黑料专区

Just 15 percent of physician assistants (PAs) practice in rural areas 鈥� a situation that has contributed to acute shortfalls in the delivery of primary care for 20 percent of the population. Moreover, not enough PAs are helping meet the demand among rural residents for close-to-home specialized care in such critical areas as mental health, rheumatology, urology, and neurology.

The new Master of Science in Physician Assistant Studies (MS-PAS) program at 黑料专区, which begins teaching its inaugural students this semester, aims to address these issues by 鈥減roviding the kind of advanced instruction that will enable more physician assistants to go into remote rural areas to practice medicine and feel confident in those settings,鈥� said Brenda Diaz, the program鈥檚 founding director. 鈥淭he intentionality of our program is what sets us apart.鈥�

Or, to put it another way, Diaz wants to give her students the tools in medicine and advocacy that will equip and inspire them to follow in the footsteps of the country鈥檚 first PAs. These people were once Navy corpsmen who, having learned many medical skills during the Vietnam War, completed the country鈥檚 first training program for physician assistants at Duke University in the 1960s 鈥� then began working in Appalachia.

Nathan Woodward, 38, is among Pfeiffer鈥檚 first PA students. He finds the focus of the program appealing, having served the rural communities near Wilmington as a paramedic for six years.

鈥淲hen I found out that this program was starting and that they were going to have a concentration offered in rural medicine, that spoke to me,鈥� he said. 鈥淚鈥檓 also looking forward to getting to know the people in this area and giving back in any way I can.鈥�

Sheryl Steele, also among Pfeiffer鈥檚 first PA students, shares Woodward鈥檚 enthusiasm for what the MS-PAS program aspires to achieve. Before coming to Pfeiffer, she worked for 31 years as a paramedic in rural areas, first in Kansas and later in North Carolina, in addition to raising three now-grown children. Along the way, she also earned a BS in emergency medical care from Western Carolina University and became an EMT instructor.

鈥淩ural medical work was already my forte,鈥� Steele said. 鈥淚t was already what I was used to. It was rewarding. I鈥檝e always enjoyed my medical experience. I left my last job of 17 years (as a senior paramedic for FirstHealth of the Carolinas in Chatham County) to come to this school. The day that I left I was in tears because there was not a day when I could say that I didn鈥檛 love what I do. I鈥檓 excited to be here because I get to grow that even higher than I ever have.鈥�  

The MS-PAS program at Pfeiffer has been about four years in the making. This past November, it received provisional accreditation from the Accreditation Review Commission on Education for the Physician Assistant, Inc. This paved the way for the first cohort of students to begin taking classes on Pfeiffer鈥檚 Misenheimer campus; 22 will do so on a temporary basis until summer 2020. At that point their permanent home will become Pfeiffer鈥檚聽Health Sciences Center聽in nearby Albemarle, the construction of which is nearing completion.

Diaz said that another 36 students will make up the MS-PAS program鈥檚 second cohort, enrolling in January 2021. After that, 45 new students will enroll each January, capitalizing on the high demand for PAs that Diaz expects to continue for many years.

Steele wanted to be part of an inaugural program.

鈥淣o new program is going to have young people starting it,鈥� she said. 鈥淚t鈥檚 going to be people with a huge amount of experience, and I was absolutely right with that. And, of course, this is a smaller school, so I knew there was going to be more one-on-one training.鈥�

Ultimately, as several studies have shown, the likelihood of PA students practicing in rural areas after they graduate increases when they receive the right kind of clinical exposure as part of their training. Thanks to the efforts of Dr. Tom Earnhardt, the director of clinical education for Pfeiffer鈥檚 MS-PSA program, Pfeiffer has affiliation agreements with all the major hospital systems serving rural patients in its area, including (but not limited to) Atrium Health, Novant Health and FirstHealth of the Carolinas. Moreover, the clinical rotations that Pfeiffer鈥檚 PA students undertake at various hospitals and clinics will be enhanced by the training that they receive at the Health Sciences Center.

The MS-PAS program, then, has all the ingredients for success. Still, Diaz allows that several obstacles stand in the way of keeping Pfeiffer-educated PAs in rural areas after they complete the 27-month program: lower pay than that offered in urban areas; isolation that can limit interaction with colleagues; settings that may not be conducive to the needs of a family.

At the same time, there are many possible rewards, both financial and personal, which Pfeiffer鈥檚 MS-PAS program will promote. The financial ones come in the form of loan repayment programs that some rural clinics offer. Pfeiffer鈥檚 PA students can expect to hear plenty about them, either from the university鈥檚 financial aid office or from visiting representatives of the clinics themselves.

As for the personal rewards: 鈥淵ou know you are making a difference,鈥� Diaz said. 鈥淭he patients are so thankful for you being there, which certainly compensates for the lower salary you may make.鈥�

Advocacy to Be a Key Part of What Students Learn in Pfeiffer鈥檚 New Physician Assistant Studies Program 

The mission of 黑料专区鈥檚 new聽Master of Science in Physician Assistant Studies (MS-PAS)聽program is clear, and it goes far beyond educating exceptional clinicians.

鈥淥ur students will also be effective advocates for their community,鈥� said Brenda Diaz, the MS-PAS director.

This advocacy will rest not only on raising awareness of problems in rural areas (and beyond) but also coming up with solutions to them. It will be integrated into the MS-PAS curriculum in a variety of ways.

Diaz spoke, for example, of teaching each of several smaller groups of students how to advocate effectively for a cause. One cause might be keeping a hospital open. In recent years, many rural hospitals have closed, having been unable to operate because of low reimbursement rates from the federal government.

鈥淚t鈥檚 through effective advocacy that we can get policy changed so that (higher) reimbursement rates and federal money can come to rural communities and support those hospitals that provide much-needed care for these communities,鈥� Diaz said. 鈥淭he return on such investments is tremendous. Functional hospitals and clinics mean healthier communities; you don鈥檛 have people losing time from work or becoming disabled because of preventable disease.鈥�

This kind of thing should appeal to Meghan Norris, who is among the first PA students at Pfeiffer. Norris, who hails from Burlington, earned a BS in biology/psychology from UNC-Chapel Hill in 2014 and, later, an MS in physiology from NC State. Before coming to Pfeiffer, she worked as a certified medical assistant for UNC Health Care.

During her undergraduate years, Norris served as the vice president of a student rural health initiative that aided a free health clinic in Fremont. The work entailed designing and distributing brochures, raising money and asking community members what they needed in terms of healthcare. Norris also worked as a volunteer in Panama and Honduras for , which works to implement sustainable health systems in the rural areas of those countries as well as in Nicaragua and Ghana.

鈥淚鈥檓 ready for classes to start,鈥� Norris said last week. 鈥淚鈥檓 jumping at the gate.鈥�

There are several other ways that advocacy will emerge in Pfeiffer鈥檚 MS-PAS program.

For example, an entire class of students will learn to identify a healthcare-related need or disparity in their backyard 鈥� then, using the Project SEED model that numerous other institutions have established, develop an initiative to address it.

The 鈥淪EED鈥� in Project SEED stands for Serving Everyone, Embracing Diversity. Diaz helped establish a project several years ago when she was teaching PA students and serving as their faculty advisor at Nova Southeastern University (NSU) in Fort Myers, Fla.

The inaugural Project SEED at NSU began when students learned that workers in orange groves were injuring their eyes. In response, they secured a donation of 600 pairs of protective glasses along with ties to secure the eyewear. They distributed the eyewear at a local Catholic church, along with instructions on what to do in the event of an eye injury, which was translated into Spanish and Creole with the assistance of NSU nursing students.

In subsequent years, this effort expanded to include not only the distribution of eyewear but also blood pressure and glucose screenings, mammograms, immunizations, nutrition education, and child physicals.

But that鈥檚 just the beginning. The Project SEED at NSU, as the one at Pfeiffer will be, is a multi-pronged effort.

For example, Project SEED Global Health gets students to think beyond the boundaries of their classrooms to identify needs in areas abroad that have been affected by natural disasters, war or famine. Diaz spoke of NSU鈥檚 PA students sending books and stethoscopes to their counterparts at a school in St. Croix after these items were lost in a hurricane there.

鈥淭he things I鈥檝e seen the students at Nova Southeastern University do over the years are pretty amazing,鈥� she said. 鈥淚 really can鈥檛 wait to see what our students at 黑料专区 will do.鈥�  

Another example: A mentorship program called Project SEED Next Generation connects PA students with high school and college students from underrepresented minority and disadvantaged populations who are interested in becoming PAs. The mentorship works this way:

Each semester, a PA student calls a mentee and asks several questions. How are you doing? How are your classes going? Are you ready to start applying to PA school?

In Diaz鈥檚 eyes, such an effort is critically important. 鈥淭he No. 1 reason why a minority student or a student from a disadvantaged population leaves college or drops out of medical school is because of lack of support from home,鈥� she said. 鈥淭hey have no mentorship outside of the university.

So, if we can be that mentor, if we can be that voice of encouragement, if that鈥檚 all it takes, then why not? It means a lot that this PA student took the time to call me and asked me how things are going.鈥�

Darwin Ramirez, who is among Pfeiffer鈥檚 first PA students, would agree.

He earned a BS from Pfeiffer in health and exercise science, graduating in 2018. During his junior year at Pfeiffer, he met Diaz and, after the two discussed his interest in pursuing a master鈥檚 degree in PA studies, she 鈥渂ecame my No. 1 fanatic,鈥� Ramirez said.

鈥淪he reached out regularly to see how I was doing in and out of my classes,鈥� he added. 鈥淲hen I faced adversity over things I had no control over, I reached out to her. She gave me advice and helped me to see things more clearly.

鈥淪he also pointed out why being a PA was such a rewarding career to go into. She shared experiences of her journey through PA school, and also of her time as a clinician. Everything she told me further empowered my desire to pursue PA school.鈥� 

Training of Students in Pfeiffer鈥檚 New Physician Assistant Studies Program Includes Ways of Addressing Personal Challenges of Rural Patients 

Students in 黑料专区鈥檚 new聽Master of Science in Physician Assistant Studies (MS-PAS)

program 鈥渘eed to demonstrate skills at the highest level,鈥� said Brenda Diaz, the program鈥檚 director. 鈥淏ut can they apply them effectively in a rural setting?鈥�

The training that the students will receive in Pfeiffer鈥檚聽Health Sciences Center聽will help ensure that the answer is yes.

The center, which will open this summer in downtown Albemarle, will feature the Center for Advanced Clinical Simulation Education, one side of which will include a 鈥渃linic鈥� with six fully equipped exam rooms. Each room will be wired for audio and visuals. This will enable instructors to evaluate recordings of the PA students engaging with patient actors in what are known as Objective Structured Clinical Examinations, which each student will do at least once a week, so that 鈥渨hen they go out on clinical rotations, they鈥檙e comfortable around patients and they鈥檙e comfortable in the clinical environment,鈥� Diaz said. (The clinical phase of Pfeiffer鈥檚 MS-PAS program lasts 12 months, with each clinical rotation lasting five weeks. It begins after students successfully complete a 15-month didactic phase of the program.)

The recordings will facilitate the assessment of a student鈥檚 ability to establish a rapport with a patient along with the quality of their physical exam technique. Is the student looking at the patient in the eye? Is the student speaking clearly? Is the student establishing a therapeutic type of relationship with the patient?

Is the student holding the stethoscope correctly? When they order labs, are they ordering the right ones and, if so, interpreting them correctly? Are they formulating the right diagnosis and treatment plans?

Most important 鈥� and this is what will make Pfeiffer鈥檚 MS-PAS program unique 鈥� the recordings will reveal how well students are responding to the personal challenges of the patient actors they are examining. The challenges in question reflect real-life experiences that Diaz and other faculty in the MS-PAS program have had working decades as PAs in rural settings.

鈥淲e want our students to be exposed to that so that they think critically,鈥� Diaz said. 鈥淚t鈥檚 not just rote memory. They need to think and keep everything in context.鈥�

One of the most common challenges is the patient who has lost their job and has no insurance. When such a scenario emerges, a PA wouldn鈥檛 order a medication that costs $200. Nor would they order labs that cost $1K. Instead, they鈥檇 come up with an appropriate treatment plan that the patient can afford, while adhering to standards of care.

She stressed that there is 鈥渁lways an alternative鈥� to, say, the listed price for a medication. 鈥淵ou pick up the phone and call the pharmaceutical company. They have patient-assistance programs. You (the PA) have to be the advocate.鈥�

(pictured
First Row (L-R) – Sheryl Steele, Rachel Nance, Ngoc Nguyen, Morgan Sox, Emily Daniecki, David DeBerry, Elizabeth Wimmer, Kayla Miles
Second Row (L-R) – Laurel Barnett, Samantha Gulledge, Elizabeth Saucedo, Hunter Rogers, Rachel Kiker, Faith Pressley, Meghan Norris, Nathan Woodward
Third Row (L-R) – Kayla Donnalley, Robert Schwartz, Darwin Ramirez, Mario Tawadrous, Dalton Helm
not pictured 鈥� Marisa Cook)

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Ken Keuffel, who authored this article, has served as Pfeiffer鈥檚 Assistant Director of Communications since December 2019. He welcomes story ideas from Pfeiffer鈥檚 faculty, staff, students, alumni, and friends. The form for submitting story ideas is Story Idea/News Item Request Form.