2.02 Promote a quality working partnership with the Utah Medical Association.
The Utah Academy has been busy and active on the legislative front. Many of you know that a recent Medicaid expansion proposal was put forth by the “Gang of six” that aimed to fund Medicaid expansion partly through increased taxes on providers in the form of a significant increase in licensing fees for many provider types, including our profession. The Academy mobilized immediately to determine what direction constituents wanted to take and then worked with other organizations such as UMA to craft a joint letter of opposition to this plan. UAPA leadership presented to the hearing, effectively representing PA interests and concerns in that hearing. The proposal was roundly defeated in its formative stage in part due to these efforts.
As always, UAPA serves as the legislative watchdog for Utah physician assistants and will continue to do so as heath care delivery and legislation surrounding this change rapidly. Effective legislative representation is one of the most valuable components of an organization such as UAPA, and one of the primary ways your voice can most effectively be heard on the hill is to belong to UAPA.
Letter from the Editor:
Dear Physician Assistant and voting citizen of Utah,
We want to make sure that you are aware, as a physician assistant licensed in Utah and a voting citizen of Utah, that there was recently a bill to promote Medicaid expansion in Utah. As physician assistants, we are dedicated to promoting access to the underserved, and are in favor of Medicaid expansion. However, tied to this bill in its recent form was a proposal that physician assistants and physicians help fund Medicaid expansion through an approximately 800% increase in our licensing fees, which we strongly opposed. It did not make sense to expect PAs and physicians to fund Medicaid expansion, and the proposed bill would have expected this. It would be like asking teachers to fund education reform. The proposal was also highly inequitable, expecting next to zero increase in licensing fees for nurse practitioners.
Thanks in large part to the leadership of UAPA and UMA, on Capitol Hill actively interacting with legislators, this bill did not pass. This leadership, on your behalf, monitors and guides this local legislation, and this is mostly through grassroots volunteerism. We understand the demands of work and life, and the inability of most physician assistants to be so actively engaged.
See website for more info or to join and add your voice: utahapa.org/memberships
Karen Law, PA-C, Secretary, UAPA
Rocky Mountain University of Health Professions Physician Assistant Program
David Payne (MS, PA-C) is the newly appointed founding director for the developing Physician Assistant (PA) Program. He expresses his excitement for the new PA program and shares some details about the direction of the program.
“Lecture is only one tool among many. The research shows that when students actively learn, they retain more. We will use all kinds of techniques in the classroom. The more creative, the better.”
A variety of innovative pedagogical approaches will be employed beyond standard lecture, including case-based, problem-based, and team-based learning. Early in the didactic phase students will be introduced to working through clinical cases as members on a healthcare team. Emphasis will be placed on critical thinking, problem-solving, applying information mined from evidence-based resources, and developing interpersonal and communication skills.
Beginning early in the didactic phase, students will be challenged to work through simulated clinical experiences with standardized patients (actors trained to portray specific patient presentations). These experiences will include presenting cases orally to faculty members simulating supervising practitioners and developing comprehensive notes, to include detailed assessments and management plans. A semester of full-time clinical rotations will also break up the didactic phase of the program, enabling students to learn subsequent didactic material with a newly formed clinical perspective.
The RMUoHP program will also include synthesized medicine modules. Instead of courses addressing content separately in clinical medicine, diagnostic skills, and pharmacotherapeutics courses, these components will be integrated into specialty-based modules (e.g. Cardiovascular, Pulmonology, Pediatrics).
Rather than a traditional research paper for their capstone project, students will develop a reflective practice portfolio. Throughout the didactic phase of the program, students will be challenged to reflect deeply on their knowledge and skill base. They will identify and quantify their strengths and weaknesses, and then be responsible for developing specific plans to address their weaknesses. During the final two semesters, they will put their plans into action and self-monitor their progress. This project will help prepare well-rounded graduates who have cultivated a consistent pattern of self-reflective practice, a skill crucial for optimal performance with- in a practice climate of rapid knowledge advancement.
Keep an eye out for more information on the PA program. We will continue to share details on our website. Any practicing PAs or Physicians with an interest in getting involved with the program at any level, from guest lecturing, to precepting students, to even joining the faculty are welcome to contact us!
The ARC-PA has granted Accreditation-Provisional status to the Rocky Mountain University of Health Professions Physician Assistant Program.
Accreditation-Provisional is an accreditation status granted when the plans and resource allocation, if fully implemented as planned, of a proposed program that has not yet enrolled students appear to demonstrate the program’s ability to meet the ARC-PA Standards or when a program holding Accreditation-Provisional status appears to demonstrate continued progress in complying with the Standards as it prepares for the graduation of the first class (cohort) of students. Accreditation-Provisional does not ensure any subsequent accreditation status. It is limited to no more than five years from matriculation of the first class.
Cara Crosby, PA-S
Hi, my name is Cara Crosby and I am a Physician Assistant student at the University of Utah. My motivation for becoming a primary care PA grew through years of volunteering at the Maliheh Free Clinic and witnessing hard working people continue to slip through the cracks of our health care system. I plan to provide primary care health care services to underserved patients in rural Utah. So clearly, I support the legislature’s efforts to cover the gap. However, a provider tax may hurt the quality of health care that these people need most: primary care. Primary Care providers are already overbooked and face financial challenges. A provider tax may further incentivize future providers to avoid the financial challenges of family medicine and encourage them to specialize, reducing the number of much needed primary care providers. Or worse, it may force current primary care providers to see more patients in a day, potentially impacting the quality of care that we all receive. Utah needs primary care providers to provide quality health care for these patients. Please cover the gap while preserving the abilities of health care providers to provide quality health care. Please consider alternative funding sources, such as reversing a 2011 diversion of tobacco settlement funds to the general fund, which could allocate $14.5 M annually toward expanding coverage. Thank you for your hard work on this important issue.
Hello From Rocky Mountain University of Health Professions!
Lorraine Brimhall, PA-S
We are excited to be part of the PA force here in Utah. We are the first cohort of students in this new PA program, the second in the state. We are in the middle of our second semester and we are studying hard and learning tons.
A major focus of RMUOHP is service. In October some of our students spent time at the “Day of Dignity” in Salt Lake City and we will be helping with Kids on the Move Halloween Fun Run in Provo.
As a class we are excited to learn the art and science of Medicine and to be able to make a difference in the lives of our patients and we love being a part of this amazing PA profession.
Benefits of Professional Organization Membership from the University of Utah
Linda Lewis, PA-S
My association with UAPA as a student has been an unbelievable. As the student UAPA representative, I was able to attend the Snowbird CME conference in August. This was an incredible chance to network with my future colleagues and a second to none opportunity to learn the most current evidence based medicine being practiced. My time as a student can easily be absorbed by my studies. UAPA experiences keep me in touch with what is going on in my community with Physician Assistants in practice, and helps me better plan for my career in the long term. The opportunities UAPA offers students, is in my opinion underutilized, but I am so glad for all I am bringing away from these associations!
UAPA Report on PANRE Focus Group
Kim McFarlane, MPAS, PA-C, DFAAPA
I recently was invited by NCCPA to be part of a PANRE Focus Group. We discussed the recertification process and potential changes for 2 ½ days.
We started the discussion with a review of the current recertification process. We then discussed various other stake holders and professional organizations and the recent advances in testing technology, including remote video proctoring options. Some of the terminology you may hear in future discussions include “Brick and Mortar” testing centers vs remote proctored testing. You may hear about hard hurdle vs soft hurdle testing and remediation as part of the recertification examination.
Discussions included continuation of status quo testing, but other proposals included a monthly series of questions which would constitute the recertification process with 5-10 questions a month. We discussed a combination of both monthly questions with a 10 year exam. There were proposals to take 2 PANRE’s after the PANCE, and then retain certification through CME, Self-Assessment and writing future test questions as part of the certification process. We also discussed a return of a new version of Pathway II. The Self-Assessment and PI requirements were also discussed, with near unanimous opinion that PI should be optional or removed altogether.
We also discussed linking exam questions to the blue print. Each topic on the blue print would have specific evidence based linked references which would be current with the testing questions and blue print links being up dated as the evidence changes.
By now you should have completed a survey from NCCPA on recertification. They will be reviewing this information at their next board meeting and by next spring hope to have some new options available for recertification in the near future.
This was a great opportunity and allowed more insight into the NCCPA and recertification process. They really are looking to make recertification a more meaningful process.
University of Utah PA Program Has Gone Global (Again)!
Scott Brown, PA-C, Member-at-Large
This past April 6 students from the University of Utah Physician Assistant Program headed to the other side of the world to put their skills to work and to learn from our partner providers in the country of Nepal. The team, led by Don and Kathy Peterson, Scott Brown PA-C and Holly Smock PA-C, partnered with Dr Ram Shrestha and the Monmahon Teaching Hospital in Kathmandu to offer clinical exposure in emergency medicine, dermatology, maternal-child health, and surgery. In addition to working in the hospital alongside Nepali providers, they also participated in a rural health camp in Dacha Nepal which was also sponsored by Monmahon.
Following their 2 and a half weeks of clinical rotations at the teaching Hospital, Scott lead the team of PA students and several Nepali providers into the mountainous and remote Annapurna region of Nepal to work at a community health clinic in the village of Ghandruk. It was here that the students partnered directly with the Health Assistants, which are Nepal’s version of a midlevel provider, and the front lines of medical treatment in the rural areas of Nepal. It was here where the students were exposed to the significant disparity that exists and were able to not only work in the clinics in both Ghandruk and Chhumrung, but also were able to fill their backpacks full of necessary medications and trek into more remote areas and offer free medical camps for those who do not have access or cannot afford treatment.
Both the urban and rural sections of this elective international rotation had a profound impact on both our UPAP students as well as the Nepali providers. We were able to teach one another, learn from one another, and join our hearts and skills to have an impact on the communities, and connect people with the clinics and providers in these remote areas in order to have continued treatment. If you’d like to read more, check out PAEA link:
University of Utah PA Program Associate Professor David Keahey, PA-C, MSPH Chosen For Prestigious Robert Wood Johnson Health Policy Fellowship
By Jennie Coombs, PA-C, PhD
David Keahey, an associate professor (clinical) at the University of Utah Physician Assistant Program (UPAP), was selected from a highly competitive field of applicants to participate in the Robert Wood Johnson Foundation Health Policy Fellowship program.
He started at the U’s PA program in 1983 when he began precepting second year students; he later was appointed the Associate Program Director. He is co-director of the Evidenced Based Medicine curriculum and master’s capstone experience. Mr. Keahey has been a Principal Investigator (PI) for Health Resources and Services Administration (HRSA) training grants and is currently the PI for the HRSA Expansion of Physician Assistant Training (EPAT) grant.
For ten years Mr. Keahey was chair of the Utah Academy of Physician Assistants’ Legislative Committee and lead efforts to write and pass two bills that improved PA scope of practice. He was chair of the Physician Assistant Education Association (PAEA) Government Relations and External Affairs Council and was the PA liaison to Society for Teachers of Family Medicine (STFM). He led the workgroup that published joint STFM/PAEA position statement, Educating Primary Care Teams for the Future: Family Medicine and Physician Assistant Inter-professional Education. He was appointed in 2012 by Health and Human Services Secretary Kathleen Sebelius to the HRSA Advisory Committee on Training in Primary Care Medicine and Dentistry (ACTPCMD) where he now serves as vice-chair and co-wrote the committee’s 10th,11th, and 12th Reports to Congress.
David grew up in rural Idaho and graduated from UPAP in 1983 after serving three years as a decorated US Army DUSTOFF flight medic. He went on to graduate from the University of Utah with a Bachelor of University Studies (Primary Care Medicine) and a Master’s of Science in Public Health. David practiced family medicine for 24 years at the Salt Lake Community Health Centers (CHC, Inc.) where he served six years as associate and medical director.
“He is highly regarded by his patients, students, and peers. He currently volunteers at the Maliheh Free Clinic each week, one of Salt Lake City’s ‘safety net clinics’, that is unique in that it serves only the poor without health insurance of any kind. My physician friends and colleagues who have worked with him there have great respect for his clinical skills and the care he provides for his patients” said David Sundwall, MD, Professor in the Division of Public Health and former vice chair of the Medicaid and CHIP Payment and Access Commission (MACPAC) and past president of the School of Medicine Alumni Association.
Meet a Board Member
Why I belong to UAPA and Joined the Board
Kevin Anderson PA-C, Member at Large
I am a University of Utah graduate from 2004. I have been aware of the profession and actually started seeing a physician assistant as a child in the early 1980s. As soon as I graduated from the Utah Physician Assistant Program in 2004, I started attending the UAPA John Allen Memorial CME conference in Mesquite, Nevada. I continued to participate in in this conference annually until it was canceled last year. As I attended this conference I was able to network with some of the board members for the UAPA. I also was able to network with, meet and interact with many of the early and current Physician Assistants of our state. I quickly realized that these people are very impressive people. Early Physician Assistant legislation was very hard fought and difficult to come by. Our predecessors pretty much scrapped and fought for every bit of ground they gained. Those of us who practice now benefit greatly from the sacrifices of those who have gone before. The realization I have had in this regard and the interactions I have had in the past have given me great satisfaction and pride in my profession. I was then and continue now to be very proud to be a Physician Assistant. We now have entered a similar age of significant change in how healthcare is expected to be delivered in the future. This has and will continue to involve a great deal of legislation and change. The era of just floating along and enjoying favorable legislation has passed. The early PAs of our state had to be well organized and have great leadership in order to navigate the legislative challenges they faced. We likewise must be well organized and have firm, solid leadership or I feel we will be left in the dust as healthcare delivery changes and adapts. The best way for us to keep ourselves in a favorable position is to maintain UAPA membership. The Academy is the vehicle that we need to invest in so that we can navigate the choppy waters ahead. Frankly, if nothing else I feel we have some duty to support and participate in the UAPA. We all benefit from the services given even if we don’t really see it. A lot of work goes on behind the scenes. Both family practice PAs as well as specialty PAs benefit from the UAPA watching out for them. I have a very busy practice and I do not have time to monitor all of legislation that goes through our state let alone on a federal level. I assume that most of you are in this same position. Because we all are busy it worries me because one simple statement or one line in a large or small piece of legislation can change the way we are able to practice or be compensated forever. In legislation and politics, it is always much easier to change, amend or argue legislation before it is passed and signed into law however once passed into law it becomes extremely difficult to change. I have no doubt that UAPA membership benefits me. It is vital to our future to maintain a solid Academy as we move ahead. I would encourage all those are not currently members to join. The fee is minimal yet vital. If you are not a member please become a member today. Also encourage colleagues and friends to also maintain membership. Thank you for your time.
Service Committee Update
UAPA’s service committee is currently exploring ideas for better working towards the part of our mission that talks about improving access to healthcare. We could use your ideas, and your help, for improving access. We would like to focus on underserved populations. Please contact Karen Law if you have ideas or want to help. Other places to look for service opportunities: