CAPA News May/June 2013 by CA Academy of PAs

News

Official Publication of the California Academy of Physician Assistants

May/June 2013

\The Magazine

Winning! With Your Action We Can Win This! Read On and Act Now! by Teresa Anderson, MPH, Public Policy Director

he 2013/2014 legislative session is proving to be quite exciting. On your behalf, CAPA has two pieces of sponsored legislation: SB 352 - Medical Assistants and SB 494 - Health Care Providers. We are working very hard on both bills as they move through the legislative process. We are very pleased and grateful to have the California Association of Physician Groups (CAPG) as co-sponsor on both bills. They have brought many hours of work and a great deal of expertise to the process. Not to mention the weight of 150 multi-specialty groups. SB 352 - Medical Assistants, authored by Senator Pavley, would eliminate legal restrictions and barriers to efficient coordinated care by allowing physicians to delegate the task of MA supervision to a PA, NP or CNM across all outpatient medical settings where they currently function, without requiring the physician’s presence.

See page 15 and act now! You can help to make SB 352 a reality. Take just a few minutes to photocopy the letter on page 15 and have your supervising physician sign it to show their support of the bill which will allow him/her to delegate the supervision of a MA to you (if he/she chooses to do so).

As many of you know this is not the first time CAPA has sought a legislative fix to allow the delegation of medical assistant supervision to PAs, NPs and CNMs. In previous efforts to address this issue we encountered opposition from California Nurses Association, this time is no different. CNA remains opposed to our bill. Many hours of leg work, many legislative office visits and thousands of letters, faxes and calls from all of you resulted in our bill moving successfully through the Senate with a 36 -2 votes on the Senate Floor. We will need that same team-based approach as we gear up to get through the Assembly.

See page 15. There are 86,000 nurses in CA. There are about 9,000 PAs. We need each and every one of you and all members of your health care team – including nurses, MAs and physicians with whom you work to sign the letter. Then you can collect them with signatures and fax to CAPA. We will deliver the stack of thousands of signed letters in SUPPORT of SB 352 to the desks of legislators.

SB 494 Health Care Providers, authored by Senator Monning, would authorize health plans to assign additional enrollees (patients) to a primary care practice/physician based on the use of a PA. To date, we have not received any opposition to this bill. That said, we have done a lot of work with stakeholder groups and the administration to discuss the capabilities and benefits of using the PA profession more efficiently to increase access to care. This bill received bipartisan support on the Senate Floor and passed out of the Senate with a 38 to 0 vote. It is now going to the Assembly Business, Professions and Consumer Protection Committee for vote. We will be calling upon all of you, our team of PAs, across the state to help push this bill too. CAPA is also a co-sponsor of AB 1208 - Medical Homes, authored by Assembly Member Pan and sponsored by California Academy of Family Physicians (CAFP). This bill would establish the Patient Centered Medical Home Act of 2013 and would define a “medical home” and a “patient centered medical home” for purposes of the Act to refer to a health care delivery model in which a patient establishes an ongoing relationship with a licensed health care provider. AB 1208 successfully made it out of the Assembly and will be heard soon in Senate Health Committee. Continued on page 14

News

Editor Gaye Breyman, CAE

Incoming 2013-2014 CAPA Board of Directors

Managing Editor Denise Werner

Term: July 1, 2013 – June 30, 2014

Proofreaders Kim Dickerson Coryn Kulesza

President Adam Marks, MPA, PA-C

Editorial Board Jeremy A. Adler, MS, PA-C Adam Marks, MPA, PA-C Bob Miller, PA Larry Rosen, PA-C Michael Scarano, Jr., Esq.

CAPA Board Of Directors President Adam Marks, MPA, PA-C president@capanet.org

Director-At-Large Ana Maldonado, MPH, DHSc, PA-C

President Elect Jeremy A. Adler, MS, PA-C

Director-At-Large Cherri L. Penne-Myers, PA-C

Vice President Roy Guizado, MS PA-C

Director-At-Large Kevin Robertson, PA-C

Secretary Joy Dugan, MSPAS, MSPH, PA-C

Treasurer Bob Miller, PA treasurer@capanet.org Directors-At-Large Anthony Gauthier, PA-C, ATC diranthony@capanet.org Roy Guizado, MS, PA-C dirroy@capanet.org

Treasurer Bob Miller, PA

Student Representative Chelsea Hemming, PA-S

2014 AAPA House of Delegates

Anthony Gauthier, PA-C, ATC Public Relations Committee Chair

Term: July 15, 2013 – July 14, 2014 Joy Dugan, MSPAS, MSPH, PA-C Katherine (Kaesa) Footracer, MS, PA-C Grace P. Landel, PA-C, MEd

Cherri L. Penne-Myers, PA-C Julie Theriault, PA-C James “Jay” D. Williamson, Jr., MS, PA-C Matthew Keane, PA-C Director-At-Large

Matthew Keane, PA-C dirmatthew@capanet.org Greg Mennie, PA-C, MSed dirgreg@capanet.org

Michael J. De Rosa, MPH, Ph.D., PA-C PA Program Relations Committee Chair

Director-At-Large James “Jay” D. Williamson, Jr., MS, PA-C

Vice President Jeremy A. Adler, MS, PA-C vicepresident@capanet.org Secretary Joy Dugan, MSPAS, MSPH, PA-C secretary@capanet.org

Departing CAPA Leaders

At The Table

Larry Rosen, PA-C dirlarry@capanet.org Student Representative Saloni Swarup, PA-S studentrep@capanet.org

The CAPA News is the official publication of the California Academy of Physician Assistants. This publication is devoted to informing physician assistants to enable them to better serve the public health and welfare. The publisher assumes no responsibility for unsolicited material. Letters to the editor are encouraged; the publisher reserves the right to publish, in whole or in part, all letters received. Byline articles express the opinion of the author and do not necessarily reflect the views or policies of the California Academy of Physician Assistants.

The CAPA office is located at: 2318 S. Fairview St. Santa Ana, CA 92704-4938 Office: (714) 427-0321 Fax: (714) 427-0324 Email: CAPA@capanet.org Internet: www.capanet.org ©2013 California Academy of Physician Assistants

CAPA NEWS

SB 352 – Medical Assistants, was heard in the Senate Business and Professions Committee on April 8, 2013. Thanks to all who attended the hearing to support SB 352.

CAPA Exhibit Booth at Pri-Med 2013 – May 2-4 in Anaheim, California. Pictured here, Anthony Gauthier, PA-C; CAPA PR Committee Chair and Director at Large and Mike Estrada, PA-C, CAPA Committee on Diversity Chair.

Greg Mennie, PA-C, MSed Director-At-Large

Larry Rosen, PA-C Director-At-Large

Thank You For Your Dedication and Service

Guam … Is Closer to North Korea Than I Thought! by Bob Miller, PA, Professional Practice Committee Chair

ast month I returned from Guam where I was asked to do a series of lectures on bleeding disorders. This was my third trip to the island to talk about an area of medicine which has been my specialty for the last 30 years. Guam is a U.S. territory located in the western Pacific Ocean and is the largest of the Mariana Islands. It is a beautiful island with tourism being the leading economic base. The majority, about 70%, of visitors come from Japan (lots of weddings) and other countries in the region. Guam’s indigenous people are the Chamorros – whose warm and friendly greeting of “Håfa Adai” is their version of aloha. The second largest source of income is the United States military with the huge Anderson Air Force base and Naval Base Guam on each end of the island. Guam has a rich military history. The country was invaded and occupied by Japan just

outwardly calm, a bit on edge. So what can you do? Eat your Spam (very popular) and move on with the day.

hours after the Pearl Harbor attack on December 7, 1941 and nearing the end of WWII the U.S. took it back in 1944. The island serves as an important U.S. strategic military home base for the Pacific. The U.S. military might located on Guam gave me only mild comfort while I was there as North Korea blustered and threatened the world, with Guam and Japan seemingly in their potential gun sights - or perhaps just within reach of their limited missile capacity. Guam, only 2,000 miles from North Korea, had the military on alert status and the island people were, although

Despite the political unrest, the symposium was attended by approximately 100+ providers including physicians, dentists, nurses and other health care providers from the island. I think this opportunity is in one way, another tangible recognition that PAs may be acknowledged as a source of expertise in medical practice. Other PAs have shared their particular skills and expertise in community settings, at local, state and national levels and in other countries. As our profession matures, I think there will be many more comparable circumstances when PAs will be asked to share their expertise and provide more positive visibility for PAs as a valued professional resource in health care delivery. Håfa Adai 

Inside This Issue Incoming 2013-2014 CAPA Board of Directors............. 2

Act Now!.................................................................. 14

Institutional Withdrawal............................................ 30

2014 AAPA House of Delegates................................... 2

SUPPORT SB 352 (Pavley) Medical Assistants: Supervision.............................................................. 15

A Letter to My New Colleagues.................................. 31

At the Table................................................................ 2 Guam … Is Closer to North Korea Than I Thought!...... 3 Politics in Action.......................................................... 4 Formalizing Our Vision................................................ 5 MIASMA (Miaoμa, Greek: Pollution)............................ 6 Prescription Drug Abuse – Is Rescheduling Hydrocodone the Answer?........................................... 8 New Professional Reporting Requirements 2013........ 10

News about the Affordable Care Act (ACA.................. 16

So What Now? A Quick Guide to Walk You Through the Door from PA-S to PA-C............................................. 32

2013 CAPA Conference............................................. 18

Apply To Be a Student Ambassador............................ 33

CAPA’s 37th Annual Conference in Palm Springs......... 20

Congratulations Graduates........................................ 33

Building a Pipeline.................................................... 21

Physician Assistant: To Be Or Not To Be...................... 34

Improving Health Literacy Improves Patient Outcomes...................................................... 22

Welcome New Members............................................ 35

New Enrollment Required By Medi-Cal....................... 23

Local Groups............................................................ 35

Controlled Substances Education Course…................ 11

Shadowing: The Catch 22 of the PA Profession........... 24

It’s Time…After Almost 18 Years, I am Stepping Down as a CAPA Leader....................... 12

A CAPA Website Tutorial – Check It Out!.................... 28

CAPA Dues Have Not Been Raised In 7 Years.............. 35

Renew Your CAPA Membership Today........................ 27

MAY/JUNE 2013

Politics in Action by Sonny Cline, PA-C, MA, M.Div, Political Action Committee Chair

s many of you know, things are well under way and there is a great deal of action at the Capitol. Many bills are being put forth, and with the Affordable Care Act being implemented in full force this coming January, there are many providers who stand ready to care for the masses. While there is quite a bit of political wrangling going on here in Sacramento, I want “Inevitably, when I find to take this time to focus on another myself interacting with type of political action that is going someone at the Capitol on every day around California.

about PA issues, it seems

This political action takes place their previous experience every time you treat a patient and with with PAs is often times an every conversation that you have with overarching predictor of a doctor when you refer a patient to how they feel about our another service or higher care. Every profession.” time you speak with a mom or dad about their child’s care, you are making a statement about who we are as a profession. At a party during a conversation about health care or when a friend

of the family asks a medical question, we represent who we are as a profession. Inevitably, when I find myself interacting with someone at the Capitol about PA issues, it seems their previous experience with PAs is often times an overarching predictor of how they feel about our profession. They may have seen a PA personally or had a friend or family member who has seen a PA, and that experience heavily influences their opinion about our profession. Of course this can be good or bad, depending on the interaction. Unfortunately, it is always the case that a bad interaction is often remembered and remembered vividly. At times, however, I find myself with someone who is asking, “What’s a PA exactly?” Then it is my job to accurately describe, but more importantly represent personally, who we are as a group. I have always remembered the strong words my primary preceptor and first employer told me... “Being a medical professional is not just another job.” We are a crucial part of society, and as such, we should always conduct ourselves honorably both in and out of the office.. I have remembered this through the years and have done my best to represent our profession well.

I say this because now, more than ever, our legislators are going to be trying to decide how to best deliver health care to a growing number of people in the years to come. As they consider our profession and where we fit into the health care equation, it is my strong hope that we are viewed as professional caregivers who engage as part of the team with a good attitude and a clear understanding of ourselves In the days to come, in the health care debates, I want to encourage all of you to go to work motivated and excited to deliver excellent care. Don’t get caught up in meaningless debates that have no purpose other than to incite anger and animosity. Instead, be amazing every day and be a walking political statement, demonstrating all of the positive attributes that we bring to health care. This goes much further politically than any legislation or anything we can say at the Capitol in a one-time testimonial. Let’s keep our focus on why we all came to health care… to be a meaningful part of peoples’ lives and bring healing through all our interactions. It’s what we love. It’s what we do every day. Be the political action that makes a real difference. 

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CAPA NEWS

Formalizing Our Vision by Adam Marks, MPA, PA-C, President

ast Summer I wrote an article which highlighted CAPA’s move towards formalizing a Vision Statement. Excerpt CAPA News 8/2012

At the beginning of each CAPA leadership year (July 1-June 30), CAPA’s newly elected leaders and committee chairs come together to discuss current issues that PAs face in California, set goals for the upcoming leadership “Good business leaders year and review create a vision, articulate the progress that CAPA has made in the past year. the vision, passionately The beginning of a new leadership own the vision, and year is always exciting with fresh relentlessly drive it to ideas and a lot of enthusiasm. completion.”

Jack Welch

This year, CAPA leaders came together for a weekend meeting in Long Beach where we started a process which was aimed at increasing CAPA’s efficiency when creating organizational goals and laying a foundation for the future. As we do every year, we reviewed the CAPA mission statement: The Mission of the California Academy of Physician Assistants is to represent and serve PAs statewide. As an advocate of its members for quality healthcare and for their valued, unique alliance with supervising physicians, CAPA will enhance, educate and empower physician

assistants for the ultimate benefit of their patients. The CAPA mission statement above is the most recent version of the Mission Statement and was last updated in 1995. CAPA’s Mission has given past leaders a foundation in which they can make their decisions knowing that it will ultimately benefit the organization and its members. Over the last seventeen years, it has served the organization well, guiding CAPA’s legislative and regulatory efforts, our budget priorities and nurturing the progression of the profession throughout the state. Over the next year, the organization will be revisiting the work that was done at the June 2012 retreat, looking toward creating a Vision Statement. The Vision Statement will guide CAPA to a future where we continually operate under optimal conditions. The Vision Statement will work in tandem with the Mission Statement and drive future organizational decision making.

My experience as an elected member of CAPA Board of Directors is that as an organization, CAPA has always had a clear vision; one which drove the organization’s decisions and mapped out future organizational goals. As we took on the process of creating a formal vision statement, it was good to look at our past and as a group look at the goals of the organization. The most difficult part of this process was creating a statement which fully embodied the vision CAPA has known and has been carrying out for many years. I am happy to announce that after a great deal of time invested in creating this vision, the board of directors unanimously voted to adopt a new vision statement. CAPA’s vision is: Fully integrate PAs into every aspect of California’s health care. Beautifully simple, it really reaches at the core of what we work to accomplish as an organization. We want to push the barriers of PA practice while carrying out activities that will enable PAs to take on various roles throughout health care regardless of practice setting, specialty or professional role. I am proud of the effort put in by the CAPA leadership and staff as well as the results of this important exercise. I hope that this statement will provide insight for our constituents and the organizations with whom we partner. Finally, I want to again thank Roy Guizado, PA-C for leading this exercise and my fellow CAPA leaders and CAPA staff for their input and determination to take this next step in CAPA’s long term strategic planning. MAY/JUNE 2013

MIASMA (Μίασμα, Greek: Pollution) by Greg Mennie, PA-C, MSed, Director-At-Large

t takes a Scotsman, and as a fellow Scotsman, I shall lead the charge… put down that white coat, take off that tie and wash your stethoscope!

Joseph Lister, c1865

In 1867, Scotsman Joseph Lister discovered that using Phenol (Carbolic Acid), actually reduced infection rates, not only when used directly on a patient, but also when used to clean the surgical instruments. Up until that time, surgeons would walk from case to case in their own clothes often contaminated with multiple patients’ fluids and reuse the same instruments without any real significant cleaning. In fact, Lister was known to go from his dissection room into surgery wearing the same coat “stiffened with blood”.1 Before Lister’s 1867 published work, Antiseptic Principle of the Practice of Surgery, the medical community held to the idea of the miasma theory of how infections occurred. This theory held that disease was caused by “bad air” and not transferable via individuals. Fast forward to 2013; we remain challenged with the transmission of “bad air” in our clinical settings, as hospitals struggle with nosocomial infections and superbugs. It seems we may all be Lister reincarnate (pre-1867) walking about in our stiffened coats, with bacteria laden ties and dirty stethoscopes. One would be hard pressed to not see, on an everyday basis, three of the most prevalent items used in modern U.S. medicine; the stethoscope, the white coat and the tie. The AMA has created resolutions

CAPA NEWS

to develop committees to consider the issue of banning the white coat in clinical settings, but beyond that, there has been very little effort or actual decision making toward any recommendations. Despite multiple studies over the last decade showing these three everyday medical items as great harbingers of bacterial colonies, including MRSA, there seems to be a lack of willpower in the medical, administrative and scientific communities to suggest any recommendations on the proper care or need for use of these non-esssential clinical accessories. Some institutions have taken it upon themselves to make some changes. In 2008, the Scottish National Health Service banned white coats and moved to a system of color specific scrubs based on one’s role in the hospital. The Mayo Clinic requires their doctors dress in “business wear” (may include ties), but does not include the white coat. It’s unclear if Mayo does this because of bacterial colonization, or if it’s a use of “visual and experiential clues to tell a compelling story to customers”.2,3 Science? There are multiple studies in the literature citing the coat and tie as breeding grounds for bacteria but, as you can imagine, there is little in the way of cause and effect of actual transmission rates secondary to these items. When comparing a change in attire, such as the use of scrubs in Scotland, there is one study noting no significant difference in bacterial counts on scrubs vs. white coats. However, the study was also limited to just that, comparing scrubs vs. the white coat bacterial count and did not look at actual infection related rates.4 With that said, one surely could at least entertain the probability that because these items contain bacterial counts they may

directly contribute to some of the infections transmitted to our patients. We could also consider that with the exception of the stethoscope there is no appreciable benefit to the patient when it comes to the use of a white coat and tie and there is reasonable argument there may be harm. As reported in PLOS, one MRSA infection can cost a hospital $60,000.5 Hospitals have a multitude of requirements and guidelines to help reduce the spread of disease and infection, such as strict isolation precautions, provider compliance with hand washing, early catheter removal, etc. These guidelines must have something to do with the Hospital Acquired Infection decrease noted by the CDC in recent years (18% decrease in MRSA infections, 32% decrease in central line infections, 8% decrease in surgical-site, and a 6% reduction in catheter-associated urinary tract infections).6 Given the severity and costs associated with such infections, it would seem reasonable to consider other potential nidus reductions to mitigate the risk of infection spread, especially in this day of superbugs and antibiotic resistance. Why do we even wear a white coat?7 The iconic white coat for physicians had its debut in the 20th century. It was considered a costume. Up until that time, the practice of medicine was mostly associated with snake oil. The coat was used to invoke the idea of science and the new notion of medical practice moved hand-inhand to promote this more credible idea of practice. The white coat (probably not actually white, but rather beige, and in some accounts, perhaps even black) was used as a symbol for the profession not as a clinical tool. In fact, in 2010, the

British publication The Telegraph published an article that noted rumblings at the BMJ to reinstitute white coats to their physicians. In the article, the author states “some doctors believe the real motive for the NHS phasing out the laboratory-style coats, as it did in 2007, was political. They think it was an attempt by the dreaded pen-pushers in management to throw their weight around and dis-empower doctors”8. So why do we hold onto this archaic process? What clinical purpose is there in the white coat other than habit, and some unspoken hierarchy, when it seems its current unintended modern purpose is to carry around superbugs?

Why a Tie?9 This 1622 portrait is said to be the oldest known portrait of the tie, formerly known as a cravat (Ivan Gundulic (1589-1638) with his cravat in 1622).Ties, just like the white coat, have no positive clinical significance for a patient. Again, just a fashion trend that has evolved to denote some unspoken level of professionalism. There are a few potential stories as to the original purpose or creation of the tie, however, the most widely agreed upon origin of the tie’s use is from the Thirty Years War (1618-1648). It was a standard part of the Croatian soldier’s uniform, but it was Louis

the XIV who thrust the tie into its current everyday fashion trend. The King was quite enamored with these soldiers’ scarves or “cravats” and took to wearing them on a daily basis. He was sort of the Justin Bieber of his time in fashion trend setting, and it spread across France and eventually the globe. Regardless of the tie’s origin, we no longer run around with buggy whips, nor do we walk from surgery to surgery in the same blue blood stiffened coat. How far do we go? Stethoscopes are also colonized with bacteria10, but there is a much better argument for stethoscopes being a clinical necessity as compared to white coats or ties. Perhaps developing guidelines of frequent cleaning of our stethoscopes, just as we’ve developed guidelines for strict isolation protocols in hospitals, can be adopted to reduce its’ fomite capacity. One must also realize that white coats and ties can’t be wiped down during the work day and are rarely washed on a regular basis. However, scrubs, as a general rule, turn over very frequently, as do our usual non-tie accessorized business attire. Most studies don’t track continued growth of the colonies, but rather just the day’s growth. A recent study from 2011 looked at white coat vs. uniform bacterial counts, but again only in an 8-hour period. This study also looked at washing frequency and found that there was no significant difference on the effect of colony counts on provider wrists based on the frequency of washing. The researchers noted that to have any measurable impact on colony counts one would have to change clothing throughout the day and bacterial contamination occurred within hours of donning newly laundered uniforms.4 Since there is a difference earlier in the day regarding

actual counts between garments, then perhaps we should look at the significance of the bacteria over time on garments washed infrequently or not changed out. Admittedly, if we are to try and discover actual cause and effect we have to look at true transmission, thus we can only hypothesize what the impact may be. While colony counts may be the same over the work day between garments and not significantly different based on washing frequency, other variables such as how often a garment comes in contact with a patient, have not been looked at. The structure of the white coat with long sleeves obviously has a higher chance of coming into contact with the patient, but whether that infers transmission higher than short sleeve scrubs one can only speculate. Medicines’ “Hanging Chad” There are studies looking at higher potential contact patient items and higher counts of colonized bacteria. What about badges, and pens and everything else we use in health care. Not all the items we use in our daily routine have been studied but we realize our environment is “cleandirty” and not all items come in contact with the patients. There are some studies looking at the bacterial counts on lanyards and badges worn by health care workers, with lanyards having the highest bacteria count out of the two.11,12 One could extrapolate that just like ties, lanyards hang down and cross patients and objects throughout the clinical setting at a higher rate than badges, thus show higher counts, which in turn may cross infect at higher rates. Perhaps this is more empirical evidence to look at hanging objects, such as ties and long sleeves and actual transmission. Continued on page 26

MAY/JUNE 2013

Prescription Drug Abuse – Is Rescheduling Hydrocodone the Answ by Jeremy A. Adler, MS, PA-C, Vice President

ver the last number of years, thefts and burglaries? As one quickly more and more discussion realizes, and this list certainly is not has revolved around the issue exhaustive, the problem is multiof prescription drug abuse in the dimensional and amorphous. It is United States. These conversations almost a problem that could be are occurring in the general pubdescribed as “you know it when you lic, patients, health care providers, see it.” regulators, lawmakers, law enforcement, manufacturers and the media. Since defining the problem is elusive, Depending on one’s viewpoint, many “fixing” it is incredibly challenging. passionate opinions have emerged as Many different approaches have to the cause, prevention and solution been proposed, implemented and are pending. Many have expressed for the problem concern that there are not clear that the White objectives or measurements to see House Office of if the interventions actually have National Drug The medical record of any Policy has called the intended effect. In an effort patient cared for by a physician the “biggest to resolve one problem, are others assistant for whom the public health created? Programs have targeted issue facing improving provider education as a physician assistant’s Schedule our times.”1 A key component to reducing prescripII drug order has been issued or key challenge tion drug abuse. The Food and Drug carried out shall be reviewed Administration (FDA) has mandated has been to Risk Evaluation and Mitigation just define the and countersigned and dated Strategies (REMS) programs to problem. Is the by a supervising physician and create a number of education efproblem only surgeon within seven days. forts for providers, pharmacies and that Americans patients (www.ER-LA-opioidREMS. are dying from com). Additional requirements for overdose? Are (California Business and Professions some medications include patient the overdoses Code 3502.1 (e)) registries and centralized pharmacies. from single Interestingly, short acting opioids, medications or including hydrocodone (recognized in combination as the most abused opioid), have with other prescription medication, alcohol or illegal drugs? Was the drug been excluded from REMS. One can always argue that the better we legally obtained for an “approprieducate our health care workforce, ate” and “legitimate” condition? Was the better and more appropriate the it prescribed and monitored by a care can be provided. Unfortunately, health care provider? Are the deaths government data reports that over actually poisonings by the drug, or 80% of the prescription medications was the drug just present at the time of death? Is the problem that young taken non-medically were acquired illegally by the user. Also, limited people have been taking prescripevidence exists for how opioids tion medication non-medically at an increased rate and younger age? Have should appropriately be used and what are legitimate medical condihealth care providers left legitimate tions.2 Based on government funding medical practice and turned into “drug dealers?” Do we track admispatterns of clinical pain research, it sions to detoxification and drug treat- is unlikely that quality evidence will ment facilities? ER visits involving be emerging any time soon. Other medication related issues? Pharmacy approaches have included scheduling 8

CAPA NEWS

and rescheduling of commonly abused medications. The Controlled Substances Act of 1970 established five schedules of controlled substances spanning from no medical purpose and a high level of abuse (Schedule I) to a low level of abuse (Schedule V). Carisoprodol (Soma®) was rescheduled to a Schedule IV federally controlled substance in 2012 over concerns of abuse. A number of states have scheduled tramadol as a controlled substance as well. The current topic is surrounding rescheduling hydrocodone from a Schedule III to a Schedule II. Somehow lost in the discussion about prescription drug abuse has been the need for access by appropriate and legitimate patients. Pain relief and improved quality of life in those suffering chronic pain appears to be less of a priority than the problems of drug abuse. Let’s be blunt, chronic pain has its own morbidity and mortality. Pain can be life threatening, unmanageable pain is a significant cause of suicide. Untreated pain also results in loss of productivity, high health care costs and a whole host of comorbidities. When considering policies, programs and regulations around prescription drug abuse, one must be cognizant of the unintended consequences. Earlier this year, the FDA convened an advisory panel to make recommendations about hydrocodone. The majority on the panel recommended moving hydrocodone from a Schedule III to a Schedule II controlled substance in all forms. Hydrocodone is currently only Schedule III if it has less than 15mg of hydrocodone per unit dose. This change in scheduling would certainly have far reaching impact. Hydrocodone is the most prescribed medication in America,

wer? and Americans use 99% of the world’s hydrocodone. The Centers for Disease Control (CDC) has published that enough hydrocodone is dispensed in the US to provide every adult in the country 5mg every 4 hours continuously around the clock for 30 days.3 As the FDA and Drug Enforcement Administration (DEA) are considering the recommendations of the advisory panel, US Congress has submitted legislation, which if passed, would mandate the scheduling change. United States SB 621 (Manchin) and HR 1285 (Buchanan) called the Safe Prescribing Act of 2013 has tremendous support by elected officials. Does scheduling effect our profession as PAs in caring for patients? Are there PA specific unintended consequences? Although California’s PAs have the ability to register for Schedule II privileges with the DEA, more than a dozen states do not authorize PAs to write for Schedule II medications (Figure 1). PAs in those states without Schedule II authority will not be able to provide hydrocodone. Also, Schedule II medications have a higher administrative burden,

they require a written prescription (no phone/fax prescriptions outside of a 72 hour emergency supply with follow up paper prescription), and no refills can be placed. Schedule II medications are generally more expensive from increase regulation and typically require greater health care encounters resulting in the need for increased health care manpower and increased costs for patients. Also, appropriate prescribing may be jeopardized by clinicians not willing to manage the increased regulatory scrutiny. California does have some restrictions for controlled substances, for example PAs must obtain patientspecific approval from their supervising physician before providing a patient with a controlled substance. Assembly Bill 3 in 2008 does allow a PA who has taken an approved Controlled Substance Education Course, passed an exam and has the authority delegated to them by their supervising physician to remove this requirement. PA supervision is additionally affected. In California, PA regulations require that 100% of all chart notes for Schedule II drug orders be cosigned by the supervising physician. It can be anticipated that

Figure 1: Physician Assistant Scheduled Drug Authorization by State

SOURCE: Drug Enforcement Administration, January 9, 2013 http://www.deadiversion.usdoj.gov/drugreg/practioners/mlp_by_state.pdf, Accessed 5/8/13

PAs may seek alternative medications because of the administrative challenges. Other medications potentially substituted may include codeine, tramadol, NSAIDs, benzodiazepines or other Schedule II opioids that may be more affordable, i.e. methadone. All of these substitutions carry risks of their own: (1) codeine may have no effect in up to 10% of patients based on poor metabolism at the cytochrome P450 enzyme CYP2D6, and with limited efficacy, could result in increased consumption and overdose, (2) tramadol may cause seizures and serotonin syndrome, (3) NSAIDs have significant warnings regarding bleeding, gastrointestinal ulcers, cardiovascular disease and stroke, (4) benzodiazepines can cause overdose, addiction and are used non-medically by abusers, and (5) if cost drives prescribers to use methadone, increased deaths can be expected. Methadone accounts for only 2% of opioids prescribed, but has been implicated in nearly 40% of single-opioid deaths. One may reasonably predict that rescheduling of hydrocodone will result in a decreased utilization of this medication, but there is no assurance it will be less abused. Does a drug schedule offer protection from abuse? Oxycodone and OxyContin® have always been Schedule II, and currently oxycodone is more commonly abused than hydrocodone. Surprisingly, when looking at emergency room visits related to opioids from the Drug Abuse Warning Network, the Prescription Drug Research Center reported that although the volume of hydrocodone exceeded the combination of all Schedule II drugs reported, it ranked 10th in health consequences in the emergency room. Continued on page 20

MAY/JUNE 2013

New Professional Reporting Requirements 2013 By Bob Miller, PA, Professional Practice Committee Chair

n the last November/December issue of the CAPA News I had mentioned a group of existing reporting requirements for some professionals which were now being applied to physician assistants. This existing group of laws has become to be known as the 800 series of law found in the Business and Professions Code (B&P). Our newly named Physician Assistant Board (PAB) (formerly the PAC) has posted approximately seven pages of explanation regarding the “Five major sections include 800 series laws and how they will now be applied to our reporting requirements profession. PAs and other related stakerelated to (1) medical holders must now be in compliance or risk malpractice, (2) criminal possible significant enforcement action.

convictions and (3)

This article is meant to only highlight some of the content of these new responalong with reporting sibilities and will not cover these toprequirements for (4) ics in depth. Every PA should become coroners and (5) court familiar with these laws and if you find clerks.” that you are in a situation related to any of these potential reporting responsibilities you should read the laws and seek valid information regarding your particular situation and consider consulting reliable legal counsel if necessary. Remember, reporting an action against you does not necessarily lead to further enforcement as an outcome. Cases are usually considered on their individual merit and underlying circumstances and may not lead to further disciplinary action against the PA.

peer review reporting,

CAPA NEWS

The purpose of this article is to make you aware of these responsibilities and to inform you where you can find the information. Explanation regarding these laws can be found on the PAB website under the “Licensees” tab titled “Professional Reporting Requirements”. This section also includes links to further information. The following italicized quotations in this article were excerpted from that website. The PAB website is found at www.pac.ca.gov. The website explanation begins with this quote: Effective January 1, 2013, the professional reporting requirements of Business and Professions Code sections 801.01, 802.1, 802.5, 803, 803.5, 803.6 and 805 apply to Physician Assistants. Reports must be submitted in writing regarding certain malpractice settlements, arbitration awards or civil judgments, as well as certain criminal charges and convictions. For your convenience, you may use the forms provided by Medical Board of California to report the appropriate information and, based on a cooperative agreement, you may submit the forms either to the Physician Assistant Board or to the Medical Board of California. Five major sections include reporting requirements related to (1) medical malpractice, (2) criminal convictions and (3) peer review reporting, along with reporting requirements for (4) coroners and (5) court clerks. Medical Malpractice Reporting may: … apply to professional liability insurers, self-insured governmental agencies, physician assistants, physicians and/or their attorneys, and employers. This section goes on to briefly explain how the PA may require reporting even when settlements are brought

against the medical group or corporation and also when a PA is named in a medical practice case which occurred in another state. It discusses issues of award apportionment regarding settlements and judgments and the potential for public disclosure. And this section answers the question of what happens when a report is filed with the PAB or Medical Board: Pursuant to an agreement between the boards, Medical Board of California staff in the Central Complaint Unit review all information provided to determine whether a violation of the Physician Assistant Practice Act or the Medical Practice Act may have occurred. If it is referred for investigation, each named physician assistant is given an opportunity to respond. Reporting of criminal convictions may include indictments, a felony or a misdemeanor. This also explains other B&P Code sections which may apply to unprofessional conduct and offenses related to the function of a PA. Another question which is often posed to the PAB is answered: The Board frequently receives questions about how a criminal conviction might affect a physician assistant’s license to practice medicine. The question is not as straightforward as it would appear because every situation is different and is evaluated on a case-by-case basis. For these reasons, the Board will not provide any legal advice to either the physician assistant or his/her legal representative. And: A conviction that may not, at first glance, appear to be substantially related to the qualifications, functions or duties of a physician assistant, may, under closer scrutiny, be

revealed to be otherwise (e.g., reckless driving, DUIs, and sex crimes). All information related to the criminal case is considered, such as when the arrest occurred; the circumstances surrounding the arrest; any previous history of arrests or convictions; and the physician assistant’s compliance with the court’s terms and conditions. Peer review reporting discusses the responsibilities to report when certain restrictions, denials or termination of privileges are placed on an individual PA’s practice in health facilities or other practice settings. Investigations may be required when restrictions or rejections are imposed for a medical

disciplinary cause. The “805 report” is discussed in length and the failure to file this report may result in large fines. The Coroner has responsibility to report when a death may be the result of negligence or incompetence on the part of the professional medical provider.

Thank you to the Physician Assistant Board for highlighting these new requirements on their website and making this information easily available for California PAs. 

Find more information at www. pac.ca.gov. Find the “Highlights” section in the center of the home page and click on “Professional Reporting Requirements”

Court clerks must report: … certain judgments for death or personal injury or criminal convictions to the appropriate licensing agency. For a physician assistant, those acts must be reported to the Physician Assistant Board or the Medical Board of California.

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* Saturday, August 17, 2013 UC Davis Education Building 4610 X Street, Ste 2128 Lecture Hall 1222 Sacramento, CA 95817

Wednesday, October 2, 2013 Renaissance Palm Springs (preceding the CAPA Conference) 888 E Tahquitz Canyon Way Palm Springs, CA 92262

Sunday, February 23, 2014 Napa Valley Marriott 3425 Solano Ave Napa, CA 94558 (707) 253-8600

*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.

MAY/JUNE 2013

It’s Time… After Almost 18 Years, I am Stepping Down as a CAPA Leader by Larry Rosen, PA-C, Director-At-Large

n 1957, I graduated from the University of Michigan. It was a proud, exciting time in Ann Arbor; Inter-Fraternity Council member, Tau Delta Phi board leader, campus activist, U of M television producer/director (I even did television on-air color for a Homecoming parade. Terrifying experience.) Lifelong friends were made there, friends I still see today, some 56 years later. My time in Ann Arbor shaped my life, directed the course of my future in so many ways; cherished memories of the “maize and blue,” leaps of personal growth and confidence; a happy, evolving journey. In my closet hangs a thread-worn Michigan jacket. A sleeve is torn. The Michigan lettering is faded. I wore it for many years, ever proud to be a Wolverine. And always fun to share a “Go Blue!” with strangers on a street who saw the jacket and hailed a member of an awesome family. Today, that jacket hangs retired in my closet. Time has taken its toll on the fabric and regrettably on my BMI. The jacket no longer fits. As with CAPA, “to everything there is a season.” My time with this

CAPA NEWS

organization has been fruitful, life changing. But the jacket no longer fits. The Academy landscape is changing and, in my opinion, not always for the better. But growth is not without growing pains. The debates that give birth to progress are heated and illuminating. None of us were elected to the board to simply agree with one another. Rather, we are charged with bringing to the table ideas and energy shaped by experience and a passionate commitment to advance our profession. All of us share that passion. All of us want what is best for our members. We may have disagreed on priorities or a course to follow but the zeal for betterment was and remains unwavering. There are new faces on the board; good-minded, dedicated people who will work hard to fulfill CAPA’s mission. The Patient Protection and Affordable Care Act will forever change the medical landscape of California. There is a crushing need for more PAs to embrace primary care as a specialty. Preceptor sites to train future PAs are in woefully short supply. The physician-physician assistant team practice model needs constant attention through promotion

and implementation. Scope of practice and reimbursement issues that prevent PAs from practicing at the top of their licenses are being addressed and will continue to call upon the best efforts of the CAPA board to protect and grow our profession. I trust that the current CAPA leadership will continue their role as honored members of the debate on these and all other issues that impact the PA’s leadership role in advancing quality medical care for our patients. I am proud of my years with CAPA. They were filled with innovation. We made great strides in promoting the profession, both in the patient and physician communities. Our celebrated conferences remain the best in the country. Our legislative achievements are a model for all state chapters. CAPA leaders, past and present, continue to contribute at the highest levels to the ever-changing continuum of health care in our state and in our nation. Through deeds and personal exceptionalism, they serve us well, every day. They deserve our respect and gratitude. For my personal service, I have been amply rewarded by CAPA. PA of the

Decade was no trifling acknowledgement to me. Humbling would be an understatement. Others thought me worthy, however, and that honor holds a special place in my heart. But more than the plaques and ceremonies, what I cherish most are the friendships I’ve accumulated over the years, lasting, deeply profound examples of the caring and support colleagues can have for one another. They have celebrated the best of times with me and held me up when I thought the falls were irreversible. The late Andy Rooney, a beloved fixture of CBS’ 60 MINUTES, once said… “I’ve learned that the easiest way for me to grow as a person is to surround myself with people smarter than I am.” I’ve been fortunate and wise enough to do just that. As I write this article at my favorite beachside café, there is a tap at the window. It is Freddi Gidan-Segal, my friend and mentor since my days as a PA student. I show her the first line of the article and we spend the next hour reminiscing about CAPA days; the PSAs, the Doc-to-Doc dinners,

countless public relations projects that made us all proud to be physician assistants. As I do with so many other friends, Freddi and I share a warm, comfortable history together; professional successes and disappointments all bundled together to weave an enduring, affectionate canvas of memories.

that they will build strong leaders and make them know that their voices are welcomed and respected. Experienced leaders can be intimidating to the newly initiated. New leaders will often need encouragement to speak out and they should be given it in large doses. Wonderful things can happen when a welcome door is held open.

To say that CAPA was my second family would be to minimize the truth. My wife, Joyce, knows too well the thousands of hours spent away in meetings, conferences, travel, retreats, not only doing the work of CAPA but having so much fun doing it. So very much fun. Some of the best times of my life. Selfishly, I loved it. As all is said and done, I will be happy, in modest payback, to have left a footprint or two behind that will be well remembered.

And I also wish to thank the CAPA members for their years of support and confidence. Many of you have come up to me to thank me for the projects I have done, the articles I have written, the things I have said that may have inspired a positive change in your lives. Sharing those feelings meant a great deal to me. Knowing the work was appreciated truly made the work joyful. I will miss that very much.

In leaving, I wish the CAPA board and staff well. My hope is that they will continue to do good and fruitful work on our behalf. That they will debate the issues with honesty and fairness. That they will listen to one another’s ideas thoughtfully. Even the bad ones may carry the seeds of something worth nourishing. Above all,

I consider myself a lucky man, blessed with the pride of achievement and a bountiful larder of fond memories and friendships. My CAPA jacket may no longer fit but it hangs, in my closet, with pride… right next to the maize and blue. 

MAY/JUNE 2013

What if each and every PA got each member of their health care team to sign the letter on the next page? What would that look like? What impact would that have on California legislators when our lobbyists walk in their office with a stack of letters so big it takes two people to carry it all? Can you picture the legislator trying to see over the stacks as we talk about the importance of physicians being able to delegate supervision of MAs to PAs? We will scan all of the letters, put the file on a thumb drive and leave it behind with legislators for their reference. Be sure to include all of the requested information at the bottom of the letter. Legislators live and die by numbers. By the amount of money they can raise, by the number of votes they receive in an election AND when legislation is before them, by the number of letters/emails/calls they receive either in favor or opposition of that legislation.

CAPA members receive Action Alerts via email so you can send a specific email to your legislator from a PA’s perspective. The letter on the next page is for other health care providers. If you work with a PA who isn’t a CAPA member, get them to join and do their part! If you haven’t renewed your membership, please do so today. We live and die by membership numbers too. California PAs need to GO BIG and get as many letters from the entire health care team as possible. Don’t let the opposition (the California Nurses Association) be more active and more vocal. SB 352 needs to pass!! Most definitely your supervising physician needs to support this so you can be as effective as possible. Help to make the physicians’ voice be heard on this issue.

Go TEAM CAPA!! With Your Efforts We Can Win This!

Act today! The letters matter. Get as many people in your practice as you can to sign the letter. Even if it is simply your supervising physician who signs it. That will matter and make a difference. To BE SURE it gets to us, please take it upon yourself to fax all of the letters to CAPA. Or, you could ask your MA to do it!! 

Winning! With Your Action We Can Win This! Read On and Act Now! Continued from page 1

In the coming days/weeks, you will see various Action Alerts in your email box. Based on the AMAZING response from previous requests for emails to legislators and comments from legislators about that tremendous response, we know when future Action Alerts are sent, CAPA members 14

CAPA NEWS

will again let their voices be heard. Keep those emails coming. They really make a difference. They have made a huge difference so far in this legislative session. THANK YOU, THANK YOU, THANK YOU…. You ALWAYS come through! We have a long way to go so keep up the great work.

We will keep you updated via email and in the next issue of the CAPA News. We hope by the CAPA Conference in October, we will be celebrating the Governor’s signature on both of our bills. 

Fill out section at the bottom and fax to CAPA at (714) 427-0324. SUPPORT SB 352 (Pavley) Medical assistants: supervision. Dear California Legislator:

I live and work in California and am a member of a health care team serving the residents of California. As a member of a health care team that includes MAs as an important part of that team, I strongly urge you to vote yes on SB 352 (Pavley) when you have the opportunity to do so.

SB 352 will allow physician assistants, nurse practitioners or certified nurse-midwife to supervise medical assistants in medical office settings. MAs are an important part of the health care team and are widely used in physicians’ offices and other outpatient settings throughout the state. The Bureau of Labor and Statistics (2011) reports nearly 82,000 MAs are employed in California. In 2001 legislation passed that allows physician assistants, nurse practitioners or certified nursemidwife to supervise medical assistants in community clinics (Health and Safety code 1204). Since SB 352 is substantially the same legislation as SB 252, the foregoing comments apply equally to the current proposal: MAs can function in physicians’ offices and other outpatient settings as safely under PA and NP supervision as under physician supervision. As further support for the safety of this proposal, to date the Physician Assistant Committee (Physician Assistant Board as of May 2013) of the Department of Consumer Affairs has not reported any patient safety issues or disciplinary action related to PA supervision of MAs in the licensed clinic settings where they are currently permitted. SB 352 would eliminate legal restrictions and barriers to efficient coordinated care by allowing physicians to delegate the task of MA supervision to a PA, NP or CNM across all outpatient medical settings where they currently function, without requiring the physician’s presence.

Given that PAs have been delegated the task of supervising MAs when the physician in not physically present in specified licensed community clinics for over a decade, it is prudent to eliminate legal restrictions and barriers to efficient coordinated care by allowing physicians to delegate the task of MA supervision to a PA across all outpatient medical settings where PAs and NPs currently function, without requiring the physician’s presence. This change is necessary if California hopes to accommodate the dramatic increase in patients expected to result from PPACA. I URGE YOUR YES VOTE ON SB 352. _______________________________ Date _________________________________________ Full name

_______________________________________________ Note if MD, DO, DPM, NP, RN, MA, other

_________________________________________ Practice City and Zip Code

_______________________________________________ Email address or phone number (print carefully)

News about the Affordable Care Act (ACA) by Roy Guizado, MS, PA-C, Director-At-Large and Student Affairs Committee Chair

merica will soon enter a revolutionary era in public health care. The Affordable Care Act (ACA), which, according to California State Senator Ed Hernandez, O.D., is known interchangeably as the Patient Protection and Affordable Care Act (PPACA) or Obamacare, will have far-reaching implications, especially as it pertains to health care access. From a national perspective, ACA means that physician assistants will be: “It is certain that PAs will Recognized as one of the primary health make an impact in the way care professionals in the U.S. today. health care is managed and Recognized as a vital component in prodelivered to all patients viding quality, cost effective delivery of healthcare. Eligible as ACA is enacted and for 10% bonus for primary care codes implemented.” through Medicare. Allowed to order skilled nursing facility care for Medicare beneficiaries. Embraced as healthcare professionals in patient-centered primary care medical homes and other new models of care designed to better coordinate care through team-based practice. The ACA will provide for extended health insurance coverage for adult children up to age 26. Also, a child cannot be denied coverage based on a pre-existing condition. ACA will continue select preventive services without cost sharing, a choice of primary care providers, the use of the nearest emergency roo, and prescription drug support for Medicare patients. At a recent a public forum held at Western University of Health Sciences, State Senator Hernandez 16

CAPA NEWS

outlined how ACA will specifically affect California, and what California is doing to comply with the ACA. Starting in January 2014, a patient cannot be denied health insurance coverage based on a pre-existing condition. There will no longer be an annual limit or lifetime limit on health insurance coverage. Gender discrimination in health care premiums will stop. Most people over the age of 18 will be required to have health insurance by law and will be penalized if they do not get coverage. The 2014 penalty will be 1% of the annual income or $95 whichever is greater, but the penalty will increase to 2.5% or $695 by 2016. Beginning October of 2013, Californians in need of insurance can purchase policies through a traditional broker or through an insurance exchange that the state is creating called Covered California. An individual making less than $15,415 can qualify for Medi-Cal at no cost. Individual making up to $44,680 are eligible for a tax credit of $2,304 that can be used to pay an insurance premium. Individuals making over $44,680 do not qualify for government subsidies or tax credits, but are still eligible to buy health insurance through Covered California. A family of four making less than $31,810 qualifies for Medi-Cal. A

family of four making up to $92,200 can receive a tax credit of $4,740 that can be used to pay an insurance premium. A family of four making over $92,200 does not qualify for government subsidies or tax credits, but are still eligible to buy health insurance through Covered California. Open enrollment for Covered California will be held October 1, 2013 through March 31, 2014. (www.coveredca.com). All health insurance newly sold to individuals and small businesses must be classified as one of the four levels of coverage – bronze, silver, gold or platinum. (See Figure 1) All health insurance sold in Covered California must include the following 10 services: • Ambulatory patient Services • Emergency Services • Hospitalization • Maternity and Newborn Care • Mental Health and Substance Use Disorders • Prescription drugs • Rehabilitative and Habilitative Services and Devices • Laboratory • Preventive and Wellness Services and Chronic Disease Management • Pediatric Services, including Oral and Vision Care

Figure 1: Health Insurance Coverage Classifications Coverage Levels Level

% Paid by Health Plan

% Paid by Patient

Platinum

Gold

Silver

Bronze

State Senator Hernandez did point out some barriers to the ACA. Access to health care is problematic, especially in rural and inner city areas. More providers must serve in these areas. He believes that Medi-Cal reimbursement rates must be adjusted so that ongoing funding is sufficient for provider networks. The scope of practice of PAs, nurse practitioners and pharmacists must be adjusted to insure that there are enough health care providers to treat the poor. He stressed that health care cost containment must be explored to include coordinated patient care and transparency. The increasing number of aging baby boomers (ages 60 and older) along with new individuals coming to California will also present difficulties in ACA implementation.

ACA is upon us and will affect all health care providers in California. California is trying to anticipate some of the ACA changes by setting up an insurance exchange, increasing MediCal reimbursement and enhancing the scope of practice of PAs. CAPA

is providing its assistance to sponsor and support legislation that enhances the PA scope of practice. It is certain that PAs will make an impact in the way health care is managed and delivered to all patients as ACA is enacted and implemented. ď Ž

MAY/JUNE 2013

The 2013 CAPA Conference…

CAPA Student Medical Challenge Bowl – Aqua CME

At CAPA, we are all about PAs and all about providing you with the most valuable and unique learning experience. We have a program filled with topics targeted to PAs and presented by dynamic speakers. More than that, the CAPA Conference is an incredible experience in and of itself. Each of you bring something special to the conference.

USC, 2012 CAPA Student Challenge Bowl Winner

You all make it unique and special and we at CAPA have a great time creating events and opportunities so you have the ultimate PA experience while learning a lot, hanging out with friends and colleagues and enjoying beautiful Palm Springs. It doesn’t get much better than that. We hope to see you in Palm Springs!

Hands-On Workshops

Your Favorite Workshops Return:

EKG Boot Camp with Jennifer Carlquist – 4 Hours on October 2, 2013 Slit Lamp: Urgent Care and ER – 2 Hours Expert Suturing – 2 Hours Suturing – 2 Hours Neurology Exam with Nancy Nielsen-Brown – 2 Hours

We’re back poolside for the Student Medical Challenge Bowl. On Saturday afternoon, just as the sun begins to set behind the mountains, the game begins. You won’t want to miss this fun, light-hearted, Jeopardystyle game show format event. PA students answer questions in order to vie for the championship title, the coveted Student Challenge Bowl Trophy and cash prize for winning program’s Student Society. It has become a highlight of the CAPA Conference and so much fun to watch (and learn). So, bring your sunglasses, have a beer, soft drink and/or popcorn (which we supply), grab a lounge chair and see who will win this year’s CAPA Student Medical Challenge Bowl

Call: 760-322-6000 You will want to reserve your hotel room early. We have a block of rooms at the Renaissance Palm Springs and the Palm Springs Hilton. Hotel rooms will sell out. New this year! Special parking and in-room internet fees for CAPA. $5 parking and $5 internet each day!

2013 Annual CAPA Conference October 3 – 6 | Renaissance Palm Springs Saturday afternoon, Greg Mennie and the CAPA All-Star Band Will Be On Hand For A PArty At The Pool!

Friday Evening at the CAPA Conference 9:00 P.M. The Dance and American PA Idol Competition The nightclubs of Palm Springs can’t compete with the PA PArty of the Year. It is the place to be on Friday night. We transform the beautiful lobby of the Convention Center into PArty Central with music that will please everyone. 2012 American PA Idol Winner, Jamie McCoy, At 10:00 p.m. our American PA PA-S with two of the Idol judges, Brian Tessier, Idol show begins. The PArty PA-C and Tim Wood, MS, PA-C continues as PAs compete and the audience votes to name the next American PA Idol. The Dance and American PA Idol Competition are included with your registration and guests are welcome to attend at no charge. There will be a cash bar. This really is an event you won’t want to miss!

APPLICATION

(Deadline August 12, 2013)

Sign U p for Id ol Today !

Name _________________________________________________ Address ________________________________________________ City ______________________________St _____ Zip ____________ I will be performing:  solo  as a duet

 as a group of____________

Which category best describes your style of singing?  Pop/Top 40  Rock  Country Western  Rhythm and Blues  Gospel  Easy Listening  Rap/Hip Hop  Jazz  Show Tunes

Enjoy the incredible concert before, during and after the Student Challenge Bowl. In case you don’t get enough dancing and music on Friday night at the CAPA Dance and American PA Idol Competition, we have more fun in store on the pool deck Saturday afternoon – a live band with PA, Greg Mennie on drums!

CAPA All-Star Band Saturday Afternoon,October 5, 2013 at the CAPA Conference in Palm Springs Our special thanks to Greg Mennie, PA-C and the band

Sunday Morning at the CAPA Conference

____________________________________________________ Title of songs (please choose 3) you would like to sing: 1) ____________________________________________________ 2) ____________________________________________________ 3) ____________________________________________________ Would you say that your voice is (don’t be modest):  Absolute perfection!  Everyone tells me I have a great voice  Just okay  Not that great, but I love to sing & get a crowd going

Scrubs and Slippers Get really comfy and wear your scrubs and slippers! Stay until the last lecture ends and you could win a set of scrubs and beautifully tailored lab coat from Medelita, sponsors of Scrubs and Slippers!

CAPA’s 37th Annual Conference in Palm Springs by Eric Glassman, MHS, PA-C, CME Committee Chair

e all know that we need to get our 100 hours of CME including 50 Category I CME to meet the NCCPA guidelines every two years. We also know that there are many, many CME opportunities out there to acquire these hours. But, you should also know that we can get those required hours, as well as have a relaxing time and some fun in the sun, every fall in Palm Springs at CAPA’s Annual Conference. Many of you know exactly what I’m talking about and if you have never been to one of these amazing conferences then I suggest you come and see what all of the excitement is about. If you have been a regular at the Annual Conference in Palm Springs, I hope you have seen the improvement in lectures, fun and activities year after year. There is no other state association’s conference that is quite like it. Last year we had over 1000

attendees and the energy, attendance numbers and fun keep growing. We have reviewed your feedback from last year’s conference and are incorporating it into another high quality Conference for you to enjoy. This year’s Conference will offer 21 hours of Category I CME Many of our top speakers will be returning for more lectures, as well as lots of new and innovative speakers with topics you will both enjoy and learn about up to-date changes in medicine. We are in the process of creating this schedule and it will again be a wellbalanced program for all P’s whether you work in a primary care setting, a specialty setting or getting prepared for the PANRE or PANCE. In addition to the high quality CME offered at our Annual Conference, we always include fun activities that make this Conference more like a mini vacation or reunion with old

classmates or co-workers. We offer six meals as part of the Basic Course conference registration. We have poolside activities Saturday afternoon with a live band and a conference highlight,“Student Medical Challenge Bow.” CAPA also hosts the always popular Dance PArty on Friday evening where you can catch up with old friends or make some new ones. Also, many of the PA Programs have alumni receptions in the evenings throughout the conference to reconnect with former classmates and instructors. Whatever brings you to Palm Springs in October, we hope to see you there. We know you have many opportunities for CME every year but this is the conference you DON’T want to miss. So, mark your calendar now and get the necessary time off of work, or just come for the weekend. This year’s dates are October 3-6. See you there! 

Prescription Drug Abuse – Is Rescheduling Hydrocodone the Answer? Continued from page 9

Balancing the needs for the person in pain and reducing misuse, abuse and diversion in our communities has no easy and obvious solutions. It will take the efforts of all stakeholders to collaboratively develop solutions through a better understanding of the issues, defining the problems, creating metrics that are trackable and using technology and innovation. The American Academy of Pain Medicine has made recommendations that I support: addressing knowledge gaps in acute, subacute and chronic pain, starting education about scheduled medications early in medical training and continuing throughout one’s career, emphasizing safety and encouraging comprehensive, multi-disciplinary care.4 In summary, regulatory changes can have a far reaching effect on patient care, health 20

CAPA NEWS

care providers and the public. CAPA does not have a formal position on whether or not hydrocodone should be rescheduled, but does want its membership to know that the unintended consequence cannot be fully predicted or ignored. Keeping hydrocodone as a Schedule III has its own set of concerns and problems as well. CAPA has been leader in training the PA workforce in California on appropriate controlled substance management through the Controlled Substance Education Course. Over half the PA workforce has attended this course and received the latest information from clinical practice guidelines. CAPA continues to stay abreast of the issues affecting our membership, patients and communities. 

Endnotes: 1 Michael Botticelli, Deputy Director of the White House Office of National Control Policy, February 21, 2013, Joint Forum to Promote Appropriate Prescribing and Dispensing, Medical Board of California and California Board of Pharmacy, San Francisco, CA 2 Chou, R. et al. Opioid Treatment Guidelines: Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. J Pain. 10(2): pp 113-130, 2009. 3 Centers for Disease Control and Prevention (CDC). Vital signs: overdoses of prescription opioid pain relievers---United States, 1999--2008. MMWR Morbidity and Mortality Weekly Report. 2011;60(43):1487-92. 4 A Position Statement from the American Academy of Pain Medicine: American Academy of Pain Medicine Comments on Rescheduling Hydrocodone: Patient and Public Health Considerations. 2013.

Building a Pipeline by Michael Estrada, PA-C, MS, DHSc, Committee on Diversity Chair

study conducted by the Institute of Medicine (IOM) suggests that minority health professionals are the answer to eliminating health disparities in vulnerable populations. California is currently experiencing a shortage of health professionals that include an uneven distribution of health care workers, changes in educational programs and curriculum, scope of practice laws and reimbursement for professional services (Coffman, 2012). By 2014, there will be an increase in demand for health care professionals in all of California and throughout the nation especially in primary care. The “Physician assistants, in impact of these chalparticular, have a relatively lenges will have a detrimental effect on health care and the large proportion of their health care workforce.

members practicing in

The good news is physician assistants (PAs) nationwide are practicing in communities with a high rural and medically underserved areas proportion of low-income and California has the highest numbers or minority residents of PAs working in vulnerable popula(Coffman, 2012).” tions (Grumbach, Mertz, Coffman, & Palazzo, 2003). Overall a higher proportion of non-physician primary care clinicians practice in underserved areas and care for large numbers of minority patients and patients who are Medicaid beneficiaries or uninsured. Physician assistants, in particular, have a relatively large proportion of their members practicing in rural communities, and in communities with a high proportion of low-income or minority residents (Coffman, 2012).

rural communities, and in

But in order to continue to meet the need of primary care, especially in vulnerable populations, recruitment, retention and matriculation of minority health professionals has to become a passion that ensures success among those interested in the PA profession. In essence, we need to create a pipeline that will identify, track and support minority students from underserved regions with the hope that they return to practice after graduation to their respective communities. In theory, a pipeline from primary to secondary to post secondary education training and finally to professional training, channels the flow of a diverse and talented stream into the health care workforce (Sullivan, 2004). To guarantee that there is equal flow throw the pipeline, a genuine and objective assessment must be made and understood as to why, even by today’s standards, race and ethnicity still act as a barrier for access to health care and health care education. Some of the challenges met by minorities pursuing health care pathways include a lack of educational resources, disparities in learning outcomes especially in reading and in math, low high school graduation rates, low aspirations, a perception among minority youth that education is of little value and most importantly, a significant lack of rolemodeling and mentoring (Sullivan, 2004).

Diversity is a key to excellence in health care. In order to achieve that vision, care must be provided by a well-trained, qualified, and culturally competent health profession workforce that mirrors the diversity of the population it serves (Sullivan, 2004). The creation of a mechanism, a pipeline that will flow throughout California to enable students of diverse backgrounds, from diverse communities to gain access and join the PA profession can provide both an answer and a solution to the health care dilemma that is rising in California.  Works Cited

Coffman, J. (2012). California Program on Access to Care White Paper: Impact of National Health Care Reform on California’s Demand for Health Professionals. San Francisco: California Health Workforce Alliance. Grumbach, K., Mertz, E., Coffman, J., & Palazzo, M. (2003). Who is Caring for the Underserved? A Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington. Annals of Family Medicine , 97-104 . Sullivan, T. (2004). Missing Persons: Minorities in the Health Care Professions. College Park: The Minority Health and Health Equity Archive, University of Maryland.

The changing landscape in PA education coupled with the increased need for primary care providers and the shortage of minority health professionals will undoubtedly have an impact on health care and the health care work force. Our focus should always be on excellence and providing high quality health care and health care education. MAY/JUNE 2013

Improving Health Literacy Improves Patient Outcomes

magine this, one morning you see a new patient, whom you diagnose with hypertension. You provide education, including how to take his antihypertensive medications, and send him on his way. Late the next day, you get a call that your patient ended up in the Emergency Department (ED) because he overdosed on his medication, taking six pills instead of two. His family wants to sue you for not giving him the right instructions. You recall that talking with the patient, he shook his head “no” when you asked, “Do you have any questions?” What happened in this situation? The answer is that like many health care providers, you probably overestimated the patient’s health literacy. According to a 2003 report from the Department of Health and Human Services (the most

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recent available data), only 12 percent of U.S. adults have “proficient” health literacy, meaning they can understand and use health information effectively, and more than a third have a basic or below basic level. That translates into millions of people in the United States who don’t understand the vital health information we give them. Such lack of knowledge can be deadly. A 2011 report from the Agency for Healthcare Research and Quality (AHRQ) found that low health literacy is linked to poorer health status and a higher risk of death. It can also result in communication failures that lead to adverse events and potentially, the courtroom. To change this paradigm, PAs need to recognize the issue of health literacy and use tools and patient-friendly education materials to help ensure comprehension.

You’re “on-call” 24/7. Make sure your malpractice coverage is too.

A “Universal” Resource You can’t tell a patient’s health literacy by looking at him or her. That’s why the North Carolina Program on Health Literacy says that just as we use universal precautions to prevent spread of blood-borne disease for all patients, we need to use health literacy universal precautions for all patients. The North Carolina program developed the Health Literacy Universal Precautions Toolkit, available as a free download at www.nchealthliteracy.org/toolkit. The toolkit, commissioned by the Agency for Healthcare Research and Quality, includes steps that health care providers can easily implement in their practice such as selecting provided tools, applying them and assessing how effective they were in the interaction Continued on page 23

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

CAPA NEWS

New Enrollment Required By Medi-Cal by Teresa Anderson, MPH, Public Policy Director

s a result of the Patient Protection and Affordable Care Act (ACA), some providers in California are now required to enroll in Medi-Cal for the sole purpose of ordering, referring or prescribing to Medi-Cal beneficiaries. Effective January 1, 2013, eligible providers, including physician assistants, are required to enroll in MediCal as Ordering/ Referring/Prescribing (ORP) providers. Questions? ORP providers are health care providers Please contact: who only order, refer Provider Enrollment Division or prescribe to covered beneficiaries, but Phone (916) 323-1945 do not submit claims Internet Address: for their services.

http://www.dhcs.ca

The new federal regulations prompting this change include 42 Code of Federal Regulations (CFR) Section 455.410 (b), which mandates that the “State Medicaid agency must require all ordering or referring physicians or other professionals providing services under the State Plan or under a waiver of the

plan to be enrolled as participating providers,” and 42 CFR Section 455.440, which mandates that the “State Medicaid agency must require all claims for payment for items and services that were ordered and referred to contain the national provider identifier (NPI) of the physician or the other professional who ordered or referred such items or services.” The State of California has enacted laws that conform to the new federal regulations. Welfare and Institutions (W&I) Code, Section 14043.1(b)&(o) requires the enrollment of ORP providers as participating providers in Medi-Cal. Additionally, W&I Code, Section 14043.15(b)(3) requires that the NPI of the ORP provider must be listed on the reimbursement claim form from the provider to whom the ORP referred. Providers, including physician assistants, who are already enrolled in Medicare or Medi-Cal, with an individual (Type 1) NPI, do not have to enroll as ORP providers. However, those providers who serve Medicare or Medi-Cal patients and who are

not enrolled in either program with an individual (Type 1) NPI, must enroll with Medi-Cal as an ORP provider. Providers affected by this new requirement include physician assistants who are employed by federally qualified health centers, rural health clinics, tribal health clinics and community clinics. For additional information regarding enrollment as an ORP provider, please see the provider bulletin, Medi-Cal Requirement for Ordering/ Referring/Prescribing Providers Forms and Procedures, located on the Department of Health Care Services (DHCS) website at http://files.medical.ca.gov/pubsdoco/Publications/ masters-other/provappsenroll/PED_ November2012_21036_3.pdf. The Medi-Cal Ordering/ Referring/Prescribing Provider Application can be found at http://files.medi-cal.ca.gov/ pubsdoco/Publications/mastersother/provappsenroll/23enrollment_ DHCS6219.pdf. 

Improving Health Literacy Improves Patient Outcomes Continued from page 22

with the patient. Tools include a reminder of key communication strategies and a handout of systems patients can use to keep track of their medications. Ensure your patients understand the information you provide to increase patient safety and reduce the likelihood of a possible lawsuit.  Source: North Carolina Program on Health Literacy. Health Literacy Universal Precautions Toolkit. http://nchealthliteracy.org/toolkit. Accessed Feb. 10, 2012.

Resources: Health Literacy Interventions and Outcomes: An Update of the Literacy and Health Outcomes Systematic Review of the Literature. 2011. http://www. ahrq.gov/ clinic/tp/lituptp.htm. Accessed Feb. 10, 2011. The Joint Commission. Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals. Accessed Feb. 6, 2012.

This risk management information was provided by Healthcare Providers Service Organization (HPSO), the #1 provider of professional liability insurance for over 1 million healthcare professionals, and is now offering the same quality coverage, financial strength and level of service to Physician Assistants. The professional liability insurance policy is administered through HPSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an email to service@ hpso.com or call 1-800-982-9491. www.hpso.com.

MAY/JUNE 2013

Shadowing: The Catch 22 of the PA Profession by Anthony Gauthier, PA-C, ATC, Director-At-Large and Public Policy Committee Chair

ave you ever let an aspiring physician assistant shadow you?

If you answered “yes,” I commend you and thank you for helping to strengthen the future of our profession. For those who answered “no,” I understand and am aware of the roadblocks (personal or corporate policy) that prevent you from wanting or having a shadow. In its essence, shadowing is allowing one to be a fly on the wall in the room. They should not interact or be in anyway involved in the treatment of a patient. The shadow should focus on observing the way you interact with the patient. While reviewing requirements for admission to PA schools, I learned having hours shadowing a PA is either a program requirement or strongly recommended. Most programs do not have a designated number of shadow hours required,

but the undertone is that the more one has the better. However, there are programs with a required number of shadowing hours. On one occasion, after shadowing me, a student handed me a document on program letterhead to sign, verifying he spent 4 hours shadowing me. In addition, CASPA has a location to record the number of hours spent shadowing a health care professional. Reflecting back on my personal journey to PA school, I was fortunate enough to be able to shadow various PAs working in a variety of sub-specialties. The keyword here is fortunate. I had a family friend who was a PA and she was kind enough to let me shadow her on numerous occasions. Also, my uncle, a registered nurse, was working in a busy hospital ER at the time I was considering PA school and he was able to get me time shadowing PAs working in the ER. Notice a trend? I was able to shadow because of the people in my network. What if one does not

have the contacts to gain shadowing experience from a PA? This, my colleagues, is what I hear from aspiring PAs on a routine basis. The Aspiring PA’s Dilemma: “To get into PA school I need to shadow a PA, I do not know or have contacts with any PAs. Therefore, I cannot become a PA.” You may think this is preposterous and that one can get into PA school without shadowing a PA. However, this is the perceived notion and many go to great lengths to shadow anyone for any amount of time. If there is an opportunity to shadow a PA in Los Angeles but they live in Riverside, a Pre-PA won’t even give it a second thought, they will make it happen so they can get the shadowing hours and experience. What is the solution? This is where the Catch 22 gracefully enters stage left. As a practicing PA with an interest in helping potential PAs, I have heard the proposed solutions in Table 1

CAPA’s 37th Annual Conference October 3-6, 2013

Optional Workshops, October 3 and 5

Controlled Substances Education Course

October 2, 2013 – Prior to the CAPA Conference 24

CAPA NEWS

from aspiring PAs and my current PA colleagues. As a profession we may never develop a solution which satisfies both the Pre-PA and practicing PAs.

Why spent the time worrying about this when one is already a practicing PA? • The gratification that you get when you receive a call from a prior shadow informing you they were accepted into PA school.

• The joy in their voice as they thank you for the help and guidance along the way. 

Table 1: Proposed Solutions Proposed Solution

Outcome

PA Programs could de-emphasize the importance of shadowing.

Students would not have a strong understanding of PAs’ daily tasks and the role PAs play in medicine.

Aspiring PAs can reach out and contact local PAs for possible shadowing experience.

This act of “cold calling” can result in rejections and potential negative feedback from PAs.

More PAs could allow students to shadow them.

PA might get behind in clinic. Patients may feel uncomfortable with a stranger in the room. Patient’s confidentiality may be breached. Clinic policy prevents the option of shadowing.

Hospitals could allow volunteering Pre-PAs to shadow after they completed X number of hours.

Patient confidentiality, HIPAA, general liability have precedence and become a major roadblock.

Websites created to connect potential PAs to shadow current PAs. (examples: PAshadowonline.com and capanet.org)

PAs signed up to shadow become inundated with emails or phone calls to the point where they take themselves off the list.

University Pre-PA clubs make connections with local practicing PAs.

Allows students to create a network of PAs they can reach out to.

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.

The CAPA Conference Planning Committee comprised of CAPA members who help us identify gaps in medical knowledge of PAs working in various practices/specialties. Once we identify the needs of our potential audience, we will come up with lecture topics. We will then need to find exceptional speakers to address those topics. We are very discerning in our speaker selection which makes for an excellent program and ensures a quality conference for those who attend. This is no easy task, but with the help of every CAPA member, it is manageable. If you know of an exceptional speaker; one who is knowledgeable, entertaining and engaging, please let us know. We will add them and their lecture topic to our list. Once our conference program topic “wish list” is developed, we can start to match speakers with topics. Your help is invaluable. We hope you will take a moment, throughout the year as you hear speakers to let us know the names of the ones you enjoyed and learned the most from.

Please give us a call or send us an e-mail! Email: capa@capanet.org Phone: (714) 427-0321 Fax: (714) 427-0324

Thank you and we hope to see you at the CAPA Conference on October 3-6, 2013 MAY/JUNE 2013

MIASMA (Μίασμα, Greek: Pollution) Continued from page 7

Greg Mennie, PA-C, MSed

RNIA ALIFO

ACAD

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CIAN

I am not aware of any positive effect white coats and ties have on our patients and, in fact as the literature demonstrates, they may actually cause harm. At what point do we accept that change is a good thing. Lister was mocked when he first proposed some of his thoughts, and yet, it is now the standard of care. I’ll admit that there is no easy answer or definitive study to help us solve this issue, and as clinicians, we should always strive for the first rule of do no harm and consider erring on the side of that tenet. I don’t believe we will see the “medical system” adapt any sweeping change with regard to ties and white coats in the near future. Old habits are hard to break no matter how many problems they may contribute to. Just remember, wipe and clean frequently, because when we put on our white coat and tie, we also put on Alcaligenes species, Coagulase-Negative Staphylococci (CNS), Vancomycin-Resistant Enterococci (VRE), Escherichia coli, Pseudomonas aeruginosa, Diphtheroid, Methicillin-Sensitive S. aureus, MRSA and Enterococcus faecalis.12 

2. Berry L. Bendapudi N. Clueing in Customers. Harvard Business Review. February 2003.

References 1. Louis, Fu Kuo-Tai. Great Names in the History of Orthopaedics XIV: Joseph Lister (1827 e 1912) Part 2. Journal of Orthopaedics, Trauma and Rehabilitation. 2011;(15): 30-38.

7. Chen A. Why Do Doctor’s Wear White Coats: Because they say science. Slate Web site. 2009. Available at: http://www. slate.com/articles/news_and_politics/ explainer/2009 /06/why_do_doctors_wear_ white_coats.html. Accessed April 22, 2013.

ASSIS

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nia Califor tant’s n Assis Physicia ing Physician’s pervis k and Su andboo Legal H no, Jr. ael Scara LLP R. Mich Lardner Foley & ral Counsel CAPA Gene

THIRD

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3. Banning Doctors White Coats. Medi-Threads website. 2010. Available at: http://medithreads.com/americanmedical-association-considers-banningdoctors%E2%80%99-white-coats/ . Accessed April 23, 2013. 4. Burden M. Cervantes L. Weed D. Keniston A. Price C. Albert R. Newly cleaned physician uniforms and infrequently washed white coats have similar rates of bacterial contamination after an 8-hour workday: a randomized controlled trial. J Hosp Med. 2011 April; 6(4): 177–182. Published online 2011 February 10. doi: 10.1002/jhm.864 5. Anderson DJ, Kaye KS, Chen LF, Schmader KE, Choi Y, et al. (2009) Clinical and Financial Outcomes Due to Methicillin Resistant Staphylococcus aureus Surgical Site Infection: A Multi-Center Matched Outcomes Study. PLoS ONE 4(12): e8305. doi:10.1371/journal.pone.0008305 6. National Targets and Metrics. Monitoring Progress Toward Action Plan Goals: A Mid-Term Assessment. U.S. Dept. of Health and Human Services Web site. 2012. Available at: http://www.hhs.gov/ash/ initiatives/hai/nationaltargets/index .html. Accessed April 23, 2013.

8. Brown A. Is it time the NHS brought back white coats for doctors, whatever the bossy managers say? The UK Telegraph Web Site. 2010. Available at: http://blogs.telegraph.co. uk /news/ andrewmcfbrown/100052649/is-it-timethe-nhs-brought-back-white-coats-fordoctors-whatever-the-bossy-managers-say. Accessed April 22, 2013 9. Kay S. How did we start wearing neckties? North by Northwestern Web site. 2011. Available at: http://www. northbynorthwestern.com/ story/ how -didwe- start -wearing-neckties/. Accessed April 21, 2013. 10. Russell A, Secrest J, Schreeder C. Stethoscopes as a source of hospital-acquired methicillin-resistant Staphylococcus aureus. Journal of Perianesth Nurs. 2012; 27(2):827. 11. Kotsanas D, Scott C, Gillespie EE, Korman TM, Stuart RL. What’s hanging around your neck? Pathogenic bacteria on identity badges and lanyards. Med J Aust. 2008;188:5-8. 12. Abuannadi M. Neckties for Physicians: Rethinking the Practice With Resistant Infections on the Rise, a Professional Tradition Should Take a Back Seat. Infectious Disease Special Edition Web site. 2011. Available at: http://www.idse.net/ ViewArticle. aspx?d=Bacterial+Infections %2F+MRSA&d_id=211&i=May+2011&i_ id=727&a_id=17033

Third Edition of the California Physician Assistant’s and Supervising Physician’s Legal Handbook*

ichael Scarano, Jr., Esq. authored the California Physician Assistant’s and Supervising Physician’s Legal Handbook. Newly updated, it answers scores of questions in a concise, clear fashion, with citations and appendices that will permit practitioners to read the operative statutes and regulations for themselves. A must have for all California practices employing PAs. Visit the CAPA website at www.capanet.org for more information or to order the book online. *CAPA Member Price - $34.95 Non Member Price - $54.95

CAPA NEWS

Renew Your CAPA Membership Today! Renew Online at www.capanet.org There are many reasons to support CAPA. The number one reason for most is that you have a desire to see things change for PAs in California. Change for the better! CAPA is here to promote and protect California PAs. Remember, there are those who want to change things to limit PAs’ ability to practice. Each and every day we are your eyes and ears. We have a dream team working to make PA practice here in California better for you. Your membership dues are what makes this possible.

It is surprising that many PAs don’t realize that our operational budget is funded by dues dollars. Without membership dues, we don’t exist. The more members we have, the greater our ability to serve your needs. We need every member to renew and we need your non-member colleagues to join and pay their fair share. Together we are stronger!! Our numbers and our strength must continually grow. Growth (strength) can’t happen with intermittent membership as issues arise. We need every PA in the state to be a member each and every year.

Remember — Momentum Is Key To Our Success We Need Your Support Year After Year Your Dues Dollars At Work:

Thank you for being there to make the day-to-day operation of CAPA possible. Because of you and dedicated PAs like you, we are able to keep: • CAPA’s wonderful staff to answer your questions and take care of your needs. • CAPA’s amazing legal counsel, Mike Scarano, watching out for your interests. • CAPA’s exceptional Public Policy Director, Teresa Anderson, working for you every day in Sacramento. • CAPA’s phones on, our magazine published, our website up, etc., etc.

CAPA Members can log-in and view Job Listings. Employers know that the CAPA website is the best place to advertise for PA positions in California. Check the listings often. MAY/JUNE 2013

A CAPA Website Tutorial – Check It Out! by Coryn Kulesza, Membership Services Representative

ne of the most valuable benefits of CAPA membership is the Members Only information contained on the CAPA Website. The PA Laws and Regulations site is one of the most popular. You worked hard for your PA license, it is always prudent to know the laws and regulations. Let’s start with the Home Page. To log in to capanet.org, click on one of the circled links.

If you log in successfully, you will return to the page at which you started. If there is a problem logging in, an error message will appear. This error means either your username or password is incorrect. If this comes up, try again. You may have just entered it incorrectly. If you still can’t log in, you may click the blue “Forgot Username or Password” button and an email will be sent to address we have on file. If you no longer have that email address available to you, please call the office. We are happy to help troubleshoot and/or reset your username or password over the phone. Once a current CAPA member has successfully logged in, they will have access to all the member protected pages and their unique Member Portal.

Join CAPA

CAPA NEWS

Member Portal

You can get to your Member Portal from any page. Just look for these buttons.

Your Member Portal allows you to view previous orders, place a new order, register for events, edit your profile, reset your password and more.

If you would like to see all job listings available, leave all of the fields blank and click Search. This will display all job opportunities on the website.

We encourage you to go and take a look at your unique Member Portal. You can update your information and also choose to be included in the on-line Membership Directory if you wish. Once you click Member Portal you will see the following page:

To view complete details of one of the job listings, click on the magnifying glass next to the job you would like to see. It will then display the details of the job opening.

From the member portal you may also view the job listings (or you may always use the JOBS tab at the top of the any page on the website.) While in your Member Portal, to view the job listings click on â&#x20AC;&#x153;Search CAPA Job Boardâ&#x20AC;? in the Career Center section. See the following page:

Please give us a call if you need assistance. Or, you may email us at capa@capanet.org. Job listings can be searched by using the various criteria above.

Thank you for being a CAPA member!! MAY/JUNE 2013

Students Students Students Students Students Students Institutional Withdrawal Natalie Armstrong, PA-S, USC Class of 2014

uring my second week at Olympia Medical Center, I decided to work an overnight shift. At 10:30 p.m., a guy walked in to the ER and was triaged as having a foreign body in his eye. My preceptors were on break and told me to see the patient, remove the foreign body and present the case to them in a timely manner. I walked into the room to see the patient. He had his face covered with the blankets and said, “I’ll answer all of “He had his face covered your questions with the blanket over my with the blankets and head.” I thought it said, “I’ll answer all of your was a little weird, but I decided to obtain questions with the blanket my history: “What happened sir?” he replied “Well, I just over my head.” got released from jail, I borrowed some scissors from someone and tried to cut my jail wristband off of my wrist. The scissors were dull so I decided to open them wide and pull back as hard as I could. The next thing I knew, one of the blades from the scissors was stuck in my eye.” I took a moment to process it all and asked, “Is the scissor blade still in your eye?” He replied, “No, I pulled it out because I wanted to see if the wristband was off.” I then swallowed my nausea and said “Can you show me your eyes?” he pulled the blanket from over his good eye and looked at me with a smile. I put my hand on his shoulder and said “Don’t worry Andy, we will take good care of you.” He proceeded to remove the blanket off of his injured eye and all I saw was a black ball on top of his 30

CAPA NEWS

iris- it looked as if he had a raisin on top of his eye ball.

he does not want to speak to anyone and he wants to sign an AMA.”

Although I was alarmed by what I saw, I could not determine if it was an actual foreign body or a part of his eye. I completed my eye exam and he had no vision in his injured eye and was in 10/10 pain, but refused pain medication. Instead, he asked “you mind if I can get a sandwich and some juice?” I didn’t want to give him food just yet because I knew surgery was in his near future. I excused myself and talked it over with my preceptors. They could not believe the story, but once they saw him they agreed to call an ophthalmologist and have surgery scheduled. Once the ophthalmologist came and evaluated the patient, he confirmed that the patient had a ruptured globe and the foreign body I described as a “raisin” was actually the patient’s iris and lens. The patient was scheduled for surgery that night and I was able to make a follow-up visit the next day. He still had no vision in his injured eye, but was able to see shadows. He was discharged from the hospital after five days.

I walked over to him and said, “Hey Andy remember me?” He looked up and once he saw my face he said “You know, I have no where to go. I tried to injure myself and it did not work. Everyone says if you injure your eye you will be in the hospital for a long time and they released me, they just let me go with no place to go. I don’t want to go back to jail, but I was there so long I have no home.” I asked, “Do you think you are going to hurt someone?” he replied “No, I am going to kill myself if they make me sign a paper and kick me out. I don’t know what to do with myself.”

During my fifth week at Olympia Medical Center, I decided to work another late shift. Over the intercom I heard a call for security for a psych patient. I looked around and noticed that the patient everyone was trying to control was Andy. I went to my preceptor and said “Can I try to talk to him, I saw this guy a few weeks ago when he ruptured his eye. He was recently released from jail and maybe he needs some one to talk to.” My preceptor replied “Go ahead, but he has made it very clear

I reassured him that once again we would take good care of him. I notified my preceptor of his situation and requested a psych evaluation. All of the nurses were upset with me because they said You are housing a nut case and we can sure use that bed for a real sick patient.” I ignored all of the negativity and knew that I was doing this guy a favor. My preceptor asked why I was so caring for this patient and I replied “I feel he is suffering from institutional withdrawal, he doesn’t want to be in jail but he is accustomed to being in an institution. Would you stab yourself in the eye for a sandwich and a place to sleep?” He didn’t say anything for a while and then replied “You’re going to be a great PA some day.” 

Students Students Students Students Students Students A Letter to My New Colleagues by Joy Dugan, MPH, PA-C, Secretary Dear New Grads, Congratulations, you’ve made it through one of the most rigorous academic programs possible! You are now on your way to taking the PANCE and becoming a licensed PA. One year ago, I was in your shoes, nervously awaiting my PANCE scores and applying for jobs. The first few weeks of clinical practice will be tough. There is no preceptor overseeing your every medical decision. You have to interpret the labs and create treatment plans. This is where the “art of medicine” and the true meaning of “clinical practice” develop. For at least the first few weeks, you will go home feeling as if your brain is “numb,” as you revisit every patient you saw that day. Some say this “New Grad Syndrome” can even last for years. But fear not, we have all been there. It does get easier; month-by-month you will become more confident in your skills as a provider. Kudos to you when other providers start to ask you for advice and clinical input! On your first day of work, realize that everybody from the receptionist to medical assistant to nurse has been at the office longer than you. Value their input and experience. Show them respect and they will make your first few weeks at your new job a little less stressful. It doesn’t hurt to bring them doughnuts either! I urge you to seek out great mentors. Being involved in CAPA, I have met some amazing PAs that have taken me under their proverbial wing. (Special thanks to Larry, Mike D., Julie T, and the entire Touro faculty.)

A big bonus is if one of your greatest mentors could be your supervising physician. I urge you to not just choose the job, but also the physician you will be working with. Also, don’t chase the paycheck - that will come later. By now, you have probably heard the saying “when you hear hoofbeats behind you, don’t expect to see a zebra.. The caveat, every so often, “zebras” do appear at your family practice office. One afternoon, I had a patient requesting refills on their asthma medication. Routine visit, I thought; however, the patient was tachycardiac, tachypneic and slightly dizzy. The patient ended up having bilateral pulmonary embolisms, which could have been overlooked had I not been en grained to develop a differential diagnosis and take a good history even on routine visits. Those “do not miss” diagnoses you studied for the PANCE do actually happen in real life. We all love to share our funny patient stories. Facebook and social

networking are a great place to connect with your old PA school buddies. Just remember the HIPAA and PA practice laws do not just count in the clinical setting. Be careful what you post and make sure your settings are private. You may not want a future employer to see some of the pictures you took while vacationing in Mexico after the PANCE. My last piece of advice to you is: don’t just let your medical textbooks collect dust. After a much-needed PA school break, actually read those textbooks! Try to attend as many CME lectures and read as many articles as you can. Your education has only just begun, so I challenge you to be the most brilliant and upto-date PA possible. Every PA is an ambassador for the PA profession – so, make us proud! Good luck on your first year as a PAC, I hope you love every minute of it! Sincerely, A First Year Grad 

Saturday, October 5, 2013 – Student Track For Those Students Registered for the Conference 10:30 – 11:30 a.m.

How to Be a Great Student At Your Clinical Site – Mitzi D’Aquila, PA-C

11:30- 1:00 p.m.

Exhibit Hall

1:00 p.m.

Lunch in the Grand Ballroom

2:15 p.m. – 2:55 p.m.

Networking & Prize Drawings

3:00 p.m. – 3:15 p.m.

CAPA – Your California PA Advocate

3:15 p.m.

Ice Cream Break

3:30 p.m.- 4:30 p.m.

Speed Mentoring – Spend Quality Time With PA Leaders MAY/JUNE 2013

Students Students Students Students Students Students So What Now? A Quick Guide to Walk You Through the Door from PA-S to PA-C by Coury Clemens, MSPAS, MPH, PA-C, CAPA Member, Touro University Class of 2012

irst of all, congratulations! Completing your PA program is a daunting experience and one that requires consistent guidance and support. Becoming licensed as a certified physician assistant is no different. That’s why I’ve put together this multi-purpose instruction guide to lead you through all of the obstacles that lie in the way between graduating from a PA program “Don’t forget, you’re not a and working in the clinic or hospital.

student anymore…time to upgrade your apparel and order a long white coat!”

Step 1: Taking the PANCE ($475 in 2012) (http://www.nccpa. net/Pance.aspx)

I know, the price of the PANCE hurts, but let it serve as extra motivation to conquer it at your first confrontation. At this stage of the game, you must create a “Student Sign-in” login account. To do so, follow the link above. Once you’ve completed this, you now have full access to everything you need on the NCCPA website in order to register for and eventually schedule your PANCE date. Be sure to check with your program administrators to confirm the earliest date you are eligible to take the PANCE. Fill out a PANCE registration application and submit your $475 payment. You will receive an e-mail within approximately seven days 32

CAPA NEWS

providing you the appropriate resources to schedule a date, time and location of your future PANCE. Good luck! Step 2: Physician Assistant Licensure ($200 License fees + $25 application fee = $225) (http://www.pac.ca.gov/forms_pubs/ pa_app_package.pdf ) You’re almost there! Applying for your PA license contains several steps, each of which is outlined below. The website above will take you to the Physician Assistant Board (formerly the Physician Assistant Committee) general information page regarding applying for your PA license. Remember that all of these steps can be initiated before you’ve actually taken your PANCE (except for the release of your PANCE scores) and are preferred since it usually takes about one month for your PA license application to be received and reviewed. As long as you’ve successfully completed your PA program, you will not be penalized for opening an application too early. Note: When obtaining a small passport size photo for your application, consider having multiple copies for future PA-related applications (i.e. hospital privilege forms, etc.). Live Scan: Applicants must have a live scan fingerprint service performed for the application to be eligible for consideration. Within the PA Board general information packet there is a “Request for Live Scan

Service” form. Each of the three (3) forms needs to be completely filled out and must include the pertinent information from the Live Scan agency. Live Scan locations can be found at: http://ag.ca.gov/fingerprints/ publications/contact.php Once the Live Scan service has been performed, the Live Scan service provider will send their copy of the “Request for Live Scan Service” form directly to the Physician Assistant Board. Of the remaining two (2) completed forms, you must include one (1) of them in your PA licensure packet that you will eventually be sending to the Physician Assistant Board while keeping the other form for your records. Notary: The Physician Assistant Licensure Application must be presented to a notary in order for the application to be rendered complete. Pages 1-4 of the PA Licensure Application, along with an affixed passport sized photo must be included in the notarized packet. Do not forget to have an ID on hand for all notary services. Certification of Completion: The Certification of Completion of Physician Assistant Training Program must be filled out by the applicant (only section A) and sent to the appropriate PA program’s administrative office. Section B must be filled out by the administrative body and sent to the Physician Assistant Board address located on the form.

Students Students Students Students Students Students Apply To Be a Student Ambassador

Verification of Licensure: This form must be completed if you’ve previously held a medical license of any sort, including an EMT certification. For instance, if you’ve previously been certified as an EMT, you must include this information under Question #10 of the Physician Assistant Licensure Application. Completion of Form PA6 must follow ‘YES’ answers to question #10. Previously certified EMTs or other medical professionals must fill out Part I of Form PA6 only. The form should then be forwarded to the appropriate licensing committee for completion (i.e. NREMT). Again, it would be professional and appropriate to include an individually stamped and addressed (to Physician Assistant Board) envelope for the appropriate licensing committee for completion. Request for Release of PANCE scores from the NCCPA: Congratulations, you passed! Once you have taken your PANCE, you must visit www.nccpa. net in order to have your scores released to the Physician Assistant Board. White Coat: Don’t forget, you’re not a student anymore…time to upgrade your apparel and order a long white coat! If your program doesn’t provide white coat services for you, search online and get your white coat embroidered and sent to your doorstep. You did it! 

APA would like to extend an invaluable educational and leadership opportunity for physician assistant students in the state of California. CAPA’s Continuing Medical Education Committee is preparing for the 37th Annual CAPA Conference in Palm Springs, October 3-6, 2013. The Annual Conference is a big event and we rely on Student Ambassadors to ensure that things run smoothly. Student Ambassadors will serve in a variety of functions that include being door and room monitors, runners, and audio-visual liaisons. In return for their hard work, CAPA will offer lodging at the beautiful Renaissance Palm Springs and/ or registration fees for eligible Student Ambassadors. The Student Ambassadors will be able to attend some CME lectures and, if desired, they may pay to attend workshops. Student Ambassadors must be willing to share a hotel room with two other Student Ambassadors. No other lodging subsidies will be provided. Students will also have the opportunity to meet physician assistants from across the nation with various levels of experience and to see the importance of their political involvement for the success of this great profession. Interested PA students who are currently enrolled in a California PA Program and who are Student members of CAPA, are asked to write a brief paragraph about themselves stating which PA program they attend and why they would like to serve as a Student Ambassador. Please email (capa@capanet.org), mail, or fax your information to the CAPA office, C/O Student Ambassador Program. Deadline is July 26, 2013. For complete information, please visit the CAPA website at: http://www.capanet.org/ Students_Pre-PA/Student-Ambassador-Program/. We look forward to working with you!

Congratulations Graduates

APA would like to congratulate all students graduating from the Physician Assistant Programs across California. Best wishes as you prepare to take the NCCPA PANCE exam, and begin your career as a PA. We look forward to working with all of you as our colleagues as we continue to advocate for our profession.

Congratulations to the 2013 Graduates of:         

Loma Linda University of Health Sciences Riverside County Regional Medical Center/Riverside College Samuel Merritt University San Joaquin Valley College Stanford University, School of Medicine Touro University - California, College of Health Sciences University of California, Davis University of Southern California, Keck School of Medicine Western University of Health Sciences

MAY/JUNE 2013

Students Students Students Students Students Students Physician Assistant: To Be Or Not To Be by Saloni A. Swarup, PA-S, Student Representative

am sure that the title of this article must have you perplexed. You must be wondering, “What does she mean by to be or not to be?” I have a very simple answer to your question. Go back to your drawing board! Go back to the basics!

By this time in our educational careers, we have learned and memorized almost every pathophysiology, clinical skill and pharmacological intervention that helps us diagnose and treat a condition based on our “We want to take care of patient’s symptoms and physical exam people and heal them. findings. Today electronic medical We want to aid our records (EMRs) remind us to ask patients by reducing their our patients about every minute pain and discomfort and question behind every symptom with help them improve their which our patients present, so we have quality of life.” a complete medical history from the patient. This helps us feel satisfied as we have completed our patient’s chart. However, what many of us forget is the person who walked into our medical office/hospital was our patient and not the chart! The primary question that I would like to ask is, “What has happened to the “art” of medicine?” Today we practice empirically-based clinical medicine which undoubtedly helps us arrive at the correct diagnosis most of the time. But, what use is all of our hard work if our patients do not 34

CAPA NEWS

leave our clinics/hospitals feeling like they have been catered to and taken care of? This article is my attempt to remind myself about effective and empathetic clinical care as I walk through my rotations as a 2nd year PA student. I would love to learn the skills and facilities to become an excellent diagnostician. As an excellent diagnostician, I would be able to arrive at a correct diagnosis given the patients signs and symptoms and our various methods of diagnostic studies. However, all this work would be futile unless I learn how to be an excellent clinician. An excellent clinician would be able to do everything a diagnostician does, along with educate the patient about his/ her condition, be empathetic towards the patient, his or her reaction and the patient’s family. In this manner the clinician can not only empower the patient with knowledge and support, but also help the patient improve their overall quality of life and the prognosis. So “to be or not to be” this ideal PA? As PAs we are trained and taught to be caring and efficient clinicians who treat our patients “whole”istically. As a PA student, I remember my teachers, preceptors and several PA-Cs taught and reminded me about the efficiency of having an effective bedside manner. Through our knowledge and familiarity with disease and health care, we must teach our patients how to develop and maintain a healthier lifestyle for themselves and their families. Knowledge is power, power that can help patients heal from various illnesses and prevent their children

from developing such illnesses by educating them. In this manner, we can create a plan to help families work in unison toward better health. If we are able to improve our patient’s lifestyles and habits, we would be successful in decreasing the incidence and prevalence of chronic medical conditions in our society. As we embark on our journey as PA-Cs, this is just a gentle nudge and reminder to us to remember the original reason that we decided to become PAs. We want to take care of people and heal them. We want to aid our patients by reducing their pain and discomfort and help them improve their quality of life. However, we can do better via preventive health medicine. We can become the tools for our patients that aid them in prevention/delaying of developing chronic health conditions. With this multi-pronged approach, not only will we reduce the current rate of disease and illness, we will develop a culture of better health and healthier life. In this manner, we will thrive as a healthier and happier society. Good Luck and remember I am always here to help. 

Welcome New Members

Local Groups

March 21, 2013 through May 20, 2013 Jillian Allard, PA-C Shelley Baella, PA-C Karissa Bartholme, PA-S Christin Bawa, PA-C Jason Berryhill, PA-C Vanessa Blasic Keith Bond, PA-S Chad Brown, PA-C Katina Candee, PA-C Brandy Carrillo, PA-S Suzy Choi, PA-C Kelsey Collins, PA-S Jeffrey Cronin, PA-S Francesca Cuttaia, PA-S Doreen Cuzzupoli Almira Dukovic, PA-C Linda Duong, ATC, PA-S April Dutcher, PA-S Mark Espat Naghmeh Fathi Jamie Fukai, PA-C, MS Jillian Gilpatrick Kevin Groh, PA-S Kelly Hall, PA-C Joan Harmon Vichanna Heng Megan Hensley, PA-C

Joel Hernandez, EMT Sara Huffman, PA-S Hannah Inman Barbara Irish Chelsea Kauffman Jasleen Kaur Manpreet Kaur, PA-C Corinne Kaveny, PA-S Chelsea Kirscher, PA Sarah Krall, PA-S Jessica Kramer Tiffany Le, PA-C Wayman Lee, PA-S Victoria Lindsay, PA-C Leah Lovely, PA-C Josh MacLaren Kevin Mann, PA-C Daniel McBride, PA-C Eileen McDermott, PA-C Beth Miller, PA-S Stephanie Miller, PA-S Tatyana Mitina, PA-C Wendy Monteon, PA-C Johnny Morales Sumanth Mothe, PA-C, M.M.S Caroline Nguyen, PA-S Vivian Nguyen, PA-S

Erin Pollett, PA-S Tiffany Pong, PA-C Natalie Reed, PA-C Sheri Rosenblatt, PA-C Jose Ruvalcaba, PA Serena Sam Mollie Schneider, PA-S Keshea Stevenson, PA-C Laura Stillman, PA-C Siraj Syeda, PA-C Brian Taussig, PA-S Stephen Thurston, PA-S Bradley Toews Russell Trepanier, PA-C Diane Truong Victoria Tung, MPA, PA-C Jacqueline Turner, PA-C Jon Ukishima Derek Urban, PA-S Lilia Valdez Sarah Vensel, PA-C Julia Wehling Dustin Wetmore, PA-C Brent Wood, PA-C Touraj Yari Catherine Yaw Mondana Zargarnian

CAPA Dues Have Not Been Raised In 7 Years Because of the continued strength in the number of PAs who are members of CAPA, we have been able to keep our membership dues at $175 per year. We need each and every one of you to renew your CAPA membership (if you have not already done so) to keep the membership numbers up and to keep the membership dues amount low. Please talk with your PA colleagues to encourage them to join CAPA so they can do their part for the PA profession in California. California Medical Assistants Association California Academy of Physician Assistants California Athletic Trainers Association California Physical Therapy Association California Association of Nurse Practitioners California Psychological Association California Pharmacists Association California Osteopathic Physicians & Surgeons California Medical Association California Optometric Association California Chiropractic Association *includes local medical society which varies

$100 $175 $195 $245 $250 $347 $390 $475 $800+* $813 $948

1. Redding Area PA/NP Alliance P.O. Box 993515, Redding, CA 960-3515 Summer Ross, PA-C; (530) 225-6194 summerlynn712@gmail.com 2. Physician Assistant Society of Sacramento (PASS) Carlos De Villa, PA-C, PASS President; (916) 973-6185, pasocietyofsac@yahoo.com Atul Sharma, PA-C, MMS, MPH, CHES; (916) 397-6035, pasocietyofsac@yahoo.com 3. Contra Costa Clinicians Association Brian Costello, PA-C; (925) 852-8706 contracostapas.com 4. San Francisco Bay Area Physician Assistants (SFBAPA) www.sfbapa.com, Martin Kramer, PA-C; (415) 433-5359 220 Lombard St., Apt. 118, San Francisco, CA 94111-1155 mkramersf@hotmail.com 5. Bay Area Mid-Level Practitioners Rose Abendroth, PA-C; (650) 697-3583, Fax: (650) 692-6251, rosepard@aol.com Matt Dillon, PA-C; (650) 591-6601, mattdillon42@hotmail.com 6. Bay Area Non-Docs Linda Oâ&#x20AC;&#x2122;Keeffe, PA-C; (650) 366-2050, lindapac@aol.com 7. Northcoast Association of Advanced Practice Clinicians John Coleman, PA-C; (707) 845-6008, streetdrag49@sbcglobal.net 8. Stanislaus County NP/PA Network Brian Cormier, PA-C; (209) 605-4966, briancor@verizon.net, www.nppanetwork.org 9. Stockton Midlevels Emma Calvert, PA-C; stocktonmidlevels@gmail.com 10. Journal Club for PAs and NPs (Fresno area) Cristina Lopez, PA-C; (559) 875-4060; Fax: (559) 875-3434, clopez875@aol.com; 2134 10th St, Sanger, CA 93657 11. Central Coast Nurse Practitioners & Physician Assistants Kris Dillworth, NP; ccnppa@yahoo.com Sharon Girard, PA-C; (305) 803-1560; ccnppa@yahoo.com 12. So Cal PAs Linda Aghakhanian, PA-C; want2heal@hotmail.com 13. Orange County Hung Nguyen, PA-C; (714) 846-8178; nhy52@yahoo.com 14. San Gabriel Valley Local Group M. Rachel DuBria, PA-C; (818) 744-6159, racheldca@aol.com 15. San Fernando/Santa Clarita Valley Group Jonah Tan, MPT, PA-C; (818) 634-0007, jotptpa@yahoo.com 16. Coachella Valley Physician Assistant Group Matthew Keane, MS, PA-C; mkeanepas@gmail.com 17. San Diego Area Patrick Astourian MS PA-C; pastourian@gmail.com www.SDPASOCIETY.com.

MAY/JUNE 2013

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

PA Data is Needed for Legislators and Policy Makers in Sacramento

California PA Practice in 2013 â&#x20AC;&#x201C; A Leading Edge Survey California Academy of Physician Assistants

www.capanet.org/PAsurvey

Spend Just A Few Minutes To Take A Quick On-line Survey For A Chance To Win A 32 GB iPad + More! CAPA is PArtnering with the Office of Statewide Health Planning and Development (OSHPD) to gather workforce data on PA practice in California. An OSHPD report will be published in 2013 using the data collected. Your response is imperative to make the report valid and meaningful. Take a short survey (4-6 minutes to answer 22 important multiple choice questions) and you will be entered into a drawing for one of the following: 1) 32 GB, 3rd Generation iPad 2) Conference registration at the 2014 CAPA at Napa Conference

3) Conference registration at the 2013 CAPA Conference in Palm Springs 4) One Year CAPA Membership

Survey Will Be Ending Soon! Every California PA Matters â&#x20AC;&#x201C; Do It Today!