Official Publication of the California Academy of Physician Assistants
2013 – Two Huge Legislative Victories for California PAs by Teresa Anderson, MPH, Public Policy Director
Governor Signs SB 352 and SB 494
hat is the definition of success? Though there are several variations, the Merriam-Webster Dictionary gives one definition as the correct or desired result of an attempt. Therefore, in case there was any doubt, we can say CAPA has achieved success with our legislative agenda this past year. We began the legislative session with an attempt to achieve an ambitious agenda that included two sponsored bills– one that was coming back before the legislature for the third time and the other a totally new idea in California. We are proud to say the correct or desired result of both legislative attempts resulted in success for CAPA as both SB 352 Medical Assistant Supervision and SB 494 Health Care Providers were signed into law by Governor Jerry Brown. Reflecting back on the legislative session, 10 months of striving for success, provides the opportunity to
look at how and why we were able to achieve such an ambitious agenda. CAPA has worked very hard over the years to develop a strong and positive working relationship with the legislature. Thanks to those relationships and years of working together we were fortunate to have two really strong authors and their staff behind our bills. Senator Pavley authored SB 352 Medical Assistant Supervision and Senator Monning authored SB 494 Health Care Providers. Each bill had challenges that the authors and their staff worked tirelessly to overcome. California Association of Physician Groups (CAPG) has been a longtime friend and supporter of CAPA. We were so lucky, and grateful, to have them as a co-sponsor for both bills. Their Senior Vice President of Government Affairs, Bill Barcellona, is one of the state’s leading experts on managed care law and the Knox-Keene Act, which was the foundation of SB 494. We benefited tremendously from his knowledge, advocacy and lobbying on both bills. Without a doubt, the support we had from CAPG was crucial in moving SB 494 to the forefront. Sponsoring two bills and getting them both signed in the same
session takes an enormous amount of work. As the bills move through the legislative process, go through committee hearings and floor hearings there are literally hundreds of hours of meetings with legislators, staff, committee consultants, stakeholders, opposition and anyone else who has an interest in the bill. Once the decision was made to embark on the path of two sponsored bills, CAPA hired a high-powered contract lobbyist with expertise in health systems and health profession issues. Kathryn Scott of Capitol Partners was hired as the lead lobbyist for our sponsored bills. Without a doubt, Kathryn brought highly refined lobbying skill, in-depth knowledge of our issues and strong ties to members of the legislature and Governor’s office. Not only did CAPA benefit from all that Kathryn herself had to offer, we also benefited from the entire team at Capitol Partners. It must be said…our success did not happen by accident. CAPA has incredible leadership!!!! It is through the leadership that strategic decisions about advancing and safeguarding the profession are made. The leadership acts with deliberation and intent providing the opportunity and ability to look at the landscape and respond accordingly versus waiting and reacting to any given issue. Continued on page 4
Editor Gaye Breyman, CAE Managing Editor Denise Werner Proofreaders Kim Dickerson Coryn Kulesza
Editorial Board Jeremy A. Adler, MS, PA-C Roy Guizado, MS, PA-C Adam Marks, MPA, PA-C Bob Miller, PA Michael Scarano, Jr., Esq. CAPA Board Of Directors President Adam Marks, MPA, PA-C email@example.com President Elect Jeremy A. Adler, MS, PA-C firstname.lastname@example.org
CAPA/OSHPD Workforce Survey Results
n partnership with the Office of Statewide Health Planning and Development (OSHPD), CAPA developed a workforce survey for physician California Academy of Physician Assistants assistants. Based on findings from the survey OSHPD has produced a survey snapshot which is available at http://www.capanet.org/uploadedFiles/Content/PA_Laws_and_Regs/SurveySnapshot.pdf. A comprehensive report, scheduled for publication in 2014, will provide greater detail about the PA profession in CA. We are excited about this report, as it will be very useful data in health workforce development and policy discussions. On behalf of CAPA we would like to thank OSHPD for their hard work in analyzing survey data, developing the PA Survey Snapshot and creating a comprehensive report dedicated to the PA profession.
Eric Glassman Honored with the Quinnipiac University Alumni of the Year Award
Vice President Roy Guizado, MS, PA-C email@example.com
n August 10, 2013, the Quinnipiac University (QU) PA Program awarded Eric Glassman, PA-C, their Alumni of the Year Award. Eric was unable to attend, but sent a heartfelt note which was read to the audience.
Secretary Joy Dugan, MSPH, PA-C firstname.lastname@example.org Treasurer Bob Miller, PA email@example.com Directors-At-Large Ana Maldonado, MPH, DHSc, PA-C firstname.lastname@example.org Cherri L. Penne-Myers, PA-C email@example.com Kevin Robertson, MPH, PA-C firstname.lastname@example.org Jay Williamson, MS, PA-C email@example.com Student Representative Chelsea Hemming, PA-S firstname.lastname@example.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 ©2013 California Academy of Physician Assistants
After graduating from QU, Eric moved back to California and that was lucky for us. Eric served on the CAPA Board from 2007 to 2012. He was CAPA President in 2011 and 2012. He was also CME Committee Chair in 2011, 2012 and 2013. Eric’s leadership style and skills are impressive and his integrity in all he does is admired. He has served the PAs of California well. Excerpted from Eric’s note to Quinnipiac University: “I’ve taken what I’ve learned from such a great group of faculty members and applied it both in my daily practice in orthopedic surgery and to my leadership roles in California. I hope the faculty has also inspired you to be challenged with being the best PA possible, going into a leadership role and continuing to serve those in need by volunteering. Good luck with your future and I hope I have the opportunity to meet you in the future.”
Heard Any Great Speakers Lately?
very year at the CAPA Conference in Palm Springs we hear it said: “You guys have the best speakers. How do you do it?” The answer is we hand pick them based on referrals, feedback and firsthand experiences. Please help us identify the great speakers out there. Keep your ears open for interesting topics and excellent speakers. Please let us know
what/who they are. You can email us, call us and/or fax us the information. Email: email@example.com Phone: (714) 427-0321 Fax: (714) 427-0324 Thank you and we hope to see you at the CAPA at Napa Conference on February 22, 2014 and the CAPA Conference on October 16-19, 2014 at the Renaissance Hotel and Palm Springs Convention Center.
Inspiration and Advocacy by Adam Marks, MPA, PA-C, President
Les Howard, PA proudly pinning Adam Marks, PA-C
his year’s CAPA Conference in Palm Springs was another incredible event. The Conference consistently offers opportunities to connect with old friends and colleagues and meet new ones. And, I always enjoy spending some time with the students. As one who served in the National Health Service Corp (NHSC) Loan Repayment Program and found that experience extremely rewarding (both monetarily and professionally), I always encourage students, new graduates and even seasoned PAs to take advantage of the NHSC Loan Repayment Program. While driving home from Palm Springs, I tried to remember when I was first made aware of the NHSC Loan Repayment Program and the availability to repay $40,000-$60,000 of student loans over the span of two
years in exchange for being a primary care provider in an underserved area. I couldn’t remember the exact moment in which I was informed of the NHSC Loan Repayment Program and that probably was because it was the mantra of my training program. I remember sitting at the information sessions at San Joaquin Valley College and listening to an impassioned Program Director, Les Howard, preaching about the genesis of the PA profession and the need for more PAs in primary care, especially in the rural areas of the Central Valley.
More information about the NHSC can be found at nhsc.hrsa.gov. Les championed that message to students from the first day of didactic year until our pinning ceremony. He continually emphasized the
importance of serving the underserved and providing primary care services. Those who have had the opportunity to meet Les Howard know that when he is passionate about something, he has the ability to create a following of “disciples” who carry the message to others. He has been an important professional figure in my life and has given me the tools to not only be a successful primary care PA, but an advocate for the profession and for underserved populations. For those who know Les, either through educational circles, CAPA leadership experiences or having been a student in a program in which he was faulty, you know what I mean when I speak of his passion. I find myself meeting PAs across the state and once I mention that I went to SJVC, the conversation quickly turns into a discussion about how Les Howard positively influenced their lives and their career. This article, at least initially in my mind, was going to be an Continued on page 9
Inside This Issue CAPA/OSHPD Workforce Survey Results...................... 2 Eric Glassman Honored with the Quinnipiac University Alumni of the Year Award........................... 2 Heard Any Great Speakers Lately? ............................. 2 Inspiration and Advocacy............................................ 3 Important Information for Patients and PAs................. 4 Someone Asked…..................................................... 5 Help Me, Help You...................................................... 6 Interprofessional Collaborative Practice: Enhancing the Practice of PAs and Pharmacists............. 7 CAPA Leadership – An Opportunity to Serve. An Opportunity To Grow................................................... 8 Changes Coming to Health Care in 2014......................10
In 2013 CAPA Sponsored and Successfully Passed Two Legislative Proposals.......................................... 11 What I Know For Sure............................................... 11 Public Health Conundrum: E-Cigarettes...................... 12 Educating the World About Our Wonderful Profession:.. 13 PAs Trending............................................................. 14 CAPA’s 37th Annual Conference................................. 15 2013 CAPA Conference In Palm Springs..................... 16 CAPA and DOJ Collaborate Over CURES Signups!........ 18 USC Wins CAPA’s 2013 Student Challenge Bowl.......... 19 American PA Idol All-Stars – What A Show!!.............. 19 Chronic Pain Management in the Homeless Population.... 20 What Are You Doing to Help the PA Profession?......... 21
Why Be a Clinical Preceptor?..................................... 22 Time to Raise Awareness of Metastatic Breast Cancer.... 24 SJVC PA Student Society Honors Veterans................... 25 Controlled Substances Education Course..................... 26 PA Programs Host 2013 CAPA Controlled Substances Education Courses.................................... 26 CAPA at Napa........................................................... 27 Preparing for Change Can Lower Your Exposure to Risk... 28 Thank You 2013 Student Ambassadors...................... 29 CAPA Student Scholarships........................................ 29 PA School Tips........................................................... 30 Welcome New Members............................................ 31 Local Groups............................................................ 31 NOVEMBER/DECEMBER 2013
SB 1301 - Important Information for Patients and PAs
ew Senate Bill 1301 allows a pharmacist to dispense up to a 90-day supply of a drug, other than a controlled substance or psychotropic medication, to a patient with a valid prescription.
To view a copy of the bill, please visit: http://tinyurl.com/c8t6hwv
“A single chain drug store makes about 4.5 million calls a month to obtain authorization
to dispense more than a 30-day supply of a
drug.* Now with SB 1301, some of these calls may not be necessary.” Before Senate Bill 1301 went into effect on January 1, 2013, this option was encouraged through mail-order pharmacies. Now patients may enjoy the convenience of a 90-day prescription supply directly from their local pharmacy. In order to dispense a 90-day supply: • The patient must have completed an initial 30-day
Co-pay savings for your patients (where coverage permits)
prescription to ensure safety and tolerability Total amount prescribed must be at least 90-day supply The prescriber must not have specified a certain prescribing method as medically necessary The pharmacist must notify the prescriber of the change in quantity dispensed
The benefits of Senate Bill 1301 include: • Freedom to provide medications in amounts that are most convenient for patients • Fewer trips to the pharmacy for refill prescriptions, which may help patients better adhere to their treatment regimen
References: 1. Official California legislative information. Hearing date: April 23, 2012. Bill analysis. Bill No. SB 1301. http://www.leginfo.ca.gov/pub/1112/bill/sen/sb_1301-1350/sb_1301_ cfa_20120419_160011_sen_comm. html. Accessed March 20, 2013. 2. Taitel M, Fensterheim L, Kirkham H, Sekula R, Duncan I. Medication days’ supply, adherence, wastage, and cost among chronic patients in Medicaid. Medicare Medicaid Res Rev. 2012;2(3):E1-E13. doi: http:// dx.doi.org/10.5600/mmrr.002.03. a04. *According to the National Association of Chain Drug Stores (NACDS), Walgreens makes 4.5 million authorization calls of this sort each month.
2013 – Two Huge Legislative Victories for California PAs Continued from page 1
SB 494 is the perfect example of how CAPA has positioned itself to respond accordingly. The concept for this bill evolved after a coalition meeting in which it was discovered that PAs were specifically not named as primary care providers due to “inability to have a panel.” Within seconds of leaving the meeting, phones started ringing, texts started flying and emails were being sent. CAPA’s Executive Committee convened a conference call within a few short days, we engaged with AAPA on national policy issues related 4
to provider status and paneling, consulted with our legal counsel and began looking at the possibly of a legislative fix to ensure PAs could have primary care provider status. The Executive Committee recognized the importance of this issue brought it to the Board and the green light was given. All of that happened in just a few short weeks prior to the legislative language introduction deadline! The team-based work began. CAPA’s legal counsel, Mike Scarano, drafted language for the policy and legislative staff to begin working on both bills.
Every staff person at CAPA had a hand in achieving success as there were many hours of conference calls, organizing letters, drafting and redrafting amendments, research, responding to late opposition and meetings. ABOVE ALL, our ultimate success was because of all of you…CAPA MEMBERS! It was your letters, your voice and your dedication that allowed CAPA TO ACHIEVE SUCCESS! It was an amazing legislative session and your pride in your profession has shone through thousands of letters to the legislature and Governor.
Someone Asked… by Bob Miller, PA, Professional Practice Committee Chair
his column is to briefly discuss some FAQs coming in to the CAPA office. Hopefully others will find this information useful.
heard Medicare has added Q. Irestrictions making it difficult for a PA to facilitate a hospital admission? Can you explain?
published a A. Medicare Final Rule on August 19,
2013. The Final Rule went into implementation on October 1, 2013. The language as it was implemented “There is a new would have made it nearly requirement for impossible for a PA to admit a patient interstate (not intrastate) to the hospital (or to facilitate drivers to obtain their an admission in CA) without the physical examination physician being present. One of the from a provider who is a major problems in this new Rule is the certified and registered requirement to have a physician signed medical examiner (ME).” certification for the admission. The uproar was significant and resulted in talks with Medicare to try to fix this problem. Michael Powe, at AAPA, reports that Medicare did not intend to cause this significant barrier to efficiency when a hospital admission is required. Their intention was to document that inpatient hospital services were indeed reasonable and necessary. A five page Medicare directive was issued on September 5, 2013 titled: Hospital Admission Order and Certification (put the title and date into your search engine and you will have the directive).
A physician signed “certification” for the “hospital stay” will still be required to document the necessity for inpatient services but some questions remain. Will the certification be tied to the discharge summary? Will it need to be signed within 30 days? Will the certification signature need to be in person or electronic? Talks are ongoing regarding these issues at the national level.
What’s happening with Medicare and DME? Wait a minute – this was covered in the last issue of CAPA News. What’s up?
Since last writing something A. changed with this requirement
for a physician signature for certain DME – the date – again. It was determined that more time was needed to fully implement the new certification signature requirement. A new enforcement date will be announced during 2014. Until recently, PAs could order DME for Medicare beneficiaries as needed - without a physician co-signature. However, there is a new Medicare rule pertaining to certain expensive DME and a new requirement for a physician documented face-to-face visit. As explained in an article in Medicare Learning Network publication “MLN Matters” MM8304 (revised on June 28, 2013), the face-to-face “encounter must occur within the 6 months before the order is written for the DME.” The visit may be conducted by a physician, PA, NP or CNS, but the documentation in the medical record must be signed (or co-signed) by the physician.
although CMS had allowed a delay until October 1, 2013 (but a new postponement will be announced during 2014) after which, all are expected to be in compliance. AAPA has had input to reduce this added layer of administrative burden and according to Michael Powe, Sr. VP of Reimbursement and Professional Advocacy at AAPA, discussions are ongoing. Do I need to be certified to do Q. physical exams for commercial drivers now?
There is a new requirement for A. interstate (not intrastate) drivers to obtain their physical examination from a provider who is a certified and registered medical examiner (ME). The new regulations took effect on May 21, 2012 but enforcement will begin May 21, 2014. The National Transportation and Safety Board (NTSB) had concluded that improper medical certification has contributed to crashes.
The Federal Motor Carrier Safety Administration has established the National Registry of Certified Medical Examiners (NRCME). Applicants to become a Medical Examiner (ME) must register with the NRCME, complete the required training and the ME Certification Test. There is required refresher training every five years and retesting every 10 years. There are also administrative and record keeping requirements.
This new rule is a result of Section 6407 of the Affordable Care Act and goes into effect on July 1, 2013 NOVEMBER/DECEMBER 2013
Help Me, Help You by Sonny Cline, PA-C, MA, M.Div, Political Action Committee Chair Patient: “I’m still hurting, why am I not getting any better.” Provider: “Well John, did you do those back exercises we talked about or go to physical therapy? Have you been taking the medications I prescribed?” Patient: “No I haven’t had time to do all that and that medicine didn’t do anything.” Provider: “How long did you take it?” Patient: “2 days.” How many times have we been through conversations like this and experienced frustrations as the patient has not followed our medical advice and now is no better or worse than they were when we first saw them. It seems silly doesn’t it that someone would take off work, spend time and money to see you, ask your opinion then ignore your advice, only to feel much worse and see no real change in their life. Let’s be honest, we are not giving this advice randomly, we all went to
you and what you do? Like the patient I mentioned previously, would you prefer to continue to have back pain and gripe about how things aren’t any better?
school, studied like crazy, crammed tons of information in our heads and on top of it all, most of us have acquired extensive experience in treating illness, which is worth gold when it comes to diagnosis and treatment.
I think not! We are moving forward in health care. We are now being included more often than not in conversations at both the state level and the national level when it comes to health care policy. We are practicing good medicine and people are hearing about it. Let’s keep that momentum going. Let’s set the bar high and have the goal of finally putting to rest that age-old question: “What’s a PA?” and instead make it common knowledge not only who we are but what a great job we do making health care accessible for everyone.
I have been and probably always will be mystified by this phenomenon of people ignoring advice that is completely and only for their benefit. Which is why, of course, I am equally mystified when people don’t give to the CAPA Political Action Committee (PAC). I mean, this is an organization that’s sole purpose is to educate legislatures on what PAs do in medical practice, what we are capable of doing in the future health care system and ensuring the long term success of PAs practicing in the state of California. Yes, we use your money for one purpose, to run around the capitol telling everyone who will listen, how great you are and all the wonderful things you do for health care in the state of California. Help me understand, would you rather we not tell them? Would you rather us be silent when people give misinformation about
Don’t be that hard-headed patient, give to the CAPA PAC today, every dollar you give counts to make your future a good one. Thanks for all you do, Sonny
Yes, I Want to Do My Part for the PA Profession in California (Donate online at www.capanet.org or mail this form to the CAPA office.) Name____________________________________________________________________________________________________
$25.00 $50.00 $100.00 $200.00 $____________
Address ________________________________________City___________________________ State______ Zip_______________ Phone _______________________________________ Email ______________________________________________________ Amount of cash/check/credit card donation: $_______________________
If donation is $100 or more, please list employer_________________________________________________________________________________________ Please make checks payable to CAPA PAC. You may also pay by credit card. All contributions are voluntary. PAC ID # 981553
Interprofessional Collaborative Practice: Enhancing the Practice of PAs and Pharmacists by Ana Maldonado, MPH, DHSc, PA-C, Director-At-Large
he current health care reform efforts in the United States (US) have provided the country with a template to share a common vision, to communicate goals and to set priorities for a more efficient, effective and inclusive health care system for all Americans. The trend in medical education for physicians, physician assistants, pharmacists and other non-physician providers is to bridge “One of the basic the educational and professional chasms tenets of the goal that isolate health care professionals, of interprofessional often resulting learning and practice in compromised continuity and is to focus on preparing quality of care for patients. all health professions,
students and providers to deliberatively work together with the common goal of creating and building a safer, better, patient community and population-centered US health care system.”
In the United States, the divisive battles between health care disciplines and the lack of understanding of the scope of practice of the members of the health care team have contributed, at times, to compromised patient care, resulting in poor outcomes and increased health care costs. Focused analysis and reporting of this dilemma has led to a shift in administrative, legislative and funding priorities in support of multidisciplinary health care teams. Previously, some of the proposed measures to reduce health care distribution disparity and to increase continuity of care have not included the practice’s physician assistants and
pharmacists. This exclusion has been characterized, at times, as a lack of respect for the capabilities and value of physician assistants and other nonphysician providers in practice. Through the consorted efforts of the Institute of Medicine, Accreditation Council of Graduate Medical Education, the Interprofessional Education Collaborative and reports from their expert panels published in 2003, 2010, and 2011 respectively, established core competencies for interprofessional collaborative medical practices to be developed. The principle component of these reports was to define the difference between teamwork and teambased care as an essential aspect of an interprofessional collaborative practice. One of the basic tenets of the goal of interprofessional learning and practice is to focus on preparing all health professions, students and providers to deliberatively work together with the common goal of creating and building a safer, better, patient community and populationcentered US health care system. With the recent passage of Senate Bill 494, the inclusion of the physician assistant as a viable primary care provider within the health care team has expanded the potential for serving larger populations within California managed care systems. This legislation establishes the foundation for the expansion of medical services throughout the state, delivered with the team-based model.
supervision enhances the delivery and continuity of care for patients. Other recent legislation that expands the provider-base of collaborative health care delivery is the Senate Bill 493, which expands the scope of practice for California pharmacists. This bill authorizes a pharmacist to administer drugs and biological products ordered by a prescriber. Additionally, the bill authorizes pharmacists to order and interpret tests for the purpose of monitoring and managing the efficacy and toxicity of drug therapies and to independently initiate and administer routine vaccinations. It also creates the position of the advanced practice pharmacist which allows a pharmacist to perform patient assessments and certain other functions as specified. The expansion of the roles of nonphysician providers within the US health care system demonstrates the national and state commitment to increase access to care. The current trend for expansion of health care providers’ roles and responsibilities is not to erode the role of other primary providers, the intent is to expand integrated care to individuals and communities. Let us look to the future of health care delivery with the anticipation of providing a patient-centered care system delivered by providers prepared to administer care effectively and collaboratively.
The passage of Senate Bill 352 allows for physician assistants to supervise medical assistants in private and non-community clinic practices that were not previously authorized. This expansion of the scope of NOVEMBER/DECEMBER 2013
CAPA Leadership – An Opportunity to Serve. An Opportunity To Grow. by Kevin Robertson, MS, PA-C, Director-At-Large
s of this writing, I have been on the CAPA Board of Directors for a little over five months. For many years I have been a CAPA member and have attended most CAPA Conferences. My experiences at the Conferences as well as my admiration for the incredible work CAPA has done always had me thinking I wanted to get involved and give back in some way. I had shared my interest with friends and colleagues over the years, but found that the timing just wasn’t right for me to actually get involved as either a committee member, committee chair or elected leader. That all changed in 2013. My life circumstances made it the right time for me. Was it the right time for CAPA? Were my interests, talents and skills in line with CAPA’s short and long term goals? I decided to find out. My friend and former classmate, Eric Glassman, PA-C had just finished a two-year term as CAPA President
so I started with Eric. He shared a bit about CAPA’s current goals and legislative agenda. He also invited me to apply to be on the Continuing Medical Education Committee of which he was the Chair. The board approved my appointment to the CME Committee at their November 2012 meeting. After serving as a committee member for a short time, I was further encouraged to talk to the Nominating Committee Chair and President, Adam Marks, PA-C. Eric also suggested that I talk with CAPA Executive Director, Gaye Breyman, CAE. I connected with both. Gaye has been doing this a long time and has seen over 350 PAs come through leadership positions in CAPA. Gaye and Adam spent quite a bit of time on the phone with me and we also talked at length at the CAPA at Napa conference in February 2013. Both Gaye and Adam helped me to understand the various board positions and the time commitment. And, those conversations made it crystal clear
CAPA Leadership Opportunities Elections for the 2014-2015 CAPA Board of Directors and for Delegates to the AAPA House of Delegates in San Francisco in 2015 will be held in the Spring. If you are interested in running for office, please contact CAPA President Elect and Nominating Committee Chair, Jeremy Adler, MS, PA-C at firstname.lastname@example.org to learn more about CAPA leadership and where your experience and skills are most needed. Important Deadlines: Deadline for the CAPA office to receive Candidate Data Form for those who wish to be reviewed/endorsed by the Nominating Committee: March 3, 2014 Deadline for the CAPA office to receive Candidate Data Form for those who do not wish to go through the Nominating Committee: February 14, 2014
that these were encouraging and passionate people who are part of a high-functioning and passionate team. The leaders and staff work hard and they enjoy their work and have fun along the way. Having been through the interview and vetting process and serving briefly on the CME Committee, I had even more respect and admiration for CAPA. It is clear why California PAs are so well regarded and represented. An organization is only as good as its leaders and you are incredibly well represented – if I may say so myself! Now serving as a Director-At-Large, I am learning a great deal from the seasoned leaders on the board and from our Executive and Public Policy Directors. Their dedication and commitment to excellence is to be admired for sure. CAPA’s Executive Committee is awesome. It is a pleasure to serve with these PAs. I got involved to give back and find that while doing that, I am learning a great deal and experiencing a team environment that is gratifying and exciting. If you are interested in becoming more involved with CAPA, I encourage you to get in touch with President Elect, Jeremy Adler, PAC. He is the current Nominating Committee Chair. You may know Jeremy if you have taken CAPA’s Controlled Substances Education Course. He is an instructor and the coordinator for the courses. He also was the Founder and President of the San Diego Local Group for many years. He begins his term as CAPA President on July 1, 2013 and is incredibly well qualified to lead CAPA. His experience, style
and commitment to CAPA and California PAs will serve us well. CAPA’s future is bright because of the team of leaders and staff we have in place. New leaders are always sought after and if you have an interest in learning more about how you can help, please contact Jeremy Adler at email@example.com.
is apportioned based on the number of AAPA members in California in a specific year. California is usually apportioned six to eight delegates. Their role is to represent AAPA members in California at the AAPA House of Delegates held in conjunction with the AAPA Conference each year.
It should be noted that there is NO requirement in length of practice before becoming involved in CAPA. One can start immediately upon graduation; in fact, there are many roles for involvement as a PA student.
Committee Service There are various committee opportunities for PAs to become involved in CAPA leadership, affording an outlet for strengths or interests in service one may have. This is often a great stepping-stone toward the Board of Directors or House of Delegate positions, or simply a way to fulfill an interest in helping your professional peers to support PAs in California. You can learn about CAPA and CAPA can learn about your strengths and interests. Various committees allow those with particular social or professional interests to get involved and help steer the direction of our envied organization. These committees include: Student Affairs, Public Education, Continuing Medical Education, Professional Practice and the Committee on Diversity.
There is a distinction between the CAPA Board of Directors, Committees, and Delegates to the American Academy of Physician Assistants’ House of Delegates. CAPA Board of Directors The board is comprised of 10 positions: Typically there is a President, President Elect, VicePresident, Secretary, and Treasurer, three to five Directors-At-Large and a Student Representative. AAPA House of Delegates The numbers of delegates vary and
As I praise the Academy and its leadership structure, I have to include the CAPA Staff. They are integral in tirelessly running and implementing the business of the “I got involved to give organization. They are among the best back and find that and they make sure that leadership has while doing that, I am the human resources to carry out their responsibilities, among learning a great deal many other vital and experiencing a team functions of CAPA. They consistently environment that is work to make the organization and its gratifying and exciting. ” leaders shine. I hope you can tell that I am very happy serving California’s PAs through leadership in CAPA. I encourage any California PA interested in more involvement in their profession to learn more about CAPA and see if CAPA leadership is a good fit. It’s a great way to learn about every aspect of our profession, and to meet some fun, friendly and driven PAs.
Inspiration and Advocacy Continued from page 3
informational blurb on the NHSC Loan Repayment Program. It is instead what I think is a more important message: Be passionate. Find a purpose and use your experience to help influence others. Look at what drives you. What is your passion? Once identified, I
encourage you to be an advocate for that cause; take time out of your schedule to share the message with colleagues, inspire the next generation of PAs or join a larger group of professionals (CAPA, for example!) with the same passion. It is through advocacy that issues are moved forward and by spreading the message, you will create a trickle-down effect
to those who you inspire with your message. My mentor, Les Howard’s legacy will be/is the hundreds of PA students (disciples!) who have not only been well educated, but empowered by his passion, love of the profession and PA education. Thank you, Les.
Changes Coming to Health Care in 2014 New Improvements in the Health Insurance Market The Patient Protection and Affordable Care Act (Affordable Care Act) is the federal law passed in 2010 that provides affordable health insurance to more Americans. The historic law will change the way health insurance companies provide coverage, as well as the way patients get coverage. This fact sheet describes a few of the changes happening in health insurance. Important Changes for Patients More Health Insurance Options. The Affordable Care Act establishes state marketplaces, where individuals and small businesses can shop for health insurance on the Internet, in person or by phone. These marketplaces will help make health insurance much more reasonably priced and easier to get. California’s marketplace, named Covered California™, will offer millions of Californians a variety of health insurance plans available for purchase. Affordable Coverage and Financial Assistance. Covered California will help individuals and families determine whether they may get federal financial assistance that will cut the cost of health insurance or whether they qualify for free health insurance through Medi-Cal. Many small businesses also will be able to provide employee health insurance, using federal tax credits to reduce premium costs. 10
Protections for Patients. All health insurance plans (not counting most plans sold before March 10, 2010) must provide health insurance for individuals and their families even if someone has a health condition such as diabetes or asthma. That health insurance cannot be dropped if someone gets sick. Patients also cannot be denied a health insurance plan if they make an honest mistake when filling out the application. Increased Coverage. The Affordable Care Act strengthens Medicare, Medicaid (Medi-Cal in California) and other very important programs for millions. In addition, those who have not yet turned 26 and whose parents have health insurance can now be included in their parents’ health insurance plan. Fines for No Coverage. Starting in January 2014, most adults will be required to have public — such as Medi-Cal or Medicare — or or private health insurance or pay a fine. The fine becomes more costly over a three-year period. In 2014, the fine will be 1 percent of yearly income or $95 per person, whichever is greater. For adults with children, the fine for lack of coverage for the child is $47.50. By 2016, the fine will be 2.5 percent of income or $695 for an individual, $2,085 for a family, whichever is greater. What Businesses Will Need to Do. Employers with 50 or more full-time employees that do not offer health insurance that employees can afford, or that offer a health insurance plan that does not meet certain requirements, may receive a fine starting in 2015. Under the Affordable Care Act, all health insurance plans must follow certain rules.
Rate Increases. Health insurance companies must give a reason for any increase in premiums. Insurance companies must spend 80 percent of the money they receive from premiums on delivering quality health care, not on costs such as salaries and advertising. No Limits to Health Care an Individual Receives in His or Her Lifetime. Health insurance companies cannot set a dollar amount limit for key health benefits during a person’s lifetime. Preventive Care. All new health insurance plans must cover preventive care and medical screenings, like mammograms and colonoscopies, as well as women’s services such as breastfeeding support, contraception and domestic violence screening. Health insurance companies cannot charge copayments, coinsurance or deductibles for such services. Essential Health Benefits. Newly sold health insurance plans must cover services that fall into these 10 categories of essential health benefits: ambulatory patient care emergency services hospitalization maternity and newborn care mental health and substance abuse disorder treatment prescription drugs rehabilitation and habilitation services and devices lab services preventive and wellness services and chronic disease support Continued on page 13
In 2013 CAPA Sponsored and Successfully Passed Two Legislative Proposals
T CAPA Public Policy Director, Teresa Anderson, MPH
Bill Barcellona, CAPG Senior Vice President for Government Affairs
his was a team effort and what a team we are! Thank you, CAPA members. Your CAPA membership dues allow us the resources to take on legislative proposals on your behalf. Our membership numbers allow us to stand shoulder to shoulder with other health care providers who are also committed to advancing their respective professions. Your response to Action Alerts and request for letters, made all the difference. At the CAPA Conference we had just learned that the Governor signed SB 352 – Medical Assistant Supervision. It was a wonderful celebration and we had our fingers crossed that SB 494 – Health Care Providers would soon be signed. Sponsoring two big proposals on behalf of California PAs was ambitious
but we felt confident that with our current Legislative TEAM we could do it! We had tried to pass a bill to allow PAs to supervise MAs twice in the last 10 years. We knew that with the team we had in place, the bill would make it this time. Teresa Anderson, MPH, Public Policy Director Receives Award in Palm Springs Teresa lives and breathes CAPA and PAs. She has spent the past year working on SB 352 and SB 494 along with the rest of the “CAPA Team.” We could not have a better advocate in Sacramento working full time to represent California PAs. She is admired and sometimes a little bit feared. Over the past year, a new term was coined in Sacramento: “Teresa time.” Stakeholders know that their next move just might prompt some “Teresa time” and depending on what side of the issue you are on, that could be really pleasant or not so much! When you have the opportunity to meet her, treat yourself to some “Teresa time” and let her know you appreciate her hard work.
Bill Barcellona, Senior Vice President for Government Affairs Recognized at the CAPA Conference CAPA is very grateful for the support, dedication and time Bill Barcellona, Senior Vice President for Government Affairs for California Association of Physician Groups (CAPG), committed to us in our legislative efforts this year. CAPG co-sponsored both SB 352 and SB 494 and Bill spent many hours talking about and walking us through the exciting world of KnoxKeene regulations. Bill’s extensive knowledge of the Knox-Keene Act comes from his years as Deputy Director for Plan-Provider Relations at the Department of Managed Health Care. His expertise in health care law and managed care was invaluable to us in achieving our success. He is a tremendous advocate and put a great deal of effort into promoting the merits of our bills and PAs.
What I Know For Sure by Gaye Breyman, CAE, Executive Director
he other day on the home page of my computer, I saw a posting with something Oprah Winfrey wrote. The title was “What I Know For Sure.” I know from watching my share of Oprah over the years, this was a question she often asked people she interviewed: What Do You Know For Sure? As we reach the end of 2013, one of CAPA’s most successful years EVER, I had to share a few things I Know For Sure. All of these things
contributed to our success over the past year. All make me proud to be CAPA’s Executive Director. •
CAPA is admired and respected by the leaders of other groups/associations/ agencies in the state. These relationships have taken years to progress to where we are today. The consistency in our commitment to team practice and the collegial and collaborative approach we
embrace has built trust and respect with our colleagues. That is priceless. •
Your CAPA membership dues are a bargain .
The team of PA leaders in place now are among the best we have ever had. Arguably the best ever assembled at one time.
Our long time Legal Counsel, Mike Scarano has our trust, Continued on page 20
Public Health Conundrum: E-Cigarettes by Joy Dugan, MSPH, PA-C, Secretary
recently walked into an exam room and noticed my patient had what appeared to be a cigarette in her mouth. She explained that she was smoking an electronic cigarette or “e-cigarette.” In recent months, numerous patients have inquired about my opinion on the health effects of e-cigarettes. E-cigarettes are battery-operated devices that mimic traditional tobacco cigarettes. Designed to look and feel like real cigarettes, e-cigarettes contain a LED light that shines when somebody “puffs” (or “vapes”) on the e-cigarette. They utilize rechargeable lithium batteries and a “cartomizer” (cartridge vaporizer) that is filled with liquid (commonly called “juice” or “e-liquid”) typically consisting of propylene glycol, nicotine, flavoring, and additives. Currently, the full public health implications of e-cigarettes are unknown. Few randomized studies exist utilizing e-cigarettes. As the benefits and risks are studied, e-cigarettes are subject to pending legislation and medical debates. In California, e-cigarettes are sold at gas stations, grocery stores, tobacco shops and other locations where cigarettes are typically sold. California law prohibits the sale of e-cigarettes to minors (California Health and Safety Code § 119405). California State Senate Bill 648, authored by State Senator Ellen Corbett (D-East Bay), proposed to classify e-cigarettes as a Tobacco Product in order to ban their use wherever smoking is banned. The ban included school campuses, public buildings, daycare facilities, workplaces, health care facilities, and retail food facilities. SB 648 was shelved for the remainder of the session in August 2013.
On the national level, in 2011, a federal court case gave the FDA authority to regulate e-cigarettes under existing tobacco laws instead of medication. The FDA set the deadline of October 31, 2013 to issue proposals to regulate e-cigarettes (Shan, 2013). International precedence was set on October 8, 2013, when the European Union determined that e-cigarettes would not be regulated like pharmaceuticals but will establish a minimum purchase age and advertisementcontrol. Opponents to e-cigarettes believe they are a “gate-way” for minors to use other tobacco products. In 2009, the FDA banned fruit and candyflavored cigarettes because of their disproportionate use among teens. However, this rule does not apply to e-cigarettes, which are available in multiple colors and appealing flavors like bubble gum, mint, and cherry. According to the CDC (2013), use of e-cigarettes among American middle and high school students doubled from 2011-2012. In 2011, 4.7 percent of high school students reported using e-cigarettes, which increased in 2012 to 10 percent. Proponents for the use of e-cigarettes cite that they may be safer than tobacco cigarettes and can be utilized as another option for smoking cessation. Bullen, et al. (2013) are currently conducting research to evaluate the effectiveness of e-cigarettes versus nicotine patches for cessation in Australia. This will be the first study of this scale studying e-cigarettes as a possible smoking cessation aid. As a physician assistant, I will now inquire about e-cigarette use with patients, especially adolescents, when taking a social history. Until
more research is performed on the long-term use of e-cigarettes, I will continue to remind my patients that nicotine can increase the risk of cardiovascular disease (Giardina, 2013) and is best avoided for longterm use. References
Bullen, C., Williman, J., Howe, C., Laugesen, M., McRobbie, H., Parag, V., & Walker, N. (2013). Study protocol for a randomized controlled trial of electronic cigarettes versus nicotine patch for smoking cessation. BMC Public Health. (11)786. doi: 10.1186/14712458-13-210. Center for Disease Control (2013). E-Cigarette use more than doubles among U.S. middle and high school students from 2011-2012. Retrieved from: http://www. cdc.gov/media/releases/2013/p0905ecigarette-use.html. Electronic cigarettes: restriction of use and advertising, California State Bill-648. (2013). Food and Drug Administration (2009). Candy and Fruit Flavored Cigarettes Now Illegal in United States; Step is First Under New Tobacco Law. Retrieved from: http://www.fda.gov/NewsEvents/ Newsroom/PressAnnouncements/2009/ ucm183211.htm. Giardina, EG. Cardiovascular effects of nicotine. In: UpToDate, Waltham, MA, 2013. Lowell, D. (2013). “Electronic cigarettes: A safe way to light up?” Mayo Clinic. http://www.mayoclinic.com/health/ electronic-cigarettes/AN02025 Shan, L. (2013, Sept 24). FDA should regulate e-cigarettes 40 state attorney generals say. Los Angeles Times. Retrieved from: http://www.latimes.com/business/ money/la-fi-mo-electronic-cigaretteattorney-general-20130924,0,4358504. story
Educating the World About Our Wonderful Profession: An Ongoing Mission Saloni A. Swarup, PA, Public Education Committee Chair
ello CAPA members! I would like to take this opportunity to introduce myself. My name is Saloni A. Swarup and I am your Public Education Committee Chair. After serving as CAPA’s Student Representative for the 2012-13 year, I am thrilled to partake in the mission to continue educating the world about our profession. Despite the strides that have been made within the PA profession, our career continues to be a newer and unknown profession. When asked what I do for a living, I still find myself explaining to various people on a daily basis what a PA is and what a PA does. As a result of this, our uninformed patients tend to look at us with skepticism and question whether receiving care from a PA would be equivalent to care received from a doctor. How do we answer this unasked question we know is present in our patient’s mind? Do we address it directly in dialogue, or do we let our actions speak louder than our words? This year at CAPA’s Palm Springs conference, “PAs Trending” was our tag line. I believe this phrase epitomizes how far we have come but also what we as PAs need to do to promote our profession. I believe that each and every practicing PA in the USA is an educator and facilitator of our profession. The information lies within each one of us, tools and ideas to help our profession grow and provide the ever-growing patient population with optimum health care and patient care promoting holistic healing of our patients in their individual worlds. So the question is, “What can I do to achieve these aforementioned goals?”
“So, what is a PA exactly?” We must learn to never get fed up with this question and answer it with the same enthusiasm as we answered questions at our PA school interview. Give the person asking this question as many details as they desire to create a mutual and educational conversation. 1. If you teach at a university that has an undergraduate program, create mini-lectures that introduce upcoming health care professionals about the PA profession and what the profession entails. 2. Educate yourself on the history of the PA profession and how it came into existence.
3. Keep yourself abreast of the new legislative bills that have been sponsored by CAPA and AAPA and support these bills and rejoice in our profession’s progress. 4. Create shadowing opportunities at your practice for PA students to expose patients the profession and our practice of holistic health care. By implementing these basic steps into our daily agenda, we can propel our profession forward and continue to provide our patients with exemplary health care and holistic healing.
Changes Coming to Health Care in 2014 Continued from page 10
children’s services, including dental and vision care New Tools to Choose. Covered California insurance plans will be grouped by cost and value, using consistent information so that Californians can make apples-toapples comparisons among plans, see expected costs more easily and get the coverage they need. There will be four basic levels of coverage: Platinum, Gold, Silver and Bronze. As the coverage increases, so does the monthly premium payment, but the cost when a person receives medical care is usually lower. Californians can choose to pay a higher monthly cost so that when they need medical care, they pay
less. Or they can choose to pay a lower monthly cost, which means that when they need medical care, they pay more. Each person has the choice. Families can also seek insurance through Medi-Cal. For more information, visit www. CoveredCA.com or call (800) 3001506. CoveredCA.com Covered California is the new online “marketplace” that will make it simple and affordable to purchase quality health insurance and get financial assistance to help pay for it. If your income is limited, you may be eligible for free coverage through Medi-Cal.
g in d n 2
P 0 A 13 s T r e
PAs Trending…After Almost 50 years of Hard Work and Thousands of Important Milestones, It Seems PAs Are an Overnight Success!! At the CAPA Conference, We Celebrated Our Acclaim! by Gaye Breyman, CAE, Executive Director
hank you to the hundreds of PAs who submitted your TRENDING PHOTO for this year’s CAPA Conference. What a wonderful showing of so many facets of life as a PA. The photos shown here are a very small sampling of all we received. There were many wedding, engagement, graduation, travel and new baby photos. Such warm and heartfelt captions came along with them. What a great way to start each of the meal events at the CAPA Conference, watching the photos of your colleagues’ “life events” unfold on the large screens. It was fun to watch people as they saw each photo, read the short captions and “caught up” on what was happening in the lives of their colleagues. We also had a lot of photos of PAs involved in various athletic activities. You guys are fantastic. From marathons to cross country skiing to cycling to climbing Mt. Kilimanjaro! Inspiring stuff! Photos of important family time were also very popular (and got a lot of oohs and ahhs!). Important professional milestones were also prominent (and exciting!). You were very creative and again, the captions really brought it all together. The CAPA Conference is always special, but this year’s TRENDING PHOTOS were filled with images and words which warmed our hearts and started meals with special moments shared among friends. You each bring something special every time you attend a CAPA event. Thank you for your continued willingness to go that extra step pre-conference to make the CAPA Conference a “PA happening.”
14 | CAPA’S 37TH ANNUAL CONFERENCE
For Your Generous Support of the Cyber Café and Ice Cream Breaks at the 2013 CAPA Conference
13 r 0 T 2 As
2013 CAPA CONFERENCE
n d in g
CAPA’s 37th Annual Conference – Good Times, Great Speakers by Eric Glassman, MHS, PA-C, CME Committee Chair
or those of you that attended CAPA’s 37th Annual Conference in Palm Springs, you will know exactly what I am writing about and I hope you agree. For those of you unable to attend for whatever reason, please consider joining in the learning and fun with us next year. After a year long process of planning this 4-day conference, all I can say is I am very proud to be a part of the planning of such an amazing conference with such great PAs as attendees. I’ve been to several other state conferences and this is, by far, the best I have seen. Palm Springs is CAPA’s, and hopefully all of yours, “second home” for the first week in October. We were back at the beautiful Renaissance Palm Springs and had absolutely perfect weather for everyone to enjoy. Many of you know Mark “the Bellman” who greets all of us as we enter the hotel. This year, we had a special presentation and award for him. I have personally known Mark for 11 years now and it was a great moment to see him recognized for all that he does for us. This year’s conference was well attended and I’d like to thank all those who attended and enjoyed the program and events. We had another all-star line up of speakers from some of the top physicians and PAs in their respective specialties. Some of the lectures were standing room only as the popularity of some speakers grows year after year. With your great feedback every year, we make sure to bring back the best speakers. Our Conference Planning Committee (CPC) reaches out to find new speakers every year as well. A special thanks to this year’s
CPC who helped create another stellar lineup of topics as well as speakers. In addition to the CME hours, we hope you all enjoyed the other activities planned for you this year. The Student Medical Challenge Bowl was the best that I can remember. The competition went into double overtime sudden death. USC beat Stanford in a nailbiter to the very end. We had eight PA programs participate this year. A big “congratulations” to USC who defended its title and keeps the coveted Challenge Bowl trophy for another year. We also had the annual Friday night dance and PArty at the Convention Center along with an All-Star competition of past PA Idol winners. This year, Jamie McCoy, PA-S defended her title and won against some stiff competition. We also had a sold out exhibit hall that was always filled with attendees. Several of the PA programs had alumni receptions that seem to grow
Mark Quesada If you have been to a CAPA Conference at the Renaissance Palm Springs (formerly the Wyndham) you have probably met bellman, Mark Quesada. Mark has been part of the CAPA family for many years, making the PAs who attend the CAPA Conference feel special and welcome. We thought it was time we honored him for his years of exceptional service. Prior to lunch on Friday, October 4th
every year in attendance. Lastly, we had our second year of Scrubs and Slippers for Sunday’s lectures. It’s a nice way to wind down the conference and relax with your favorite pair of scrubs and your most comfortable slippers. Thank you all who participated this year. With all the CME opportunities that exist today we want to thank you again for choosing to come to the CAPA Annual Conference in Palm Springs. If you missed this year, we hope by hearing from your colleagues who attended, seeing the photos in this issue and marking your calendars now for October 16-19, 2014, we will see you next year for another great conference. There is absolutely no other conference like ours. No other conference offers high quality CME along with the special and unique camaraderie of your fellow California PAs and colleagues. See you next year!
at the CAPA Conference, Mark was brought on stage to receive an award which read:
California Academy of Physician Assistants
Mark Quesada For Outstanding Performance In Your Recurring Role as Extreme Ambassador to All Guests at the Renaissance Palm Springs With Love and Appreciation October 4, 2013
Thank you, Mark. We will see you next year at the CAPA Conference, October 16-19, 2014.
PALM SPRINGS, CALIFORNIA | 15
g in d n 2
P 0 A 13 s T r e
2013 CAPA CONFERENCE IN PALM SPRINGS
16 | CAPA’S 37TH ANNUAL CONFERENCE
13 r 0 T 2 As
d in g
PALM SPRINGS, CALIFORNIA | 17
g in d n 2
P 0 A 13 s T r e
CURES AT CAPA
CAPA and Department of Justice Collaborate Over CURES Signups! by Jeremy A. Adler, MS, PA-C, President Elect
DOJ Analyst, Leticia Tanner and CAPA President Elect, Jeremy Adler, PA-C
PAs at the CEP America Cyber Café logging on to the CURES registration site
s the excitement of CAPA’s Annual Conference in Palm Springs settles, it is with great pride that I look back on the success of CAPA’s 2nd CURES at CAPA sign up event. Many of you have taken CAPA’s Controlled Substance Education Course and have heard Dr. Lowe and I encourage PAs to register and routinely use California’s Prescription Drug Monitoring Program called CURES (Controlled Substance Review and Utilization System). We held our first sign up event in 2012 at our Palm Springs’s conference and tried to address one of the key hurdles creating a barrier in registering PAs, specifically the need to have the application notarized. We had two notaries present at the conference last year and successfully had over 200 PAs sign up. This year’s event was even more amazing; the California Department of Justice (DOJ) attended our conference to sign up PAs directly!
18 | CAPA’S 37TH ANNUAL CONFERENCE
The idea developed at the Joint Forum to Promote Appropriate Prescribing and Dispensing conference that occurred in February 2013. The head of the CURES program, Mike Small, presented an update on CURES, and mentioned if an organization could gather at least 20 providers to sign up, he would send a DOJ agent to the event so providers could be signed up on the spot. Although it seemed to me like a long shot, with the funding of CURES in jeopardy, CAPA contacted Mr. Small and found him extremely generous. CAPA was fortunate to have the DOJ send Analyst, Leticia Tanner to our conference this year. I am not sure Ms. Tanner knew how hard she would work. In the back of my mind I was a little worried, with the DOJ attending the conference, I wanted to make sure PAs would sign up and make the DOJ’s efforts worthwhile. Well, the PAs did not let us down. We had a tremendous level of interest, and at times had a line down the hall of PAs waiting to register. We also kept Ms. Tanner constantly busy. She was signing up another PA every 3 minutes the entire time she was there. She was also able to help PAs who had started the registration process prior to the conference take the necessary steps to complete their application. Please thank the DOJ and Ms. Tanner any opportunity you get. On a personal note, I was very proud of our profession. I am a strong advocate for those patients who need access to the full spectrum of treatment for pain available today, but at the same time want to reduce and eliminate the abuse of prescription medications that are threatening our communities. Nationally published guidelines, the White House, the Centers’ for Disease
Control, myself and basically anyone involved in trying to curtail prescription drug abuse recognizes the importance of prescription drug monitoring. Of course, it only works if providers have access to the information and incorporate it into their routine practice. It has been one of my key goals of CAPA’s Controlled Substance Education Course to stress the importance of being registered with CURES and understanding the power of the database. CAPA News has published a series of articles that have discussed ways to search the database which can be found on CAPA’s website. It is my desire that all PAs will be registered with CURES and PAs will be the leaders in providing the highest quality of pain care and at the same time substantially reducing the misuse, abuse and diversion of controlled substances. Seeing all the PAs sign up for CURES at our events is taking huge leaps in reaching this goal. As far as CURES, many PAs have expressed concerns over the sustainability of funding for the program. The future for CURES looks bright with the passage of SB 809 (CURES) which has identified ongoing funding sources to maintain the database and perform upgrades. I am confident that CAPA and the DOJ will continue to partner and improve the care provided in California. CAPA, in addition to thanking Ms. Tanner and the DOJ, would like to thank everyone else in making this event a success, not limited to the staff in the Cyber Café provided by CEP America and the Student Ambassador, Whitney Burnett. If you have not registered, please do so today: https://pmp.doj.ca.gov.
13 r 0 T 2 As
STUDENT CHALLENGE BOWL
n d in g
USC Wins CAPA’s 2013 Student Challenge Bowl in Double Overtime by Anthony Gauthier, PA-C, ATC, Student Challenge Bowl Coordinatior
ear after year CAPA’s Student Challenge Bowl (SCB) is regarded by many as one of the major highlights of the conference weekend. This year’s event delivered a competition so intense; fans spent most of the event out of their seats in excitement as they cheered on their program. If you have yet to attend a SCB, I recommend you make it out to the CAPA Conference to enjoy this event. Students and program alumni enjoy the friendly competition between PA programs, the relaxed atmosphere of being poolside and the provided refreshments. PA programs throughout California participate each year, keeping the tradition alive. This year, the best and brightest from eight California PA programs battled for the coveted SCB trophy and bragging rights of being the 2013 champions. The evening kicked off poolside at the Renaissance Hotel, as the desert sun faded behind the mountains producing a serene backdrop reminding us of why CAPA chooses Palm Springs year after year for its annual conference. To start off the event fellow PA Greg Mennie and his CAPA All-Star Band rocked the hits, bringing the energy level up and getting the crowd ready for a fun, exciting Saturday night in Palm Springs. With the crowd rocking and the energy level high everyone knew it was time to kick off the 2013 SCB. The preliminary rounds were full of close competition as teams battled, answering questions similar to those asked on the PANCE and PANRE. Alumni and students
cheered on their favorite team in hopes of watching them advance to the final round. After three intense rounds of competition USC, Stanford, and San Joaquin Valley College (SJVC) proved to have what it took to make it to the final round. One could not have asked for a more entertaining final round; the three programs squared off - each taking turns having the lead. At the end of the final round, USC and Stanford were tied with SJVC claiming a respectable third place. After a five question overtime round, Stanford and USC were still tied. This led to a final, winner takes all question for the championship. In the end USC reigned victorious, claiming the 2013 championship. Having won last year as well, USC became back-to-back champions. For their efforts the team members of the
American PA Idol All-Stars – What A Show!! This was CAPA’s 10th American PA Idol Competition. Three past winners were available, willing to perform and compete to be CAPA’s All-Star American PA Idol.
top three teams each received an iTunes gift card. Champions USC also received $250 dollars towards their student society, the SCB trophy, and bragging rights for the year. The PArty continued as the band closed out the night playing great music. As fans, program alumni, and teams celebrated the completion of this year’s Student Challenge Bowl. Congratulations to all of the teams that participated. I hope that next year you will be back to keep the tradition alive and cheer your program on.
James Wiley, PA-C and Jamie McCoy, PA-S for putting on a great show in Palm Springs. We invite you to visit You Tube to see each performance at https://youtube.com/user/ CAPAConnection?feature=watch
It was an incredible show! All you would imagine, with three talented PAs who were “in it to win it.” Each performed two songs and the audience text voted to decide who would win. The audience did vote and it was Jamie McCoy, PA-S (Western U) who took home the title of CAPA All-Star American PA Idol. Our special thanks to contestants, Stephanie Rolfo, PA-C,
L to R: James Wiley, PA-C; Jamie McCoy, PA-S and Stephanie Rolfo, PA-C
PALM SPRINGS, CALIFORNIA | 19
Chronic Pain Management in the Homeless Population by Jay Williamson, MS, PA-C, Director-At-Large
ow do we treat patients in the homeless clinics for chronic pain? How do we manage patients with multiple conditions?
case manager, works closely with additional resources, housing, MediCal application assistance, assistance with social security applications.
My clinic serves the homeless of Stanislaus County where we serve a large population of new patients each day. Managing chronic pain, especially in a population where the risk is even higher added with the high risk of using opiates, must be done with caution.
Getting any previous medical records for a patient is a big challenge. Records could be from another state, another county or possibly the department of corrections. These roadblocks take time to break through and often are not very timely.
A personal and clinic guideline for my clinic in central California is to always encourage patients to get Medical Indigent Adult insurance, this is the counties version of insurance for uninsured adults, this gives them added access to hospital visits and to specialist throughout the county. While currently these patients could qualify for the MIA insurance, getting the insurance is difficult for the homeless. An original birth certificate, state ID, social security card and letter from unemployment stating they have no income are needed. Because some of these items cost money, our patients go without and end up at our doorstep. We utilize a case manager to help them with resources to get some of the needed documents. The
For screening purposes, we have inhouse Urine drug screen, (UDS) for all new patients, for follow up visits and just on a random basis. These inhouse screens test for Amphetamines, Barbiturates, Benzodiazepine, Cocaine, Ecstacy (MDMA), Methadone, Methamphetamines, TCA, Opiates (300ng), Oxycontin, PCP, Marijuana We will not ever start prescribing any narcotic pain medications if the person is actively using or buying street drugs. Typically, we screen all patients for other possible disorders, using standardized screening tools such as the PHQ-9, CAGE-7, GAD, and the Bipolar/Mood Disorder questionnaire. Missing the treatment of either depression, MDDD Mood Disorder/ Bipolar or even Schizophrenia can
greatly affect our success in helping patients with their chronic pain. Our patients must attend a group known as the “Change Group.” Examples of patients who would benefit are patients who have: substance abuse or dependence (nicotine, alcohol, illicit substances), compulsive overeating or bulimia, compulsive gambling, obesity, diabetes, anxiety and depression, other chronic illness in which behavior, modification could be helpful. We also require patients to have at least a single visit with a counselor from Behavioral Health. The narcotic and adjunctive therapy regiment for depression most often adequately helps them feel better, and makes the pain tolerable. Close follow up is always used with new patients or when new meds are started. Chronic pain management is increasingly needed in the medical settings, management in the homeless setting brings even more challenges and concerns. By utilizing multiple resources, collaborating with counselors, resource managers and the entire medical staff we are able to safely offer these services to our homeless patients.
What I Know For Sure drafted or touched by Mike in over 25 years. His warmth, his love of the PA profession and his knowledge of PA practice consistently gives California PAs a competitive edge. You want Mike on your team, and he is.
Continued from page 11
our backs and our hearts. He was and is a gift to CAPA and California PAs. A wise man that is also filled with the highest integrity in all he does. There hasn’t been a PA regulation or piece of California PA legislation that hasn’t been looked at, 20
Our financial team; our CPA and his staff and the expert
financial advisors with whom we contract, help us ensure we meet or exceed the financial requirements of California Corporation Code, our bylaws and all other governing documents. Continued on page 23
What Are You Doing to Help the PA Profession? by Cherri Penne-Myers, PA-C, Director-At-Large
re you aware of the many new Physician Assistant programs across the United States that are opening? This year alone there were nine new programs that received their provisional accreditation. Are you aware that there will be two new programs in Orange County, CA hopefully receiving their provisional accreditation between 2014 and 2015? More than ever there is a need for practicing physician assistants to get involved. What can you do? One way is to be a mentor, taking Pre-PAs or students under your wing. Answer their questions, review their essays, help them to prepare for that all-important interview, or if you “Employment of physician know them well and assistants is expected to you have worked with them, write a letter increase 30 % from 2010of recommendation. What about allowing 2020, much faster than the a Pre-PA student to average for all occupations.” shadow you? Yes, we all have hectic schedules during the day but could you give just a couple hours once or twice a week? If your supervising physician and patients are willing, you can let them shadow you a couple of hours. Most of the students I have had come through my office have been part of a Care Extender Program at a local hospital and have shadowed MD/RN/CNAs, but if they are there for over a year they can request to shadow a PA. Most have shadowed more than one PA. A few years ago CAPA developed a Shadowing Protocol that I give to all of my students. (http://www. capanet.org/uploadedFiles/Content/ Students_Pre-PA/CAPA-ShadowingBrochure-Web-Final2.pdf ) Are you aware of CAPA’s Pre-PA membership?
I encourage my Pre-PA students to join CAPA online at: http://capanet. org/Students_Pre-PA.aspx . It is important to realize that times are different than 10 - 20 years ago when we were applying to physician assistant programs. One statistic states that 80% of students in PA schools are now women. The bureau of labor statistics from March 2012 stated, “Employment of physician assistants is expected to increase 30 % from 2010-2020, much faster than the average for all occupations. As more physicians enter specialty areas of medicine there will be a greater need for primary health care providers, such as physician assistants.” AAPA (2012) predicts the number of practicing PAs will increase from 83,466 in 2010 to 128,174 in 2018. Here in California as of 2010 there were 6723 PAs in clinical practice. Today there are over 9,100 practicing PAs. It is already extremely competitive now to get into PA programs. Some students want to know how to acquire all those direct patient care experience hours (1000-2000 hours) that are required by PA programs. Did you know that 1000 hours is just 6 months of full time work? Some schools allow a combination of volunteer hours and work hours to make up the medical hours required. Often times, it may serve the student to get certified as a back office medical assistant or EMT. There are also other employment opportunities as a physical therapy assistant, Scribe, (some schools accept this), athletic trainer, medical technologist, respiratory therapist, occupational therapist, radiology technologist, LVN, RN, paramedic or military medic or corpsman. As for volunteer hours, you can suggest that the Pre-PA work in medical
tents at marathons, triathlons, and Special Olympics. It is important that students show they also are involved in the community by volunteering for programs such as Habitat for Humanity or food banks to name a couple. An important question that is often asked in interviews is “Why do you want to be a PA?” Some may call this an “elevator pitch” which is a 20 to 30 second message of four or five sentences on why you want to be a PA. Remind students and Pre-PAs to know the answer and it should also be worked into their essay. Other questions that may be part of the interview process are “What does it mean to be a PA?”, “How do PAs fit into the health care system?”, and “Why do you want to go to school at __________ program?” These are just a few of the concerns of Pre-PA students have come through my office. This year two of my past Pre-PAs were accepted into programs and are in training now. I wrote three letters of recommendation for 2014 programs. I have high hopes all three will be accepted in programs. Yes, it takes time working with the Pre-PA students, but it is well worth the effort. Please, if you are not already involved in mentoring or allowing students to shadow you, reconsider and take a Pre-PA on. Remind them that they must “pay it forward” once they become a physician assistant. What are you doing for the profession? Future PAs need us. Thank you to all the physician assistants that are out there assisting Pre-PA students now.
Why Be a Clinical Preceptor? by Christy Eskes, DHSc, MPA, PA-C, PA Program Relations Committee Chair
o you remember your clinical rotations while in training? That is probably where you learned to refine your skills and learned from those already practicing medicine. No doubt one of your preceptors inspired you to practice in their specialty because of the way they took care of their patients. Imagine if you were not able to rotate through those clinical sites and missed out on that invaluable experience!
our communities, but we are limited in part due to a lack of clinical preceptors! We have collectively several thousand applicants every year for approximately 350 slots among our existing programs. As more PA programs develop and current PA programs expand, we need more sites and preceptors who will help us train our students in a clinical setting. Would you consider stepping in and helping meet this fundamental need for our programs?
PA programs across California are poised to be able to meet the health care needs of Californians by graduating competent and compassionate PAs who will serve
Benefits to Precepting Being a clinical preceptor is one of the best ways that you can give back to those who trained you and further our profession by paying it
Established PA Programs (alphabetical by region): Northern California Samuel Merritt University, Oakland, CA 510-869-6623; Deaglin@samuelmerritt.edu Stanford University School of Medicine, Palo Alto, CA 650-725-6959; firstname.lastname@example.org Touro University California, Vallejo, CA 707-638-5809; email@example.com University of California Davis, Sacramento, CA 916-734-2145; BettyIreneMooreSON@ucdmc.ucdavis.edu Central California San Joaquin Valley College, Visalia, CA 559-622-1973; MonicaU@sjvc.edu Southern California Loma Linda University, Loma Linda, CA 909-558-7295; firstname.lastname@example.org Riverside County Regional Medical Center/Riverside Community College District, Moreno Valley, CA 951-571-6166; email@example.com
forward. Students bring enthusiasm and energy to your practice and they help keep you abreast of the latest advances in medicine. Additionally, students can be a great source of potential new employees should your practice be looking to expand. Many patients enjoy seeing students and being able to participate in the teaching experience. Many of the programs also offer various tangible benefits such as an adjunct faculty appointment, access to university facilities such as online libraries and reduced tuition for coursework. Category II CME is available to self-report for clinical precepting. For PA preceptors
University of Southern California â€“ Keck School of Medicine, Alhambra, CA 626-457-4250; firstname.lastname@example.org Western University of Health Sciences, Pomona, CA 909-469-5378; email@example.com
Developing PA Programs (alphabetical by region): Southern California (Future) The following programs have applied for provisional accreditation from the ARC-PA and expect to matriculate students on the date provided pending provisional accreditation from ARC-PA. These programs need clinical preceptors in place prior to their first class entering the program and would welcome your interest! Chapman University, Orange, CA (January 2015 matriculation) 714-744-7018; firstname.lastname@example.org Marshall B. Ketchum University, Fullerton, CA (August 2014 matriculation) 714-872-5687; email@example.com As additional developing programs move closer to accreditation and need preceptors for clinical rotations, we will provide their contact information here in the CAPA News â€“ stay tuned!
specifically, the American Academy of Physician Assistants (AAPA) has recently announced the availability of Category I CME to be offered by those programs who apply. Barriers to Precepting “I don’t have time;” “Students might slow me down;” “I’m a clinician, not a teacher.” These are commonly cited reasons not to precept a student, but there are many ways to overcome each of these potential barriers. Studies have shown that students add less than an hour to the workday and some preceptors find that students actually help improve their patient flow. One model cited frequently is the one-minute preceptor, which has
been widely accepted as the major resource for new clinical preceptors, no matter the specialty. This model helps anyone who is unsure about their teaching skills develop a simple method of precepting that has been proven to be effective for both the preceptor and the student. For this and other helpful resources, see the PA Education Association (PAEA) website (http://www.paeaonline.org/) and click on “Preceptors.” Ready to Become a Preceptor? All of California’s PA programs are available to help answer any questions you might have about becoming a preceptor. Please e-mail or call your local program
today and help us train the next generation of PAs! References:
Physician Assistant Education Association. Precepting PA Students. http://www.paeaonline.org/index. php?ht=d/sp/i/80183/pid/80183. Accessed October 9, 2013. Vinson DC, Paden C, Devera-Sales A. Impact of medical student teaching on family physicians’ use of time. J Fam Pract. 1996 Mar;42(3):243-9. Aagaard E, Teherani A, Irby DM. Effectiveness of the one-minute preceptor model for diagnosing the patient and the learner: proof of concept. Acad Med. 2004 Jan;79(1):42-9.
What I Know For Sure Continued from page 20
CAPA enjoys a rich history of PA leaders and most of them, starting with Founder, Rod Moser are CAPA members who are in awe of our current position and are proud of who we are and their role in our success. We honor them and stand on their shoulders. I have been blessed to work with hundreds over the years.
AAPA and CAPA work very well together with open communication and mutual respect. It is a wonderful relationship.
The current CAPA Board is a model of a healthy organization with several new leaders and the wisdom, blessing and institutional knowledge of seasoned ones as well.
I am often asked how I sustain my commitment to excellence and continue to passionately represent California PAs after 25+ years. It is by working with PAs of the caliber of your current leaders. This is an exceptional group with a young, driven President and President Elect who inspire the Board and who make my job a pleasure!
CAPA Public Policy Director, Teresa Anderson, MPH will celebrate her third anniversary with CAPA in February. What Teresa has been able to help us accomplish for California PAs in three years is phenomenal. CAPA’s culture attracts really smart, productive, creative people.
CAPA office staff is stellar. I often hear compliments from the members about how
wonderful they are. I know it, I seek to hire the best, I see their hard work and they help keep me motivated and energized as well. What I Know For Sure – The work each of you do every day, your willingness to participate in the legislative and regulatory process, your encouragement and gratitude for our efforts make all of the hard work worth it. Your CAPA dues dollars are what provide the means to attract and keep the best staff and consultants working for you. The team of PA leaders who spend their evenings and weekends directing it all makes for a high-performing, well-respected organization of which you can be very proud. That is what I know for sure!
Time to Raise Awareness of Metastatic Breast Cancer by Deborah Fredell-Gonzalez, PA-C, CAPA Member
ational Breast Cancer Awareness Month is behind us now. We all heard the National Cancer Institute statistic that over 12 percent of women born in the U.S. today – or 1 in 8 women – will be diagnosed with breast cancer in their lifetime. Breast cancer is the second most common form of cancer and the second-leading cause of cancer death for women. But, despite the prevalence of breast cancer and growing awareness of the disease, there is one form of breast “…the recent trend has cancer that often receives less public been for breast cancer attention and fewer community resources.
patients to return to their primary care provider for a shared model of posttreatment surveillance during the 2nd to 3rd
cancer-free year, utilizing a survivorship care plan.”
Metastatic breast cancer, also known as MBC, stage IV or Advanced Breast Cancer, is cancer that has spread beyond the breast and axillary lymph nodes to a distant site. The most common sites of metastases are the bones, lungs, liver and brain.
Approximately five percent of all new breast cancer cases are diagnosed as metastatic breast cancer and thirty percent of early stage breast cancer will eventually become metastatic. No one dies from breast cancer that remains in the breast. The metastasis of cancerous cells to a vital organ is what becomes deadly. Most new breast cancers are found on breast exam or with a mammogram, but sometimes, the first sign of cancer is somewhere other than the breast. When malignant cells are found in the body, how do we know whether 24
computed tomography (CT scan), and positron emission tomography (PET scan), performed for other reasons.
these cells represent a primary or metastatic tumor? Sometimes it is obvious from the history and physical exam, sometimes it requires further investigation. To determine whether a tumor is primary or metastatic, a pathologist examines a sample of the tumor. In general, cancer cells look like abnormal versions of cells from the tissue where the cancer began. Using specialized diagnostic tests, a pathologist is often able to tell where the cancer cells came from. Markers or antigens found in or on the cancer cells can also indicate the primary site of the cancer. Metastatic cancers may be found before or at the same time as the primary tumor, or months or years later. When a new tumor is found in a patient who has been treated for cancer in the past, it is likely to be a metastasis as opposed to another primary tumor. So how do we detect Metastatic Breast Cancer? Some people with metastatic cancer do not have symptoms. Their metastases are found by X-rays and other tests, such as magnetic resonance imaging (MRI),
Sometimes a person’s primary cancer is discovered only after the metastatic tumor causes symptoms. When symptoms of metastatic cancer occur, the type and frequency of the symptoms will depend on the size and location of the metastasis. For example, cancer that spreads to the bones is likely to cause pain and can lead to bone fractures. Sometimes identification of a pathologic fracture is the first sign of advancing disease. Cough, shortness of breath or hemoptysis may be a sign of lung involvement. Abdominal swelling or jaundice can indicate that cancer has spread to the liver. Altered mental status, seizures, or stroke-like symptoms may indicate brain metastasis. The American Cancer Society reports that at present, there is no cure for metastatic breast cancer, and the best someone diagnosed with Stage IV breast cancer can hope for is a long remission. Ultimately, the median survival rate is only two to three years and the five-year survival rate is only 15 percent. Most cancer is still discovered in the primary stage, while in just the breast or axillary lymph nodes, by the patient or their primary care provider. Metastatic cancer is generally diagnosed during the surveillance phase, or the years following the treatment of the primary cancer. Historically, the oncology team would follow the patient for at least five years to watch for recurrence or metastasis before returning the patient to their primary care provider. In many countries, and now in the U.S., a patient who previously was treated for breast cancer may
no longer see their oncologist for long-term surveillance. According to Dr. Michelle Melisko, Associate Clinical Professor of Medical Oncology and Medical Director of the UCSF Breast Cancer Survivorship Program, the recent trend has been for breast cancer patients to return to their primary care provider for a shared model of post-treatment surveillance during the 2nd to 3rd cancer-free year, utilizing a survivorship care plan. This plan should spell out which provider is responsible for ordering surveillance testing as well as screening for other cancers. Primary care providers are well versed
in cancer screening and the detection of new cancers, but in view of this shift, should educate themselves about the more subtle signs and symptoms of recurrent and metastatic breast cancer. There are roughly 155,000 American men and women living with metastatic breast cancer right now. Nearly 40,000 women and men die every year from metastatic breast cancer, and that number hasn’t improved in two decades. Despite the morbidity and mortality associated with metastatic breast cancer only five to eight percent of total funding
for breast cancer research goes to metastatic breast cancer. We need cures for breast cancer, period. But as we continue to shine a light on the importance of breast cancer awareness and research, we should also be sure that we are aggressively pursuing ways to identify and help those with metastatic breast cancer. Metastatic breast cancer is a serious health issue that warrants additional community resources to increase awareness, provide support for those affected by the disease and educate others on the prevention and early detection of metastatic disease.
SJVC PA Student Society Honors Veterans By Jed Grant, PA-C, CAPA Member
he San Joaquin Valley College Visalia PA Program Student Society hosted a special event honoring veterans on Friday, November 8th. The veterans served in the US Army, Navy, Marine Corps and Air Force branches in conflicts including WWII, Korea, Vietnam, Desert Storm, Iraq, and Afghanistan. Leonard Williams, PA-C, a long time preceptor for the SJVC PA program and a Vietnam veteran, was presented with a plaque honoring his service and commitment to training future PAs. Robert Sachs, PA-C was was also presented a plaque in appreciation of his service in Vietnam as well as his long service on the Physician Assistant Committee (now Board) of California. Mr. Sachs shared some of his experiences and spoke about what it was like to become a PA during the early years of our profession. He was followed by Mr. Ben Hagams who was captured by the Japanese and held as a POW for several years in WWII. His emotional speech was poignant and inspiring, exemplifying the profound sacrifices made by those who have served in combat for this great nation. Finally, all veterans in attendance were presented with a small American flag lapel pin in appreciation for their service. La Sierra High School Military Academy Honor Guard posted the colors and lunch was served as everyone enjoyed the company of the veterans. SJVC’s PA student body is occupied by over 30% veterans, and several members of the faculty have served in the Armed Forces.
Registe r Today
s 6 Hour Cat. I CME
Controlled Substances Education Course A Course Which Upon Successful Completion Will Allow You To Write For Controlled Substances Without Patient Specific Approval* Sunday, February 23, 2014 Napa Valley Marriott 3425 Solano Ave Napa, CA 94558 (707) 253-8600
Wednesday, October 15, 2014 Renaissance Palm Springs (preceding the CAPA Conference) 888 E Tahquitz Canyon Way Palm Springs, CA 92262 (760) 322-6000
*California Code of Regulations Sections: 1399.541(h), 1399.610 and 1399.612. A PA may administer, provide, or issue a drug order for Schedule II through V controlled substances without patient specific approval if the PA completes specified educational requirements and if his/ her Supervising Physician delegates the authority to them. Courses will be canceled if minimum number of registrants is not met.
PA Programs Host 2013 CAPA Controlled Substances Education Courses
Make the most of your trip to Napa! Plan to attend a free, CMEgranting one-day mental health training, “Mental Health in a Primary Care Setting.”
pecial thanks to UC Davis, USC and Western University. All three were gracious hosts to CAPA’s Controlled Substances Education Course in 2013. CAPA and those who took the Courses at all three programs were warmly welcomed. The staff and faculty at the programs gave generously of their time to make the day go smoothly for all involved. PA Program Directors, Mark Christiansen, PhD, PA-C (Davis); Kevin Lohenry, PhD, PA-C (USC) and Roy Guizado MS, PA-C, (Western U) have much to be proud of. All have great teams, great campuses and happy graduates who also appreciated the availability of the Controlled Substances Education Course on these beautiful campuses. We appreciate the Programs’ support of CAPA’s efforts on behalf of all California PAs.
This will be held the day after CAPA at Napa, and at the same hotel. When: Sunday 2/23/14, 9am-4pm Where: Napa Valley Marriott Hotel & Spa Cost: FREE; meals provided RSVP/Questions: Julie Charles, MBA— 707-638-5875, firstname.lastname@example.org
Cont Subs rolled ta Co nces on Suurse nday
One-Day Conference in Napa at the Napa Valley 6 Hours of Cat. I CME
Saturday, February 22, 2014 8:45 a.m. - 4:25 p.m.
CAPA at Napa
Register online at www.capanet.org
Sponsored by the
Join us in Napa. We have developed an excellent educational program set in the beautiful, lush green Napa Valley and offer it to you at a very reasonable price. CAPA is coming to Napa and you won’t want to miss it!
California Academy of Physician Assistants Application has been made to the American Academy of Physician Assistants (AAPA) for 6 hours of Category I CME credit. Approval is pending.
8:00 a.m. – 8:45 a.m.
8:00 a.m. – 8:45 a.m.
Continental Breakfast and Exhibits
PA-C PA PA-S NP MD/DO Other___________________
8:45 a.m. – 9:40 a.m.
Urticaria and Angioedema Sean Deane, MD,
PA License #___________________________________________________
9:40 a.m. – 10:35 a.m.
What’s New in HBV and HCV? Scott Moon, PA-C
Address____________________________City________________________ State________________________________ Zip Code_________________
10:35 a.m. – 11:20 a.m. Break and Exhibits
Phone (____)___________________ Fax (____)_______________________
1:20 a.m. – 11:30 a.m. CAPA: Solid and Focused 1 Jeremy Adler, MS, PA-C
1:30 a.m. – 12:20 p.m. Assessing Diability 1 Alesia Wagner, DO 2:20 p.m. – 1:10 p.m. 1
Lecture TBD Speaker TBD
1:15 p.m. – 1:25 p.m.
CAPA President’s Address Adam Marks, PA-C
1:25 p.m. – 2:25 p.m. Lunch (not eligible for CME) Lecture TBD Speaker TBA 2:30 p.m. – 3:20 p.m. Covering Covered California Robert Miller, PA 3:20 p.m. – 4:10 p.m.
Deep Vein Thrombosis Edward Kersh, MD
4:10 p.m. – 4:25 p.m.
Prize Drawing and Closing
6 Hours Category I - CME Credit Applied For Application has been made to the American Academy of Physician Assistants (AAPA) for 6 hours of Category I CME credit. Approval is pending. Courses will be canceled if minimum number of registrants is not met. The planners and sponsors of this function claim no liability for the safety of any attendee while in transit to or from this event. The planners and sponsors reserve the right to change speakers and/or cancel the event due to unforeseen circumstances without penalty. The total amount of any liability of the planners and sponsors will be limited to a refund of the registration fees.
City_________________________________________________________ State________________________________ Zip Code_________________ Phone (____)___________________ Fax (____)_______________________ CAPA Member - $150 Non-Member - $240 CAPA Member PA Student - $50 Non-Member PA Student - $70 Napa Conference and CAPA Membership through 4/30/15 - $275 Late Registration Fee after January 25, 2014 - add $20 Vegetarian Meal Required or Gluten-Fee Meal Required
Total Amount $______________
Signature_____________________________CVV#______ Exp.__________ In accordance with the Americans with Disabilities Act, please check here if you have any special needs. You will be contacted by CAPA. Mail Registration Form and make checks payable to:
California Academy of Physician Assistants 2318 S. Fairview St. • Santa Ana, CA 92704Phone: (714) 427-0321 • Fax: (714) 427-0324
or Register online at: http://www.capanet.org
Preparing for Change Can Lower Your Exposure to Risk
hether you’re switching from one specialty to another, moving from one care delivery setting to another, or adding new responsibilities within your existing practice, you need to be prepared for the change. Preparation includes knowing about (and adhering to) relevant standards and scope of practice—lack of knowledge is no excuse if a patient injury results in a lawsuit.
Change in Specialty
All PAs, regardless of role or specialty, must follow the scope and standards of practice. Each standard has several supporting competencies. Lack of adherence to standards and recommendations could make you vulnerable to legal action should a patient injury occur.
Change in Setting
Changes in care delivery setting include practice areas, and geographic relocations, such as moving from one state to another. It’s easy to forget that
setting has a tremendous impact on care delivery. You need to understand—and follow—protocols and policies in your practice setting to avoid putting yourself in a situation where you could be sued.
Change in Responsibilities
You may be asked to add another responsibility to your job, such as taking on a new procedure. It’s important to make sure you receive the education you need to be able to perform the procedure competently. Medicine is an evolving science; if the procedure is new to the field, you should check to be sure it falls within a PA’s scope of practice as defined by your state’s Practice Act.
Making the Transition
Moving from one patient population or setting to another or taking on a new responsibility all require a transition plan so you can practice safely. You may need to attend additional classes, complete online education programs, review applicable national standards and guidelines, or tap into your network
of experts. Any education you receive should be documented in your personnel file.
On the Road to Success
By taking time to prepare yourself, you can ensure your move to a new setting, population, or role is a success and keeps your risk of litigation low. 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 email@example.com or call 1-800-982-9491. www.hpso.com.
CAPA0112_Layout 1 11/29/11 4:08 PM Page 1
You’re “on-call” 24/7. Make sure your malpractice coverage is too.
Individual professional liability coverage at competitive rates.
Physician Assistants Professional Liability Insurance 888.273.4686 | www.hpso.com/oncall This program is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company, and is offered through the Healthcare Providers Service Organization Purchasing Group. Coverages, rates and limits may differ or may not be available in all states. All products and services are subject to change without notice. This material is for illustrative purposes only and is not a contract. It is intended to provide a general overview of the products and services offered. Only the policy can provide the actual terms, coverages, amounts, conditions and exclusions. CNA is a registered trademark of CNA Financial Corporation. Copyright © 2012 CNA. All rights reserved. Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services, Inc.; (AR 244489); in CA, MN & OK, AIS Affinity Insurance Agency, Inc. (CA 0795465); in CA, Aon Affinity Insurance Services, Inc., (0G94493), Aon Direct Insurance Administrator and Berkely Insurance Agency and in NY and NH, AIS Affinity Insurance Agency. ©2012 Affinity Insurance Services, Inc. CAPA112
Students Students Students Students Students Students Thank You 2013 Student Ambassadors by Roy Guizado, MS, PA-C, Vice President and Student Affairs Committee Chair As the current Vice President of the California Academy of Physician Assistants and the Chair of the Student Affairs Committee, I would like to thank all the Student Ambassadors (SAs) that participated in the CAPA Annual Conference held in Palm Springs. The Student Ambassadors for this year were: These students from their individual programs were the model of cooperation and teamwork. In the period of a few hours they developed into a unified and cohesive working team that helped the CAPA conference run smoothly. Student Ambassadors were found in every CME room, assisting at meals, working the CAPA Political Action Committee booth, working in the exhibit hall and helping with the various workshops.
Kayla Bratton – Western University of Health Sciences Whitney Burnett – Keck School of Medicine, University of Southern California Chelsea Durning – Western University of Health Sciences Laura Franco – Samuel Merritt University Chelsey Garrison – Samuel Merritt University Chelsea Hemming – Western University of Health Sciences Kathryn Johnson – Western University of Health Sciences Lindsay Kennedy – Samuel Merritt University Marisa Leal – Western University of Health Sciences Jamie McCoy – Western University of Health Sciences Ashley McGrogan – Western University of Health Sciences Marisa Rogers – Western University of Health Sciences Lindsey Smith – Western University of Health Sciences Acacia Sutherland – Western University of Health Sciences Gabriel Zapata – San Joaquin Valley College
Continued on page 30
CAPA Student Scholarships – Deadline December 31, 2013 The Ruth Webb Minority Scholarship $1000 Scholarship
Ruth Webb served as program director for the Charles R. Drew University PA Program for several years, and was actively involved with numerous local, state, and national professional organizations. She was not one to sit back and let others do the work. She took a very active role doing committee work. She served as Vice Chair of the Board on Medical Quality Assurance, member of the Physician Assistant Examining Committee, member of the California Council of PA and NP programs, and founding member of the LA County Joint Practice Advisory Council on NPs and PAs. Known for “keeping it real,” she would do whatever it took to help students achieve the goal of becoming a PA-C.
The Ray Dale Memorial Scholarship $1000 Scholarship
Ray Dale served as Executive Officer of the Physician Assistant Committee from 1980-2000, and was instrumental in the development and growth of CAPA as an organization representing our profession. Working with the Department of Consumer Affairs, he would give CAPA good counsel and support regarding legislative issues, and would help by acting as our “lobbyist” and “attorney” when CAPA could not afford one. He contributed his time and his efforts to the growth of the PA profession and protection of its consumers.
The Community Outreach Scholarship $1000 Scholarship
This scholarship will be awarded to a student who is currently in good academic standing and has demonstrated community outreach and other philanthropic activities as a student. Student Members of CAPA currently enrolled in primary care PA Programs located in the state of California are eligible to apply for CAPA scholarships. The deadline to apply for the three $1,000 CAPA Scholarships is December 31, 2013. Please visit the CAPA website for an application and for eligibility requirements.
Students Students Students Students Students Students PA School Tips by Chelsea Hemming, PA-S, Student Representative
ongratulations on getting accepted to PA school or starting rotations! You have made it! This time will challenge you and transform you in ways that you can’t even imagine. I wanted to share some of the things I did to maintain my sanity and stay positive throughout didactic year. Each of you will have your own things that keep you centered and motivated I encourage you to seek those out and make those a priority. Although PA school is incredibly difficult, I was determined to look back on didactic year on a positive note. 1. Get Involved on Campus Whether it be in your student government or a club on campus, I urge you to get involved as much as possible. Being a part of the student government allowed me to interact with many members of my class and faculty on a regular basis, which resulted in many new friendships and experiences I wouldn’t have gotten otherwise. I was given the
opportunity to advocate for the PA profession on and off campus. Networking with other individuals in the medical community can only help your career and expand your support system. I also found that speaking to pre-PAs was very rewarding. These are the next generation of PA students and they look to you for advice and mentoring. They will remind you how hard you worked to get to this point and how great this profession is. 2. Volunteer Volunteering at free clinics for the homeless and at the medical booth at the Special Olympics was one of my highlights from the last year. I will never forget my first pre-diabetic patient who thanked me for spending time with her and caring about her health. These opportunities kept me grounded and constantly reminded me why I’m in this profession. It’s easy to lose sight of the end goal, but applying my knowledge and seeing the impact of my presence is essential to survival.
3. Rest Whether it be sleeping, hanging out with your loved ones, or exercising, you need to take care of your mental health. You need these activities to recharge your battery and allow you to focus better. Research has shown that studying is more effective when you take breaks to rest your mind. This will allow you to make the most of your limited time and focus harder. These activities will remind you that you are more than just a PA student. I hope you take this advice and try and apply it to your study routine during PA school. PA school is difficult, but it’s not impossible if you take the necessary steps to keep your mental, spiritual and physical health strong. This will allow you to not only survive, but thrive in PA school. I am so excited to be going through this crazy journey with you all and please do not hesitate to contact me if you need anything.
Thank You 2013 Student Ambassadors Continued from page 29
The hours were long; some days ran from 7:00 AM to 7:00 PM. At the end of the day many of the Ambassadors retired to their rooms and instead of relaxing, they took out their textbooks and studied for their upcoming PA classes. These students demonstrated professionalism that will carry them through their careers as PAs. 30
Thank you for your infectious enthusiasm, your willingness to help each other, your ability to assist the conference attendees, your aid to the CAPA leadership team and your positive attitude throughout the conference. For the rest of the students in all the PA programs, please consider becoming a Student Ambassador in the future. Watch for a message next year from your program director as
they announce the search for new CAPA Student Ambassadors. Finally, the Student Affairs Committee Chair wishes to thank all the PA programs’ leadership that provided Student Ambassadors time away from their didactic or clinical education to participate in this year’s conference. CAPA appreciates the support you provided your students. Thanks for a great conference.
Welcome New Members
August 2, 2013 through November 18, 2013 Erik Abernethy, PA-C Erin Abston, PA-S Omar Aguey, PA-C Mary Ahmadyar Kamron Allen, PA Nathan Allen, PA-C Jennette Anderson, PA-C Jessiann Andrus, PA-C Errill Avecilla, PA-C Estelle Ayyad, PA-C Ericka Baer, PA-S Jacqueline Baggs, PA-S Adam Baker, PA-S Athena Baldwin, PA-C Donna Baldwin, PA Dennis Bansil, PA-C Dina Bedwani, PA-S Christopher Bell, PA-C Vicente Benavidez, PA-C Avi Berstock, PA-C Brittney Blanchard, PA-S Venus Blas Hugo Bravo-Chavez, PA-C Ashley Brennan, PA-C Rosa Brey Andrea Brody, PA-C Daphna Brown, PA-C Lauren Bruce, PA-C Richard Bruce, PA-S Danielle Burgess, PA-S Ashley Buse, PA-C Jesus Bustamante, PA-C Karen Cain, PA-C Andrew Calderon Mitch Calmer, PA-S Celeste Care, PA-S Tanya Cariveau, PA-C Bryan Carter, PA-S Christina Carter Arthur Chalmers, PA-S Michelle Chang, PA Caroline Cho, PA-C Luis Christie, PA-C Victoria Christison, PA-S Eric Chung, PA-S Helen Chung, PA-C Mary Kay Clark, PA-C Micah Clement, PA-S Abby Comes Yvonne Conard, PA-S Edmund Concepcion Marianne Cope Tamara Cortes, PA-C Kristin Craviotto Rupert, PA-C Beverly Cuano, PA-C Carianne Cunningham, PA-S Caroline Curley, MPH, PA-S Marc Darpel, PA-C Gourab Das, PA-S Nicole Davis Nicolas DeJong, PA-S Holly Demetrescu, PA-S Audra DiCaro, PA-S William Diez, PA-S Jessie Donovan, PA-C Kaitlin Doolan, PA-S Roseanna Duenas, PA-S
Staci Dumas, PA-C Tiffany Ebersohl, PA-C Matthew Ebling, PA-C, MSPAS Amanda Edmonson, PA-S Edith Elenes, PA-C Alicia Eller, PA-S Paige Elliott, PA-S Kelly Enfantino, PA-S Deanne Margot Enriquez, PA-S Kamand Fararooy, PA-S Daniela Feldhausen, PA-C Jeanette Foronda, PA-C Robin Fraser, PA-S Cassie Fucci, PA-S Christopher-Michael Gale, PA-C Casey Galicia, PA-S Barry Gambini Natasha Germain, PA-S Alyssa Giacalone, PA-S Kristy Goodman, MS, MPH, PA-C Julie Grant-Acquah, PA-C Thomas Hahambis, PA-C Hilary Hammond, PA-S Erin Hanauer, PA-C Marsella Hanhan, PA-S Chelsea Hardesty, PA-S Elizabeth Harris Kathryn Harris, PA-C Stephanie Haua Darla Hawkins, PA-C Mastaneh Haykani, PA-S Heather Heck, PA-S Brittany Heimann, PA-S Kendall Heming, PA-C Hugo Hernandez, PA-S Emily Ho John Hoang, PA-S Phu Hoang, PA-C Mark Hokett, PA-C Joan Holmes-Asamoah, PA-C TJ Hopson, PA-S Stephen Howard, PA-C Tunde Hrotko, PA-S Jodi-Ann Hudson-Williams, PA-S Esther Hwang, PA-C Brittany Jackson, PA-C, MPAS Keith Jackson Jessica Jacobs, PA-C Elke Jacobsen, PA-S Amber Janson, PA-S Bridget Jemison, PA-C Eric Johnson, PA-S Chelsea Joshi, PA Christine Knob, PA-C Sarah Koenig Eric Korsh, MD Maria Kostaris, PA-S Karen Kostenko, PA-S Noelle Kraus Heather Kyte, PA-S Leslie La, PA-S Eve Landa Rachel Lannigan, PA-C Michael Larsen, PA-S Cynthia Lawrence, PA-C Sara Lawson, PA-S Crystal Lee
Ji Min Lee, PA-S Cindy Lerch, PA-S Chantal LHerault Cynthia Limon Annie Lin Jayanthi Linert, PA-C Miguel Lopez Kristina Lou, PA-S Joana Lu, PA-S Alfonso Luna, PA-S Tamara Lusinyan James Macfoy, PA-S Lonnise Magallanez Daniel Mallamo, PA-C Joseph Maloney, PA Helen Mangune, PA-C David Mapes, PA-S Alejandra Martinez, PA-S Amy Martini, PA-S Kyle Masi, PA-S Yeliana Mayor, PA-S Rachael McAfee, PA Hope McGinn, PA-C Pam McLeod, PA-C Diana Medina Michael Mellman, MD Siyuan Miao, PA-S Shane Milliron, PA-S Christina Miranda, MS, PA-C Laura Miser, RMA, NREMT Michael Montiel, PA-S Stephanie Morgan, PA-S Abigail Morguelan, PA-S Daniel Munoz, PA-S Bahar Naderi, PA-C Jaime Neri, Jr., MSPA-C Carolyn Ngo, PA-S Diana Nguyen, PA Rosie Ocamica, PA Erika Oddie Tamarrah Oliver, PA-C Angela Oltman, PA-C Haley O’Neel Heather Onnigian, PA-S Spencer Packer, PA-C Prusha Paktinat, PA-S Ashley Parish, PA-S Panteha Partovi, PA-S Marienida Patam, PA-C Chelsea Pearson, PA Michael Peffer Michelle Penhaskashi Raquel Peshkepia Rebecca Pestle, PA-C Jason Peugh, PA-S Yin Phung, PA Julie Picos, PA-S Romell Pineda Anthony Pirouz, PA-S Teri Pitman, PA-C Kelley Powers Jissille Rama, PA-S Whitney Ramey, PA-C Robin Reaney, PA-S Keith Regets, PA-C Michael Reidinger Marcus RhodenHill, PA-S
Carolina Rodriguez, PA-S Cassie Rodriguez-Feo Rose Rooney, PA-C Richard Samudia, PA-C Nancy Sanchez, PA-C Yanderi Sandoval, EMT-B Nicole Sapiro, PA-S Marina Sarwary, PA-C Gerald Savellano Tiffany Schaffer, PA-C, MS Elizabeth Schmidt Dina Schnellinger, PA-C Kristina Scott Harley Searcy, PA-S Luke Seidel, PA-S Jose Serna, PA Kelly Shelby, PA-C Kevin Shelby, PA-C Anthony Shultz, PA-S Elizabeth Silva Ilana Simon, PA-S Brittany Slaughter, PA-S Ashley-Anne Smith Jennifer Smith, PA Tiffany Smith, PA-S Matthew Snarr, PA-C Mindy Song Eric Soto, PA-C Nicole Spataro, PA Greg Stevens, PA-C Amy Supernaw, PA-S Jessica Swansbrough, PA Jill Tanner, PA-S Hisano Tasedan Gary Terzian, PA-S Say Thao, PA-C Heather Thomas, PA Timothy Thue, PA-S Ricca Tinnin, PA-C Taylor Todd, PA-S Judith Tow, PA Christina Tran, PA-S Thao Truong, PA-S Wilson Truong Christian Villadolid, PA-C Seema Vohra Tyler Waldron, PA-S Nicholas Walther, PA-S Shana Wang, PA-C Omar Waziri, PA-C Lauren Weaver, PA-C Alyssa Weiner, PA-S Lindsey Whitehead, PA-S Amber Whitworth, PA-C Andrea Willcox, PA-S Ashley Williams, PA-C Jason Wolfe, PA-S Justin Wolfe, PA-S Karen Wong, PA David Woodbury, PA-S Jane Wu, PA-S Elijah Youssefi, PA-C Sarah Zalaznik, PA-C Jorge Zarate, PA-C Nicole Zynda, PA-S
Notice to CAPA members is hereby given pursuant to CA Corporation Code Section 8321. Members of CAPA have the right to request and receive CAPA’s balance sheet, an income statement and a statement of cash flows for the most recent fiscal year. Please note that the names and addresses of current members are located at the CAPA office located at 2318 S. Fairview Street, Santa Ana, CA 92704. Requests for information should be in writing and delivered to the CAPA office.
1. Redding Area PA/NP Alliance P.O. Box 993515, Redding, CA 960-3515 Summer Ross, PA-C; (530) 225-6194 firstname.lastname@example.org 2. Physician Assistant Society of Sacramento (PASS) Judi Price, PA, MPAS, PASS President; (916) 952-8327 email@example.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 firstname.lastname@example.org 5. Bay Area Mid-Level Practitioners Rose Abendroth, PA-C; (650) 697-3583, Fax: (650) 692-6251 email@example.com Matt Dillon, PA-C; (650) 591-6601, firstname.lastname@example.org 6. Bay Area Non-Docs Linda O’Keeffe, PA-C; (650) 366-2050, email@example.com 7. Northcoast Association of Advanced Practice Clinicians John Coleman, PA-C; (707) 845-6008, firstname.lastname@example.org 8. Stanislaus County NP/PA Network Brian Cormier, PA-C; (209) 605-4966, email@example.com www.nppanetwork.org 9. Stockton Midlevels Roy Blanco, PA-C; (209) 623-8580 firstname.lastname@example.org 10. Journal Club for PAs and NPs (Fresno area) Cristina Lopez, PA-C; (559) 875-4060; Fax: (559) 875-3434 email@example.com; 2134 10th St, Sanger, CA 93657 11. Central Coast Nurse Practitioners & Physician Assistants Kris Dillworth, NP; firstname.lastname@example.org Sharon Girard, PA-C; (305) 803-1560; email@example.com 12. So Cal PAs Linda Aghakhanian, PA-C; firstname.lastname@example.org 13. Orange County Hung Nguyen, PA-C; (714) 846-8178; email@example.com 14. San Gabriel Valley Local Group M. Rachel DuBria, PA-C; (818) 744-6159, firstname.lastname@example.org 15. San Fernando/Santa Clarita Valley Group Jonah Tan, MPT, PA-C; (818) 634-0007, email@example.com 16. Coachella Valley Physician Assistant Group Matthew Keane, MS, PA-C; firstname.lastname@example.org 17. San Diego Area Patrick Astourian MS PA-C; email@example.com www.SDPASOCIETY.com.
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
One-Day Conference in Napa at the Napa Valley
6 Hours of Cat. I CME
CAPA at Napa Saturday, February 22, 2014 8:45 a.m. - 4:25 p.m. Register online at www.capanet.org
Sponsored by the
California Academy of Physician Assistants
urs 6 Ho Cat. I CME
Controlled Substances Education Course for PAs Sunday, February 23, 2014 Napa Valley Marriott 3425 Solano Ave Napa, CA 94558 (707) 253-8600
Wednesday, October 15, 2014 Renaissance Palm Springs (preceding the CAPA Conference) 888 E Tahquitz Canyon Way Palm Springs, CA 92262 (760) 322-6000
California Academy of Physician Assistants CAPA News publication dated November/December 2013.