which will offer many exciting features for challenging as you have to both applicants and programs, including provide 5,000 characters.” a new and improved user interface, design, and customizable options. The change to this new platform will NOT allow for any re-applicants regardless if you have applied in the current CASPA cycle. ALL applicants will be required to begin a completely new application when the 2015-2016 cycle opens on April 22. CASPA will be unable to make exceptions to this so please keep this in mind when considering applying in the new cycle. We know you will be pleased with all of the system and application updates.”
Review the CASPA Overview Pages Once you get to the website and before applying you must review the overview page. Along the left hand side is a column which has headings titled: Before Applying, Participating Programs, Instructions and Frequently Asked Questions and numerous other subtitles. I cannot stress enough how 18
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very important it is to review these several times and to download the information to a notebook or to your desktop for easy reference as you start your application process. URL: https://portal.caspaonline. org/caspaHelpPages/aboutcaspaoverview/index.html By now, you should have an idea of schools you want to apply to. If you haven’t taken an opportunity to visit websites of the different PA Programs or it’s been a while since you visited the websites, CASPA has a list of links to review. (Side note: it is important to frequently check the PA Programs’ websites you may be applying to. Prerequisites may have changed, shadowing hours increased, or work experience hours increased). URL: https://portal.caspaonline. org/caspaHelpPages/participatingprograms/index.html
CASPA Does Not List All PA Programs It’s important to remember that not all PA programs participate with CASPA. If you are interested in the 196 ARCPA accredited PA Programs you will need to go to this website, http:// www.arc-pa.org/acc_programs/. On this website, the listed programs may have some notations. These notations could be probation, administrative probation, provisional, D: (distance campuses), aF: program may have a focused visit prior to their next ARC-PA review, or #: the program was closed for a period of time since being first accredited. Accreditationprovisional is an accreditation status for a new PA Program that has not yet enrolled students but, at the time of its comprehensive accreditation review
has demonstrated its preparedness to initiate a program in accordance with the accreditation standards. The other website to check out is http://directory.paeaonline.org/. The Physician Assistant Education Association’s (PAEA) website allows one to search for a program by state. It also denotes whether the program is accredited, accredited-provisional, developing-not accredited, or accredited-probationary. They list 204 PA Programs. CASPA also has listing for twelve developing programs for the 20152016 application cycle. Included in these developing programs are two new programs for California, Charles Drew University in Los Angeles and Southern California University of Health Sciences. URL: https://portal. caspaonline.org/caspaHelpPages/ participating-programs/index.html Stephen Pasquini, PA-C, is a family practice PA with 10 years of clinical experience. He has a website called the PALife.com. His goal is to build a useful resource for practicing PAs, PA students and prospective PAs. One of the areas of discussions is “Are You Trying to Find the Perfect PA School to Fit Your Needs?” This may interest some of you aspiring Pre-PA students, below is the link. PA Life also can be followed on Facebook, twitter, and their blog. URL: http:// www.thepalife.com/pa-schoolfinderthe-ultimate-physician-assistantschool-and-program-directory/. Others may be interested in the rankings of the PA programs
published in US News and World Reports each year. URL: http://gradschools.usnews.rankingsandreviews. com/best-graduate-schools/tophealth-schools/physician-assistantrankings.
You post your essay in the comments section and you will get our critique. It is that easy. We will try to give feedback to every single person who posts their COMPLETE essay here on this blog post in the comments section.”
Personal Statement Essay
Personal References
Next on your list is working on your personal statement essay which can be challenging as you have to provide 5,000 characters. Recently, California PA Project Access devoted a week to personal essay workshops. Here is a link to their Facebook page. https://www. facebook.com/caprojectaccess?hc_ location=ufi. Become a friend and you will certainly be pleased with the information the site provides for PAs and aspiring Pre-PAs.
Before you apply you must have three references and one of those should be a PA you shadowed. Explain to those individuals it is not a reference they write now. CASPA will send information by email to your references once the applicant has submitted their names in the CASPA application. The individuals will go online with a password and answer several questions on their observations of the applicant during shadowing.
Also, PA Pasquini has provided information on how to write the perfect personal essay on his website. URL: http://www.thepalife.com/howto-write-the-perfect-physician-assistantschool-application-essay/. If you feel you might need some assistance with your essay, do check this website. It is important to have others read your essay to give you pointers. This website offers the following, “We want to make this opportunity open to everyone who would like it and that is why we are offering free feedback on the blog.
Official Transcripts Another important item you will need is official transcripts for all of your college classes. You will need these before you start your application. You must report all courses on the transcripts, including courses you withdrew from, repeated courses, ungraded labs, test credits, gym courses, orientations or other non-graded courses. Remember, every grade must match your official transcript.
What is a Practice Analysis and Why Should I Participate? Continued from page 15
Like voting in an election—it is a right and responsibility if you want your answers to be part of the discussion. So take advantage of this opportunity to let your voice be heard, not only for yourself, but for the impact it will have on the profession. Take the time to complete the survey and think of it as an investment in your future and in the future of the profession you have chosen.
CASPA can enter some of your coursework for you for an additional fee. For information on this service see this link: https://portal. caspaonline.org/caspaHelpPages/ frequently-asked-questions/academichistory/caspa-coursework-entryservice/index.html. This article only covers a few extremely important items on the CASPA application. I would like to wish each of you aspiring PA students a successful application process and I look forward to working with you in the future.
CAPA Members can log-in and view Job Listings. Employers know that the CAPA website is the best place to advertise for PA positions in California.
Check the listings often.
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Medical malpractice claims and physician assistants Medical malpractice claims can be asserted against any healthcare provider, including physician assistants. As PAs are now found in many settings and as the demand for PAs grows, the reality is that physician assistants are more frequently finding themselves defending the care they provide to patients. This case involves a forty yearold patient who suffered a stroke two months after starting birth control pills. The patient claimed the PA did not fully inform of the risks of medication and age resulting in the patient’s stroke. The PA claimed the woman had previously taken birth control pills and knew the risks. The patient, age forty, went to the defendant family medicine clinic to obtain a prescription for birth control pills. She was seen by the defendant physician’s assistant, who conducted a complete physical exam. There were no contraindications for prescribing the pill and a prescription was provided to the patient. About two months later, the patient suffered a debilitating stroke. During the work up for the stroke, the patient was found to have a patent foramen ovale – a hole in the heart which had not closed at the time of birth. The patient’s claims went to trial as to lack of informed consent. The patient claimed that the risks and benefits were not explained to her and that she was not told of alternatives to the pill, such as an IUD. The patient claimed that use of birth control pills was not safe for a woman her age due to higher risk of stroke. The defendant physician’s assistant claimed that, despite no charting of the conversation, a detailed discussion took place before the prescription was issued. The defendant physician’s assistant also maintained that the patient had used birth control pills in the past and that she received information from other physicians regarding birth control. The defendant physician’s assistant also claimed that the stroke was due to the hole in the patient’s heart, not the use of birth control pills. According to published reports, a defense verdict was returned. Risk Management is an integral part of a healthcare professional’s standard business practice. Risk management activities include identifying and evaluating risks, followed by implementing the most advantageous methods of reducing or eliminating these risks. The following risk control recommendations can be used to enhance quality of care and reduce risk: Adopt an informed consent process that includes discussion and teach-back from the patient, and demonstrates that the patient understands the risks associated with treatment. Before engaging in treatments or interventions, the PA must obtain the patient’s informed consent, or informed refusal of recommended treatment with all discussions carefully documented. At a minimum, informed consent discussions should include: • known risks and benefits of the treatment plan, alternative treatment options and the likely consequences of declining the suggested treatment • answers to patient questions • repetition of important information by the patient to ensure understanding • written confirmation that the patient agrees to the proposed treatment • provision of pertinent patient education materials and corresponding documentation It is the PA’s duty to practice within the boundaries of a PA’s scope of practice. These are determined by four parameters: education and experience; state law; facility policy; and the supervising physician’s delegatory decisions. Complying with each boundary must be followed in order to promote effective patient-centered care and may protect you from being named in a lawsuit. By using this example, PAs have a better understanding of the risks they may encounter on a daily basis.
www.hpso.com With permission from Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN 37203-3411, 1-800-298-6288. This risk management information was provided by Healthcare Providers Service Organization (HPSO), the #1 provider of professional liability insurance for over 1 million healthcare professionals, and is now offering the same quality coverage, financial strength and level of service to Physician Assistants. The professional liability insurance policy is administered through HPSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an email to service@hpso.com or call 1-800-982-9491. www.hpso.com. CAPA 0515
Students Students Students Students Students Students PA Students Making an Impact Throughout California by Sandra Fineman, PA-C; Student Affairs Committee Chair
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alifornia PA students are not only busy in the classroom;, they are also busy sharing their newly acquired skills, and the art of medicine within local communities.
In Northern California, eight NP and PA students from UC Davis are completing their clinical training at a rural clinic in Redway, CA. During the four weeks of clinical training, the students are also participating in community outreach events including a community health fair, a twice monthly health clinic at a local high school and speaking at a community meeting addressing the impact of the growing marijuana industry on the population’s health in the county. What an incredible effect UC Davis students are making in this community and several other rural communities.
In Southern California, USC PA students participate in two downtown Los Angeles clinics where they see patients who have limited or no access to care. PA students work together with pharmacy, medical and occupational therapy students in an interdisciplinary team. By doing so, USC PA students gain a greater understanding for each profession as well as provide care to an underserved community. This is one, among many, remarkable ways that USC PA students are actively involved in the Los Angeles area. In Pomona, Western University of Health Sciences PA students dive into community service right from the start of the program. From August through December, the students assist the Claremont Unified School District with vision screenings. Annually, Western University PA students, in conjunction with the school district nurse, screen close to 4,500 elementary students. It is amazing how many elementary school students are being
Congratulations Graduates
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positively affected by Western University’s PA students. Over in Orange County, Marshall B. Ketchum University’s School of Physician Assistant Studies PA students hosted their inaugural community education outreach event by welcoming seventy 5th grade students to MBKU’s campus. The 5th graders spent the day exploring various health care related professions while expanding their knowledge of the human body with hands-on activities. This was the first of several community outreach events that the PA students at MBKU have been passionately participating in. To be a PA is a calling to serve, to heal and to comfort. May these stories inspire all PAs to continue to act upon this calling. As the Dalai Lama once said, “Just as ripples spread out when a single pebble is dropped into the water, the actions of individuals, can have far-reaching effects.”
CLASS of 2015
APA would like to congratulate all students graduating from the Physician Assistant Programs across California. Best wishes as you prepare to take the NCCPA PANCE exam, and begin your career as a PA. We look forward to working with all of you as our colleagues as we continue to advocate for our profession.
Congratulations to the 2015 Graduates of: Loma Linda University of Health Sciences Riverside County Regional Medical Center/Riverside College Samuel Merritt University San Joaquin Valley College Stanford University, School of Medicine
Touro University - California, College of Health Sciences University of California, Davis University of Southern California, Keck School of Medicine Western University of Health Sciences
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Students Students Students Students Students Students Clinical Rotations: Be Open To All Possibilities by Jamie McCoy, PA-C; Student Representative
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t’s that time of year when first-year PA students start transitioning from the didactic year to the clinical year. It’s such an exciting time because you’re finally able to take what you’ve learned over the last year or so and apply it to real life patients and real life medical scenarios. It will be your first taste of practicing medicine as a PA and it’s a great opportunity “Accept challenges for most students to and always welcome discover where they fit in the medical opportunities to learn profession.
from your mistakes. Each
It wasn’t long ago that I was in the midst of that will contribute to the type transition period and I can still of PA you’ll eventually remember exactly become.” how I was feeling prior to starting my clinical year. Excited and eager, I was also experiencing feelings of anxiousness and was slightly apprehensive because I didn’t necessarily know what to expect on my first day. Reflecting back on that year, I think about all the great experiences I had, the things I learned with each new rotation and the things I’d probably do differently if I were to do it over again.
experience, good or bad,
The first article I wrote for the CAPA News offered some advice to PA students in or starting their clinical year from the perspective of the preceptor. This month I’d like to share some advice about the clinical year from the perspective of recent 22
CAPA NEWS
PA school graduates, including myself. The clinical portion in a PA program is intimidating to the majority of students who’ve never experienced anything like it. You start to learn medicine on a whole different level. You especially learn how to work with a variety of different people as you shift from rotation to rotation and each one will have different expectations of their students. One of the most important and beneficial pieces of advice I was given during my clinical year was from my father. With the start of each new rotation and even when I started my new job as a PA, he reminded me to never stop trying to learn more and to never place myself in a position where I felt like I’d learned enough. Always strive to impress! William Fuller, PA-C, shared some great advice–he says he wished he would have known as a student before starting his clinical year. He encourages PA students to “ask their preceptor questions about the ‘gray area’ of medicine. Textbooks and examinations will teach the black and white, which is an important foundation of knowledge and will help you pass board exams but the ‘gray area’ is where the ART of practicing medicine occurs. Patients in the clinic don’t have black and white signs, symptoms or lab results like the examinations do.” Another great piece of advice that Fuller mentioned was that every student should “enjoy the experience and try to be openminded to all the specialties in
which you rotate. You may just surprise yourself and fall in love with a field of medicine you once swore you could never imagine yourself working in.” Another recent graduate, Reuben San Juan, PA-C, mentions the importance of “owning up to things.” If you make a mistake, forget to ask the patient a particular question or fail to include pertinent information on a history and physical, tell your preceptor! You are being placed in a position of trust to act in your preceptor’s stead. If they think you’re going to lie to them, you won’t be in that position for very long.” Again, the aforementioned advice is coming from PAs who’ve recently completed their clinical rotations and is a great resource for any PA student starting their clinical year. Don’t forget that now is your opportunity to take advantage of the fact that you’re still a student. Accept challenges and always welcome opportunities to learn from your mistakes. Each experience, good or bad, will contribute to the type of PA you’ll eventually become.
Welcome New Members
Local Groups
March 19, 2015 through May 20, 2015 Rea Abaniel, PA-C Talia Adams, PA Valerie Aguilar, PA-C Abigail Airoldi, PA-S Mohammad Akbari, PA-C Kamilya Amirova, RDMS Kirsten Anderson Lucas Anderson, PA-C Ryan Ansari Liliana Avelar, PA-C Marisa Barber, PA-C Kristina Barrack, PA-C Scott Becker, PA-C Keith Bersch, PA-S Kate Black, PA-C J. Christine Blinkinsop, PA-C Elizabeth Bloomfield, PAC Natasha Bove Danielle Broome, PA-C Luis Cadena, PA-S Christina Cady, MPH, ATC, PA-S Maribel Campos, RRT Laura Carr, PA-C Paul Cassedy, MD Mario Celaya, PA Ana Celaya, PA-C Jeffrey Chavez, EMT Amara Childers, PA-S Harvey Chong, EMT-I, PA-S Charlene Chow, PA-C Riley Clark George Conklin, PA-C Jeffrey Cooper, PA-C Sarah Craft, PA-C Natalie Dale, PA Michael Davis, PA-C Lawrence Dimacali Yashveer Dubbula, PA-S Megan Erickson, PA-C Emily Fish, PA-C Robert Fontanilla, PA-S Tory Foss, PA Robert Gamboe, PA-C Arturo Garcia, PA-S DeAna Garcia, PA-C Alison Haider Mark Haley, PA-C
Brian Hanes Mark Harvey, PA-C Pamela Hassler, PA-C Hang Holoyda, PA-C Kristin Humpal, PA-C Asma Hussaini, PA-C Son Huynh, PA-S Frank Jimenez, PA-C Judy Justus, PA-S Nalini Kandallu, PA Anthony Kelly, PA-C Mitsu Killion-Jacobo, PA-C Joseph King, PA Vitaley Kovalev, PA Rachel Kramer, PA-S Michelle Ladwig, PA-C Katie Le, PA-C Prescott Lederer, EMT Valerie Lee, PA-C Kelli Lem, CNA, PA-S Jenna Lightfoot, PA-C Miguel Lopez Daniel Mallamo, PA-C Kelli Malone, PA-C Joel Manilay, PA-C Eduardo Marcus, PA-C Danielle Martinez, PA-S Theresa McDonald, PA-C Jeniece McDonald, PA-S David Medina, PA-C Tinebeta Mekonnen, PA-S Elder Mendoza, PA Nancy Menges, PA-C Annelise Merriner, PA-C Glenn Morrison, PA-C Robyn Nash, PA-S Joelle Negley, PA-C Courtney Nelson, PA-S Jared Ng, PA-S Kay Nguyen, PA-S Ava Novotny, PA-C Jennifer Nowaczyk, PA-C Hugo Noyola, PA-C Clement Ogbuehi, PA-C Michael Orris, PA-S Erin Pardee, PA-C Kristin Paulson, PA
Erica Ragen, PA-C Gabriel Ramirez, PA-C Rushmi Reehal, PA-C Evelyn Rodriguez, CNA Muriel Rose, PA-C Jacquelyn Sander Victoria Sarun, PA-C Bernadette Schulman, MS, PA-C Sarah Schwartz, PA-C Bridgett Seanez, M.S. Veronica Selby, PA-C Andrea Shandling, PA-C, MPH, CPH Stephanie Sharma, PA Maryann Sheps, PA-C, DC Mark Simpson, PA-S Matthew Snarr, PA-C Prida Solis, PA-S Anna Marie Sorriso, PA-C Holley Spears, PA Kathleen Strahm, PA-S Jung Sung, PA Christina Tansy, PA-C Cody Tapp, PA-C Jodi Tarutis, PA-C Brooke Tompkins, PA-S Sherry Torng, PA-S Patty Lynn Tucker, PA-C Shannan Van Houten, PA-C Kenneth VanDerBeck, PA-C Ricardo Vega, PA-C Jeanne Villegas, PA Dawn Vinning, PA-C Candace Walker Jennifer Wallace, PA-C Haley Joy Wareham, PA-S Ashley Webber, PA-S Megan Wu, PA-C Luz Zavala-Salcedo, PA-C Arnold Zigman, PA
1. Redding Area PA/NP Alliance P.O. Box 993515, Redding, CA 96099-3515 Summer Ross, PA-C; (530) 225-6194 summerlynn712@gmail.com 2. Physician Assistant Society of Sacramento (PASS) Atul Sharma, PA-C, President; (916) 397-6035 pasocietyofsac@yahoo.com; pasocietyofsac@groups.facebook.com 3. Contra Costa Clinicians Association Brian Costello, PA-C; (925) 852-8706 contracostapas.com 4. San Francisco Bay Area Physician Assistants (SFBAPA) www.sfbapa.com, Martin Kramer, PA-C; (415) 433-5359 220 Lombard St., Apt. 118, San Francisco, CA 94111-1155 mkramersf@hotmail.com 5. Bay Area Mid-Level Practitioners Rose Abendroth, PA-C; (650) 697-3583, Fax: (650) 692-6251 rosepard@aol.com Matt Dillon, PA-C; (650) 591-6601, mattdillon42@hotmail.com 6. Bay Area Non-Docs Linda O’Keeffe, PA-C; (650) 366-2050, lindapac@aol.com 7. Northcoast Association of Advanced Practice Clinicians John Coleman, PA-C; (707) 845-6008, streetdrag49@sbcglobal.net 8. Stanislaus County NP/PA Network Brian Cormier, PA-C; (209) 605-4966, briancor@verizon.net www.nppanetwork.org 9. Stockton Midlevels Roy Blanco, PA-C; (209) 623-8580 stocktonmidlevels@gmail.com 10. Journal Club for PAs and NPs (Fresno area) Cristina Lopez, PA-C; (559) 875-4060; Fax: (559) 875-3434 clopez875@aol.com; 2134 10th St, Sanger, CA 93657-2959 11. Central Coast Nurse Practitioners & Physician Assistants Kris Dillworth, NP; ccnppa@yahoo.com Sharon Girard, PA-C; (305) 803-1560; ccnppa@yahoo.com 12. So Cal PAs Linda Aghakhanian, PA-C; want2heal@hotmail.com 13. Orange County Hung Nguyen, PA-C; nhy52@yahoo.com 14. San Gabriel Valley Local Group M. Rachel DuBria, PA-C; (818) 744-6159, racheldca@aol.com 15. San Fernando/Santa Clarita Valley Group Jonah Tan, MPT, PA-C; (818) 634-0007, jotptpa@yahoo.com 16. Coachella Valley Physician Assistant Group Matthew Keane, MS, PA-C; mkeanepas@gmail.com 17. San Diego Area Bernard Casillan, PA-C; info@sdpasociety.com www.SDPASOCIETY.com.
MAY/JUNE 2015
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California Academy of Physician Assistants 2318 S. Fairview St. Santa Ana, CA 92704-4938
PRSRT STD US POSTAGE PAID SANTA ANA, CA PERMIT NO 949
Address Service Requested
Annual Conference Inspiring PAs October 8-11 Palm Springs, CA
2015
California Academy of Physician Assistants
Optional Workshops, October 8 and 10 Controlled Substances Education Course
October 7, 2015 – Prior to the CAPA Conference
Up to rs of 26 Hou E M C I Cat.
We are thrilled to offer a diverse range of presentations from PA practice issues to PANCE review topics to current advances in medicine. Here are a handful of just some of the topics and events we have planned for you: ~~ ~~ ~~ ~~ ~~
Clarifying PI-CME Cardiology In-Depth Lupus Diagnosis and Treatment IUD Insertion Workshop Skin Lesions
Renaissance Hotel
~~ Insomnia ~~ ACLS Recertification ~~ Student Medical Challenge Bowl and so much more...
and Palm Springs Convention Center