CAPA News Jan/Feb 2013

NewsNewsOfficial Publication of the California Academy of Physician AssistantsOfficial Publication of the California Academy of Physician Assistants

January/February 2013

The Magazine\

Continued on page 17

On June 27, 2012, Governor Jerry Brown signed legislation (AB 1494) Healthy Families

Program: Medi-Cal Transition: Expansion implementing the transition of all children in the Healthy Families Program (HFP) to Medi-Cal, Access for Infants and Mothers-linked infants with family incomes above 250% of the federal


What’s Happening with California’s Healthy Families Program?by Teresa Anderson, MPH, Public Policy Director

number of patients for whom a single primary care physician may be responsible. The process is called empanelment and the patients assigned to the physician are called the physician’s “panel.” Although there are a few California Medi-Cal managed care organizations that assign panels to PAs, the current predominant practice in California is to only empanel physicians. Assigning panels to PAs is widespread and recognized by law in 18 other states. Some plans increase the number of patients who may be included on the panel of a physician who also has a PA or NP in his or her practice. However, the increase is frequently far fewer than the limit imposed on the number of patients who could be assigned to a physician or other primary care provider (PCP).

poverty level are exempt, beginning January 1, 2013. The purpose behind moving kids from the HFP to Medi-Cal is a proposed annual cost-savings estimated between $64 - $73.9 million dollars to the state general fund. The California HFP is a federally subsidized children’s health insurance program (CHIP) that provides health, dental and

vision coverage to children who do not have health coverage and do not qualify for Medi-Cal based on family income. Currently there are approximately 875,000 children in California who receive health coverage from the HFP.

The end result is that PAs are not assigned as many patients as they are qualified to manage, which dilutes their value as a health manpower resource.

This sub optimal use of resources can be easily remedied by recognizing and utilizing PAs as full-fledged PCPs.

Recognizing PAs as PCPs would also align federal and state definitions of a “primary care provider.” The federal definition of a “primary care provider” acknowledges primary care physicians, physician assistants and nurse practitioners as PCPs.2 However, California Welfare and Institution Code 14254, which defines PCPs for purposes of Medi-

C alifornia is in the midst of a well-documented shortage of primary care providers

and a serious misdistribution of specialists throughout the state. Current health care workforce deficits compromise access to care in many areas throughout the state and impede adherence to state-imposed timely access to care laws.1 Further complicating the health workforce capacity challenges is the impending increase of an estimated 4-6 million people in California who will become eligible for [private or governmental] coverage in January 2014 as a result of the Patient Protection and Affordable Care Act (PPACA).

In California, Medi-Cal managed care plans, as well as other HMOs, typically place limits on the

A Necessary Step in the Right Directionby Adam Marks, MPA, PA-C, President

2 CAPA NEWS

Editor

Gaye Breyman, CAE

Managing Editor

Denise Werner

Proofreaders

Kimberly DickersonCoryn Kulesza

Editorial Board

Jeremy A. Adler, MS, PA-CAdam Marks, MPA, PA-CBob Miller, PALarry Rosen, PA-CMichael Scarano, Jr., Esq.

CAPA Board Of Directors

President

Adam Marks, MPA, [email protected]

Vice President

Jeremy A. Adler, MS, [email protected]

Secretary

Joy Dugan, PA-C, [email protected]

Treasurer

Bob Miller, [email protected]

Directors-At-Large

Anthony Gauthier, PA-C, [email protected]

Roy Guizado, MS, [email protected]

Matthew Keane, [email protected]

Greg Mennie, PA-C, [email protected]

Larry Rosen, [email protected]

Student Representative

Saloni Swarup, [email protected]

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 92704-4938Office: (714) 427-0321Fax: (714) 427-0324Email: [email protected]: www.capanet.org©2013 California Academy of Physician Assistants

NewsNews At The Table

Sue has been appointed to be a member of California’s Healthcare

Associated Infections Advisory Committee (HAI-AC). The HAI-AC is composed of experts in the

surveillance, prevention and control of HAI from the California health care community, including health care consumers. The goal of the HAI-AC is to improve infection rates of HAI. CAPA is pleased and proud to see a PA with Sue’s extensive experience and expertise serve on this important Committee. Since 1984, Sue has worked at Scripps Clinic in the Divisions of General Surgery/Head & Neck Surgery. Sue is a graduate of the Stony Brook PA program in New York. Thank you, Sue, for filling this important role.

Congratulations, Susan Gilroy, PA-C

Glenn Mitchell sworn in by Denise Brown, Director of the California Department of Consumer Affairs

Robert Sachs, PA-C, President of the Physician Assistant Board presents Elberta Portman with a plaque upon her retirement

2013 Brings Change to the Name of the Physician Assistant Committee and a Smooth Transition of Power

On January 9, 2013, CAPA COO, Gaye Breyman, CAE along with CAPA’s Public Policy Director, Teresa Anderson and Lobbyist, Kathryn Scott, met with Senator Fran Pavley to discuss upcoming legislation. (L to R: Gaye Breyman, Senator Pavley, Teresa Anderson and Kathryn Scott).

In early December, PAC Executive Officer, El-berta Portman retired. Elberta served the PAs and health care consumers of California well and

received many honors and accolades as she left the position.

Also in December, long-time member of the Physi-cian Assistant Committee staff, Glenn Mitchell was sworn in as the new Executive Officer. Over

the years, many PA licensees may have spoken with Glenn when dealing with licensing or other issues at the PAC. Congratulations, Glenn, on your new role.

On January 1, 2013, the Physician Assistant Com-mittee became the Physician Assistant Board (PAB). Bob Sachs, PA-C, is President of the PAB and we expect that the Governor will appoint some new members to the PAB very soon.

JANUARY/FEBRUARY 2013 3

At the Table .........................................................................2

Congratulations, Susan Gilroy, MPA, PA-C ..............................2

2013 Brings Change and Another Smooth Transition of Power .....................................2

So When Do I Get My Fluoroscopy Permit? ............................3

A Teen Clinic – A Very Impressive Tour..................................4

My Trip to the Capitol ...........................................................5

Can California Physician Assistants Write for Suboxone®

and Subutex® (or generic)? ..................................................6

What an ER Is Not!...............................................................8

Those Pharmaceutical Dinners… .........................................9

When Should You Stop?......................................................10

Am I Providing Good Guidance for the Next Generation of PAs? ....................................................11

Volunteer, It Just Might Help the PA Profession More Than You Think .........................................................12

CME and Napa Valley, What More Could You Ask For? .........13

Controlled Substances Education Course ..............................14

“Mental Health Across the Life Span” .................................14

CAPA at Napa ....................................................................15

Heard Any Great Speakers Lately? .....................................16

2013 CAPA Conference ......................................................16

Specialty Care for the Uninsured: Building a Bridge to Better Access - Part 2 ..........................19

Mental Health Access in the United States ...........................20

The Language Gap of Healing ............................................22

A New Year … En Route to Rotations .................................24

e-Resources for Pre-PA & PA Student Members ....................25

2nd Annual USC PA Student Toy Drive Benefits Children’s Hospital Los Angeles! ..........................................26

Congratulations to the 2013 CAPA Scholarship Winners!!!....26

Welcome New Members .....................................................27

Local Groups......................................................................27

Inside This Issue

Many of you may vaguely remember something about CAPA supported legislation

that was passed a few years ago to allow PAs to obtain a fluoroscopy permit. Your long-term memory is intact - we just haven’t gotten there yet.

Assembly Bill 356 (Fletcher) passed and was then signed by the Governor and filed with the Secretary of State on October 11, 2009. Although this legislation created a pathway for PAs to use fluoroscopy, there were no existing regulations to address the provisions specified in AB 356. So with the law in place, regulations were then required to describe how AB 356 should be implemented to define the procedures to obtain and renew a permit and to specify the expanded scope-of-work for a PA. At this writing, the California Department of Public Health has developed regulatory language which is now in a public comment period to end on January 14, 2013. If there is no opposition to the current language it will continue to move forward without the need for more public hearings. We are not aware of opposition at this point and CAPA

So When Do I Get My Fluoroscopy Permit?by Bob Miller, PA, Professional Practice Chair

has submitted a letter of support. We still need to wait for final official completion of the regulatory process, however we hope the new regulations will be finalized soon. While we are waiting, here are some of the main points contained within the new regulations (which could still change).

Briefly, as proposed, the new regulations would:

1) Define eligibility criteria for a PA to apply for a PA-

Fluoroscopy permit, such as holding a current PA license and recognizing PAs in the definition of a “licentiate”.

2) Establish a more compact set of educational and clinical requirements to include a 40 hour didactic course followed by 40 hours of clinical training (on the job) with appropriate supervision and reporting criteria.

3) Define requirements for delegation of procedures within the DSA and for appropriate supervision by physicians who must also hold a current fluoroscopy permit. This places the practice site with the determination of what the PA will be authorized to do within the permit limitations.

4) Require a minimum of 10 hours of continuing education to renew the permit every two years.

5) Define who may offer the didactic and clinical training and guidelines for documentation of completion.

Continued on page 4

4 CAPA NEWS4 CAPA NEWS

A Teen Clinic – A Very Impressive Tourby Teresa Anderson, MPH, Public Policy Director

A fter attending Rod Moser’s session at the CAPA Confer-ence in Palm Springs, I knew

the teens in his practice must abso-lutely LOVE him – he was funny, approachable, and most of all not afraid to tell it like it is. In early December, I was lucky enough to be able to tour his teen clinic and get a chance to talk with Rod and his wife, Lindsey. They are both PAs,

both work at the Teen Clinic and both extremely passionate about providing the best health care pos-sible to the teens they serve.

I arrived a few minutes early so I sat in the waiting area, which was decorated with a fact tree for teens – each leaf had an interesting, relevant teen fact written on it. I found myself staring at the poster of sky-divers and think-ing how cool the waiting area looked. Soon thereafter, a gentleman sat in the waiting area with me and as Rod came out to greet me he excused himself to speak with the gentleman for a min-ute – I thought they were friends from way back. As it turned, out they pretty much were, Rod had been providing care to his family for years.

Some of you may already know this…Rod blogs and yes, I read his blog. In a recent post he says “perhaps the most medically under-served segment of our population is teenagers. Older teens are uncomfort-able in a standard pediatric practice.” He goes on to say teenagers deserve a medical practice where they feel at home, where they feel safe and where their unique needs are not only rec-ognized, but embraced. The Teen Clinic offers exactly that, Rod and Lindsey offer more than a service to teens, they offer an environment of comfort and trust.

Thanks to both of them for a great experience.

CAPA Members Can View the Videos On-line at www.capanet.org

Robert Miller, PACAPA Professional Practice Committee Chair

… your host on an enlightening series of videos depicting the history of physician assistant practice in California and the evolution of the Physician Assistant Practice Act.

• PA Scope of Practice• Prescriptive Authority and Protocols• Laws and Regulations• The Surgical PA• Reimbursement Issues• The New PA and the New Job

Visit Rod’s blog at http://blogs.webmd.com/all-ears/

Lindsey Moser, PA-C and Rod Moser, Ph.D., PA-C (CAPA’s Founding President)

So When Do I Get My Fluoroscopy Permit?

6) Establish the fees associated with initial permit application and renewal.

The addition of these regulations actually establishes a second pathway for PAs to obtain a fluoroscopy permit. As stated above, this new pathway is an abbreviated educational approach as a now defined “licentiate” (previously limited to those with a MD, DO, DC and DPM). The currently existing pathway is to complete a two-year course to become a certified radiologic technologist (CRT) and then complete approximately 55 hours to obtain a fluoroscopy permit. This current pathway would allow for a much wider expansion of scope of practice because the duties of the CRT are not tied to the PA license. My guess is most PAs will go for the abbreviated approach.

The above is just an overview of proposed regulations. Once they are final, we will place more complete updates in the CAPA News and the on the CAPA website.

Continued from page 3


assured and more comfortable. After greeting several colleagues I know from around Sacramento, we settled into our seats and the meeting got underway. The room was relatively full, and a panel of directors, policy people, and chiefs sat at a panel in front of me. One by one they gave us their position and statistics, driving home the reality that I face every day in clinic. Our current system is not working and we need to overhaul what we have.

After hearing approximately two hours of good information and some honest passion regarding change for the better, I could no longer hold back. Here I sat among probably a

hundred people who wanted to fig-ure out how to successfully combine mental health and primary care, and I have been doing this very thing for the past five years. I felt like I was going to burst, but in all honesty, a little nervous about standing up and speaking to this group, which is unusual for me. My time to speak came, and as the ONLY medical provider in the room amongst direc-tors and policy makers, I proceeded to tell them who I was and what I do every day. It was a great moment to be a PA! I was representing not only the PA profession, but the medical profession in general as there were NO other medical providers present.

Consequently, my last request to them was to include front-line medi-cal providers in these discussions since these policies will effect what goes on in the exam room. I am glad to tell you that they seemed recep-tive, and several greeted me after the meeting, giving me their card, and asking for mine, vowing to include me in their future discussions. So there you go, all the policy issues for the future of PAs are solved, we’re done. Not really, of course, but it’s a start and I think a good start.

I learned several things from this ex-perience. First, after hearing the facts and thoughts of those presenting and other attendees, I am convinced that

many elected of-ficials and policy makers are well-meaning and do care about what happens to patients. Secondly, I also believe that they have been doing their very best to establish those healthcare poli-cies. However,

in the past, by not including the pro-viders actually doing the work, the policy makers have created a problem they did not intend to create. It’s a problem for them because they re-ally want to pass laws and policies that help, not hurt patient care. It’s a problem for medical providers because we don’t need to be saddled with more policies that make it cum-bersome to care for the patient. And finally, it’s a big problem for the pa-tients because honestly, they just feel bad and want to be better and not be hassled by five more hoops to jump through to get care.

I was recently invited to attend a policy meeting at the Capitol regarding the combining of

mental health and primary care (thanks to Teresa Anderson, our Public Policy Director). I was especially interested because this is what I do; it is my area of expertise. And so, it was that after rearranging my schedule to attend the 10:00 a.m. to noon meeting, I arrived at the Capitol on a beautiful, sunny, blue-sky day in Sacramento. Adorned in a fitted suit and tie, which is not my usual garb, I entered the Capitol with a sense of purpose and pride. I recall feeling confident and excited as I walked the hallowed halls of the Capitol building, all the while allowing my mind to meander, thinking of all the historic events that had occurred in this place. Being a part of future history is an exciting feeling, and that was my hope, to be a part of a better future for our state and health care overall.

I found my way to a beautiful room, with the aroma of power, where the attendees were gathering. I was greeted kindly and am happy to report that my name was on “the list” of those allowed to enter through the great doors. As I walked in, I have to say that once again I was taken aback by the sense of history, purpose, and deep meaning that I have found every time I have visited our state Capitol or the nation’s Capitol in Washington, D.C. But today was different. I was a part of what would happen, and that was a very different feeling. I immediately found Teresa seated close to the front, but not obtrusively so. She is well-versed at the game. She had saved me a seat, and while I was excited to be there, I was also slightly nervous as this was not my typical environment. Sitting down beside her, I immediately felt

My Trip to the Capitolby Sonny Cline, PA-C, MA, M.Div, Political Action Committee Chair


6 CAPA NEWS

Subutex® on October 8, 2002 with a FDA label indication of maintenance treatment of opioid dependence2. These medications were placed as Schedule III narcotics. With a waiver, the physician is able to make a sepa-rate registration with the DEA and obtain an “X-number” and then will be authorized to treat between 30-100 patients for opioid dependence with these medications. The Drug Enforcement Administration (DEA) provides comprehensive information on their website for waivered physi-cians regarding the requirements of DATA3. Per DATA, PAs are not eli-gible to obtain a waiver or prescribe Suboxone® and Subutex® for the maintenance treatment of opioid dependence1. The only exception is that a PA may administer (not pre-scribe) these medications for opioid dependence to a patient who is hos-pitalized for a condition other than opioid dependence4.

There has been some confusion regarding the definition of opioid dependence. Many clinicians have interpreted opioid dependence to just represent the physical depen-dence that occurs when patients take opioids for an extended period of time. Virtually all patients tak-ing regular dosing of opioids for legitimate medical purpose (i.e. pain) become physically dependent and therefore some practitioners believe they can be diagnosed with “opioid dependence,” ICD9 304.0x. I strongly urge caution in diagnosing “opioid dependence” when refer-ring to just the physical dependence that occurs. The criteria for opioid dependence is based on the DSM-IV TR (American Psychiatric Associa-tion) definition which is more than just physical dependence, but rather a maladaptive pattern of substance use. The full criteria for Substance Dependence are listed in Box 1.

Can California Physician Assistants Write for Suboxone® and Subutex® (or generic)?by Jeremy A. Adler, MS, PA-C, Vice President

I have been asked this question many times during the delivery of CAPA’s Controlled Substances

Education Course and feel it is im-portant to provide clarification for PAs. Buprenorphine is a medication approved by the Food and Drug Administration (FDA) for managing pain in a transdermal patch and par-enteral form, the question from PAs involves wanting to use the sublin-gual form of buprenorphine (Subox-one® and Subutex®) in select patients for pain management. Sublingual

buprenorphine is only approved by the FDA for maintenance treatment of opioid dependence. Al-though the question may appear simple, the answer is some-what complicated. I will attempt to provide the history of these medications and the role that PAs have in using these medi-cations with patients.

On October 17, 2000, the Drug Addiction Treatment Act (DATA) estab-lished nationally that

“qualified physicians” could obtain a permit to obtain a waiver from the separate registration requirements of the Narcotic Addict Treatment Act, to treat opioid addiction with Schedule III, IV, and V opioid medications or combinations of such medications that have been specifi-cally approved by the FDA for that indication1. A definition of “quali-fied physician” was provided that included certification, education/training or other requirements that needed to be met. The first medica-tions approved for the use by quali-fied physicians were Suboxone® and

The confusion stems from deter-mining if it is the medication or the patient population that is restricted to treatment by qualified physi-cians. The medication in Suboxone® and Subutex® is buprenorphine, and buprenorphine has a long history in the management of pain. The FDA first approved parenteral buprenor-phine5 (Buprenex®) on December 29, 1981 for the relief of moderate to severe pain. More recently, trans-dermal buprenorphine6 (Butrans®) was approved June 30, 2010 for the management of moderate to severe chronic pain in patients requiring a continuous, around-the-clock opioid analgesic for an extended pe-riod of time. Some providers have viewed Suboxone® and Subutex® as a unique technological delivery sys-tem of buprenorphine and believe it may be helpful for specific patients in pain. Of course, proper training and a thorough understanding of the risks, benefits and alternatives is necessary prior to considering Suboxone® and Subutex® for any patient. Given that some formula-tions of buprenorphine have been approved for pain, the question that arises is, can a PA provide Sub-oxone® and Subutex® (not approved for pain) to patients for “off-label” conditions, such as pain?

The FDA does not regulate the prac-tice of medicine, but rather evaluates the safety and efficacy of medications for specific indications. It is accepted practice, and prescribers are legally allowed, to provide patients medica-tions for purposes other than their FDA approved label. The Substance Abuse and Mental Health Services Administration (SAMHSA) has specifically addressed the proposed question regarding the off-label use of Suboxone® and Subutex® for condi-tions other than opiate addiction, i.e. pain which states:

“I strongly urge caution

in diagnosing ‘opioid

dependence’ when

referring to just the

physical dependence

that occurs.”


Can California Physician Assistants Write for Suboxone® and Subutex® (or generic)?by Jeremy A. Adler, MS, PA-C, Vice President

Physicians and other practitioners who are authorized to prescribe Schedule III controlled narcotic medications under federal and state laws are eligible [to prescribe off-label Suboxone® and Subutex®] and the unique identifier under the Drug Addiction Treatment Act is not required7.

California law allows for PAs to obtain registration with the DEA for Schedule III controlled narcotic medications and therefore, as long as a PA is practicing under proper su-pervision, i.e. Delegation of Services Agreement, California License and DEA registration, PAs are able to provide Suboxone® and Subutex® for off-label uses, such as the man-agement of pain. As good practice, if these medications are provided for pain, it is important to alert the

pharmacist by writing “for pain” on the written prescription blank next to the order. Also, obtaining specific informed consent from the patient for using these medications off-label is recommended.

References:1 United States Departement of Health and Human Services - Substance Abuse and Mental Health Services Administration. Buprenorphine. Retrieved December 7, 2012, from http://buprenor-phine.samhsa.gov/titlexxxv.html.

2 Suboxone Prescribing Information. Retrieved December 7, 2012, from http://www.suboxone.com/pdfs/SuboxonePI.pdf.

3 U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control. Retrieved December 7, 2012, from http://www.deadiversion.usdoj.gov/pubs/docs/dwp_buprenorphine.htm.

4 DeDea, L. (March 9, 2011). PA prescrib-ing of buprenorphine. JAAPA, http://www.jaapa.com/pa-prescribing-of-buprenor-phine-swapping-out-aminoglycosides/article/197451/.

5 Buprenex Prescribing Information. Retrieved December 7, 2012, from http://www.drugs.com/pro/buprenex.html.

6 Butrans Prescribing Information. Retrieved December 7, 2012, from http://www.purduepharma.com/pi/prescription/butranspi.pdf.

7 Substance Abuse and Mental Health Services Administration. Frequently Asked Questions about Buprenorphine and the Drug Addiction Treatment Act of 2000. Retrieved December 7, 2012, from http://buprenorphine.samhsa.gov/faq.html#A21.

8 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. 2000.

Box 1DSM-IV TR criteria for Substance Dependence8:

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) Tolerance, as defined by either of the following:

(a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect

(b) markedly diminished effect with continued use of the same amount of the substance

(2) Withdrawal, as manifested by either of the following:

(a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)

(b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

(3) The substance is often taken in larger amounts or over a longer period than was intended

(4) There is a persistent desire or unsuccessful efforts to cut down or control substance use

(5) A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects

(6) Important social, occupational, or recreational activities are given up or reduced because of substance use

(7) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

8 CAPA NEWS

answering that question. We have participated in the development of workforce recommendations for the Governor which include PAs as a primary pathway, and also reflect our efforts to move PA practice to the top of our training. Through this process we hope to see MA supervision rights across the State and increased fund-ing for rotation opportunities for PA students. Additionally, we anxiously await final word on the authority to grant Category I CME for PAs serving as preceptors of PA students in the hopes that such change will allow us to expand class sizes and training opportunities to meet de-mand. Many of us in PA education are engaged in efforts to expand and strengthen the pipelines that feed PA training programs and reach into our underserved communities in order to expand the pool of candidates entering physician assistant training programs.

It’s an exciting time to be a PA. With the diligence of the California Academy of Physician Assistants, 2013 looks to be another year of progress and opportunity for the pro-fession as we help reshape the health care landscape. Here’s wishing all of you and all of California’s PAs a very happy new year.

L ast week I had the opportu-nity to see a new documentary called The Waiting Room. The

film was shot at Highland General Hospital, the county hospital in Oakland, California. The focus of the film was to document the culture and the community in a busy, urban emergency department waiting room. The film chronicles the efforts on the part of an overburdened staff to clear the register of patients waiting, some

seven or more hours, to be seen. We see pa-tients and their fami-lies praying together for the relief of their suffering, arguments, cell phone conversa-tions, trips to the cafeteria and the traumas that disrupt flow even further. Whether or not you live in the Bay Area, the movie will be a touching experience. Look for it at Oscar time and next year on

your local PBS affiliate. PA training programs are encouraged to follow the development of curriculum to be used as a companion to the movie (www.whatruwaitingfor.com).

Despite the human drama and the suffering depicted in the film, I was

struck by a simple thing: throughout the film we witness a number of conversations and telephone calls of the patients. Several times we hear someone say, “I’m at the doctor.” The first time I just thought it odd. “No, you’re not,” I thought to myself,

“you’re in the Emergency Room. This is not a trip to the doctor’s office.” But the second time and then the third time it happened, the reference took on a more ominous overtone. We are all aware of the excess expense and poor outcomes associated with a lack of access to primary care, and the problems resulting from over-crowding of our emergency depart-ments. This simple phrase, “I’m at the doctor,” repeated by several pa-tients during the film became a stark reminder of just how common the lack of access to basic human needs really is.

As we sit on the precipice of the Affordable Care Act and the an-ticipated result of several million Californians with new access to primary care, the simple phrase “I’m at the doctor,” also made one think about the question on everyone’s minds and lips these days – “who is going to care for all these new pa-tients?” Throughout 2011 and 2012, the California Academy of Physician Assistants worked diligently to assure the role of the physician assistant in

“The focus of the film

was to document the

culture and the community

in a busy, urban ED

waiting room.”

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

M ichael Scarano, Jr., Esq. authored the California Physician Assistant’s and Supervising Physician’s Legal Handbook. Newly updated, it answers scores of questions in a concise, clear fashion, with citations

and appendices that will permit practitioners to read the operative statutes and regulations for themselves. A must have for all California practices employing PAs. Visit the CAPA website at www.capanet.org for more information or to order the book online.

*CAPA Member Price - $34.95 Non Member Price - $54.95

California

Physician Assistant’s

and Supervising Physician’s

Legal Handbook

T H I R D E D I T I O N

C A L I F O R N I A A C A D E M Y O F P H Y S I C I A N A S S I S TA N T S

R. Michael Scarano, Jr.

Foley & Lardner LLP

CAPA General Counsel

What an ER Is Not?by Michael J. De Rosa, MPH, Ph.D., PA-C, PA Program Relations Chair


able to produce our exceptional conferences year after year without their support. The days of lavish pharmaceutical spending are over. Gone are the opulent dinners, sporting and theatrical event tickets and Mont Blanc pens. Money is scarce and the application process is tedious but occasionally persistence prevails.

There is much to be learned from our pharmaceutical colleagues and much they can learn from us. The millions of prescriptions PAs write every year hardly go unnoticed. More and more PA speakers are being added to pharmaceutical rosters. Collaboration is welcomed and drug companies want exposure where PAs gather. Gary Leach, regional director for Purdue approached me at the dinner and asked to exhibit at our 2013 Annual Conference in Palm Springs. He and his associate, Lisa Patterson, came to my office a few days later to bring samples and further establish their desire to be a resource for California PAs.

Pharm is our friend. Wherever and whenever we can nurture our relationship with them we should not hesitate to do so. CME is still learning even if you can’t log the hours and sustaining a strong CAPA connection results in benefits for all our members. Besides a filet mignon and lobster dinner is not the worst way to cap a busy day at the office.

• No CME

• A drug you may not be able to prescribe

• A weeknight sacrificed after a full day’s work

But…

I attend them as often as I can because I find, for the most part, they are worth the invested time…on several levels.

CME is just that; continuing medical education. Pharmaceutical companies pay impressive sums of money to physician and non-physician educators learned in disease processes. On-going research and the latest studies in disease management are reviewed.

Granted, the late night insomnia medication promoted at a recent dinner I attended will not appear on most of my drug protocols. Mine is a predominantly Medi-Cal HMO driven family practice environment and generics are preferred. But I still treat insomnia

nearly every day and Dr. Abidjan’s lecture was informative and thought-provoking. He is a clinical neurologist at UCLA. His insights into the pathophysiology of insomnia as well as the societal and personality traits inherent in patients with sleep disorders have proved very useful in my practice.

Unlike CME conferences where lecture rooms are packed with 100 or more registrants, weeknight

dinners are far more intimate in nature. 27 physicians, physician assistants and nurse practitioners attended my last dinner. These smaller groups present ample opportunity to ask questions related to your particular practice or patient. After dinner, one-on-one time with the speaker is always available and welcomed. The learning experience is far more engaging and personalized to your specific needs as a practitioner.

On a social level, these settings offer an opportunity to reconnect with friends and colleagues often not seen for many months at a time. Jonah Tan from Simi Valley, Kevin Robertson from Pasadena and Hugh Gibbs from Los Angeles are PA friends of mine who attended the dinner. I’m writing this article while on vacation in the Cayman Islands. It turns out that Kevin’s entire family are Caymanians and Hugh had just returned from a vacation there. Thanks to them I swam with sting rays (reluctantly) and ate some of the finest cuisine the islands had to offer.

Jonah arranged this dinner event with Purdue as he does with multiple pharmaceutical companies each year. It requires a lot of work to coordinate these events and he takes great pride in doing it. Jonah sees value in bringing together multi-specialty health care practitioners for learning and interaction. It supports the team practice model PAs subscribe to and promotes better understanding of the roles we all play in better serving the needs of our patients. I thank Jonah for his efforts.

Lastly, pharmaceutical companies are consistently supportive of our profession. CAPA would not be

“These smaller groups

present ample opportunity

to ask questions related to

your particular practice

or patient.”

Those Pharmaceutical Dinners…by Larry Rosen, PA-C, Director-At-Large

10 CAPA NEWS

A ccording to the CDC, the average life expectancy rate in the US is 78.7 years. With

more people living longer, provid-ers need to counsel their geriatric patients with respect to what cancer screening exams they should and should not consider as they age.

While there are fairly clear guide-lines as to what age a patient should start the different cancer screenings, when to stop screening becomes a much more difficult determination not only for providers and patients, but also for the experts, given the lack of scientific data. Most stud-

ies on prevention and screening tend to not include ge-riatric age patients. Extrapolating data from studies to as-sume the same bene-fit to elderly patients may not translate equally when look-ing at risk versus benefit outcomes. It’s important that providers take into consideration not only the age of the

patient when discussing screening exams, but any co-morbidities (i.e. dementia, heart disease, etc.), as well as the patient’s health values and goals.

The difference of precise age “cut-offs” provided by expert recommen-dations is a double-edged sword. In many respects, it allows providers to individualize screening recom-mendations. However, the disparity of data along with the uncertainty of benefit from a particular screen-ing test for an older patient may expose the geriatric population to unnecessary screening and subse-quent risk without benefit. In the

end, the final decision to undergo a particular screening exam rests with the patient. Hopefully, we, as their provider, can offer them educated pathways to make their decision.

Recommendations in Average Risk Individuals

Cervical Cancer Screening (Pap) - age 65 with prior normal screenings

Breast cancer Screening (Mammogram) age - 75-80

Colon Cancer Screening (Flex-Sig/Colonoscopy) - age 75 for men and age 80 for women, unless >10 year life expectancy

Prostate Cancer Screening (DRE/PSA) - age 75, may consider later if >10 year life expectancy

References• U.S. Preventive Services

Task Force. Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2008;149(9):627-637.

• ALBERT RH, et al. “Cancer Screening in the Older Patient” Am Fam Physician. 2008 Dec 15;78(12):1369-1374.

• Bellizzi KM, et al. “Prevalence of Cancer Screening in Older, Racially Diverse Adults Still Screening After All These Years” Arch Intern Med. 2011;171(22):2031-2037.

When Should You Stop?by Greg Mennie, PA-C, MSed, Director-At-Large

“The difference of precise

age ‘cut-offs’ provided by

expert recommendations is

a double-edged sword.”

We are mutually committed to continuing to improve safe access to health care by providing patient-centered, quality care within integrated, coordinated, physician-led teams.


Physician assistants are on the verge of becoming a dominant presence in health care work-

force. Currently there are approxi-mately 170 accredited PA programs in the United States and another 45 seeking accreditation between 2013 and 2015. Each of these programs will be seeking caring and dedicated men and women to become the next generation of health providers.

The current PA workforce has the unique opportunity to help mold the future of the profession by encourag-ing qualified applicants to apply to PA Programs. However, it is also our

responsibility to en-sure the applicants we recommend possess the correct qualities for successful comple-tion of PA school with the ultimate goal of becoming the next generation of quali-fied PAs.

There is no single quality that can identify a potentially outstanding PA. Just having the passion and drive to become a physician assistant or a good personal-ity and ability to get along with others

are not enough in today’s society. While these are definitely important attributes, it is a holistic mixture of qualities, including interpersonal skills, medical/community service, academic performance, and personal commitment that determines the strength of a PA applicant.

Interpersonal qualities include build-ing constructive and mutually ben-eficial relationships with individuals and groups. These qualities, when

developed, put others at ease while disarming hostility. Interpersonal skills have inclusivity of diversity and goodwill.

Medical/community service indi-cates the humanistic qualities of compassion, respect, and integrity. Compassion is the empathetic con-sciousness of others’ distress together with a desire to alleviate it. Respect is the act of providing particular at-tention to a person or a situation. Integrity is an adherence to a code of moral values.

Academic performance is a chrono-logical record of the learning process of an individual in an educational in-stitutional environment. It indicates strengths and weakness in critical thinking and the knowledge or skill acquired by study.

Personal commitment is a state of be-ing obligated or emotionally impelled to a cause, such as the PA profession. It can be an indicator of the work intensity a person may exhibit to ob-tain a goal.

As the PA profession continues to change, so do the requirements to become a physician assistant. For some of us, PA school has drasti-cally changed from when we first took our first course and has become increasingly more challenging and competitive in terms of academics, critical thinking, medical experi-ence and community service. To

help prospective applicants become as competitive and prepared as pos-sible, we, as PAs, owe it to future generations to stay current regarding accurate PA program requirements when offering application guidance. A quick online perusal of a school’s guidelines can assist in this area.

If a potential applicant asks you to write a letter of recommendation, it is critical to obtain the applicant’s pertinent information in order to make an honest and thoughtful evaluation. Ask to see a copy of their transcripts so your letter can support the academic readiness of the appli-cant. Discuss with the applicant what type of medical/community service they have provided and for how long. Be able to illustrate the applicant’s interpersonal skills in the context of the medical/community service. It is important to address the applicant’s commitment to the PA profession so as to determine that they are not planning to use the program as a stepping stone into other medical professions.

When potential PA applicants seek guidance from us, it is a tremen-dous responsibility that should not be taken lightly. Not only does it provide the opportunity to play an important role in determining the future of health care, but it is a chance to ensure the advancement of the honorable profession of physician assistant.

Am I Providing Good Guidance for the Next Generation of PAs?by Roy Guizado, MS, PA-C, Student Affairs Committee Chair

“…it is a holistic mixture

of qualities, including

interpersonal skills,

medical/community

service, academic

performance and personal

commitment that

determine the strength of a

PA applicant. ”

CAPA keeps a list at the office of PAs who are open to being “shadowed” by prospective students. If you would like to be added to the list, please let us know. Email: [email protected] or call (714) 427-0321.

12 CAPA NEWS

The start gun goes off and the hun-dreds who have gathered this fall morning start on their journey. I man my post as I listen in to the feeds coming through the two-way radio, waiting for my cue to provide help.

Groups of runners start to cross the finish line and I am tending to is-sues such as muscle cramps and an ankle sprain. As more and more participants start to finish I am sum-moned on the two-way radio to tend to a woman in her 50s who fainted after crossing the finish line. I run over, my heart now racing. Assessing the situation and asking others what they witnessed, I formulate possible causes of her symptoms. The woman becomes alert, but still lethargic. Soon another women, reporting to be the sister to the lady who fainted, tells me that her sister is diabetic and failed to eat anything prior to the race. She further explains that their original plan was to walk the five kilometer distance this morning, but they were feeling good and decided to jog most of the race. I treat the woman for hypoglycemia and she improves. I provide helpful insight on what the woman should do to monitor her sugars and recommend she contact or follow up with the clinician who manages her diabetes this week.

I am thanked by the family and con-tinue helping other runners stopping by the First Aid tent. A man in his early twenties limps up to the First Aid tent and asks for assistance. I help him to a chair as I assess a calf strain. We chat as he sits with ice wrapped to his calf. He asks where I went for EMT training, as he is in-terested in finding a career in medi-cine. I tell him that I am actually a physician assistant (PA). He is not

Volunteer, It Just Might Help the PA Profession More Than You Thinkby Anthony Gauthier, PA-C, ATC, Public Policy Committee Chair

I t’s 7:00 a.m. on a crisp Saturday morning, music is blaring and people are gathering.

“Why did I agree to this again?” The thought races through my mind as I methodically review the contents of my bag, making sure I have every-thing.

I contemplate to my-self, “It is only for a couple hours, then I can go back to bed or get on with my week-end,” as the crowd continues to grow like ants descend-ing onto a new food source.

I make my way over to the Volunteers tent and check in. I’m handed my two-way radio and guided to

the First-Aid tent. I begin to set up my makeshift exam area as I partici-pate in small talk with those working booths around me. I start to look at all the people around me as they stretch and warm-up. Faces young and old, all eager to test themselves and participate in this morning’s race.

familiar with the PA profession as he asks what one is and what one does. I answer his questions and notice him becoming very interested in the topic. The young man thanks me for the first aid service and for provid-ing insight into a new career path for him. He gingerly walks away as he thanks me again.

The race has concluded and I pack up my things and return my two-way radio. I am thanked by the race organizers for helping them out and I reply, “It was my pleasure.”

As I walk away it hits me, the mo-ment of clarity, where I understand: “This is why I volunteer.”

Early in my career, I focused my volunteer efforts on providing medical services at health fairs and athletic events. I viewed myself as someone that could provide a ser-vice for those in need. As I continue to volunteer, I begin to realize there is more to the experience than pro-viding medical care.

Over the years, I’ve come to un-derstand that when volunteering as a PA, I am an ambassador for the PA profession. If my interactions when volunteering help provide par-ticipants a greater understanding of what a PA is and what the PA’s role in medicine is, I have added to the success of the PA profession.

As PAs, we are privileged to be a part of a profession in which our knowledge and skills can impact the lives of others in positive ways. This is a reason why it is important for us to provide a helping hand whenever we can.

“Remember as a

volunteering PA, you must

still remain in compliance

with appropriate laws and

regulations which govern

our profession.”



W e all need to keep up with current trends in medicine as well as satisfy NCCPA

and the State of California require-ments for CME hours. So why not come to the Napa Valley Marriott on Saturday, February 23, 2013 to fulfill part of your CME hours? CAPA is coming to Napa again to offer you 6 hours of Category I CME credit in the beautiful sur-roundings of the historic Napa Valley and you don’t want to miss

it this year. For many of you this will be a return visit to CAPA at Napa and for some of you, it will be your first CAPA at Napa experience.

Either way, make this the year to come join us.

With the newly renovated Napa Valley Marriott we couldn’t ask for a better host hotel. The rooms are pristine and the lobby is a great place to socialize, meet new friends or just catch up with old friends, grab a drink or some food. And, to think that just minutes away are world re-nowned vineyards and tasting rooms that await your visit. Not to mention some great restaurants in the area. This truly is the ideal place for a CME conference.

We offer 6 hours of Category I CME credit as well as a 1-hour lunch lecture which may be claimed as Category II. Some highlighted speakers include: Jennifer Carlquist, PA-C back this year with “EKG Treasure Hunt-Using a Chief Complaint Based Approach

to Reading 12 Leads”, Bob Miller, PA and CAPA’s Legal Counsel Michael Scarano, will be giving a “Legal Issues Update” and Dr. James Ting will be speaking on “5 Common Pediatric Sports Injuries.” We have other excit-ing lectures, but this is just a taste of what’s in store for you.

It’s not every day that we come to-gether to see our PA colleagues and this is a great excuse to take a trip to Napa, spend some time with your col-leagues and gain new insights on your practice of medicine. This conference is a CAPA tradition and is always well attended. For the last several years this conference has sold out early, so please make sure to register early online or call the CAPA office at 714-427-0321 to ensure your spot at this year’s CAPA at Napa. Make sure to make your hotel reservations early as well. We hope you will be joining us. We look forward to seeing you and know you will enjoy this year’s conference. See you in February!

CME and Napa Valley, What More Could You Ask For?by Eric Glassman, MHS, PA-C, CME Committee Chair

CAPA at NapaVolunteer, It Just Might Help the PA Profession More Than You Think


Every PA that volunteers is, at that moment, the face of the profession. I encourage all PAs to help promote the profession when volunteering. Educate those you come in contact with and help continue to strength-en our great profession.

Remember as a volunteering PA, you must still remain in compli-ance with appropriate laws and regulations which govern our profession. You must still have an appropriate supervising physician (SP) and a Delegation of Services

Agreement (DSA) for the treatment you may be providing, signed by both the SP and PA. The SP must be accessible at least electronically. Also look into your malpractice insurance coverage which may not cover services outside of your usual practice settings. Some organiza-tions may provide malpractice coverage for volunteers covering the particular event.

CAPA at NapaReserve your room today at the Napa Valley Marriott (707) 253-8600. If they are sold out, check with the nearby Hilton Garden Inn at 707-252-0444.

See Page 15 for complete Napa Schedule and Registration Form

14 CAPA NEWS

Controlled Substances Education CourseA Course Which Upon Successful Completion Will Allow You To Write For

Controlled Substances Without Patient Specific Approval*

*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.

Sunday, February 24, 2013Napa Valley Marriott3425 Solano Ave Napa, CA 94558(707) 253-8600

Saturday, April 20, 2013Scripps Green HospitalTimken Amphitheater

10666 N Torrey Pines RdLa Jolla, CA 92037

Wednesday, October 2, 2013Renaissance Palm Springs

(preceding the CAPA Conference)888 E Tahquitz Canyon Way

Palm Springs, CA 92262

Comments From Previous Courses

Palm Springs—September 21, 2011“Enjoyable yet informative presentations from Dr. Lowe and Jeremy Adler, PA-C. Both instructors made the topics discussed interesting and applicable. Thank you!”

Oakland – August 25, 2012Very good speakers. Entertaining & informative. Thank you!

Course was overall fantastic and very applicable to clinical practice.

Inspiring and practical – Perfect!

Palm Springs – October 3, 2012Great course, very informative and practical.

Thanks – I wish I had this kind of course years ago!

Very informative. Thanks for mixing in “real life” stories and a little humor!

RegisterToday

6 Hours

Cat. ICME

Courses will be canceled if minimum number of registrants is not met.

RSVP Today—Feb. 24, 2013

“Mental Health Across the Life Span”

Plan to attend a free one-day mental health conference, hosted by Touro University California, the day after the CAPA at Napa conference. Topics will include: adult ADHD, psychopharmacology, and issues specific to returning veterans. When: Sunday 2/24/13, 9am-4pm Where: Napa Marriott Cost: FREE; meals provided

Make the most of your trip to Napa!

For more information or to RSVP, contact Julie Charles at 707-638-5875 or email: [email protected]

FREE


Application has been made to the American Academy of Physician Assistants (AAPA) for 6 hours of Category I CME credit. Approval is pending.

Controlled Substances Courseon Sunday

Saturday, February 23, 20138:45 a.m. - 4:25 p.m.

Register online at www.capanet.org

Sponsored by theCalifornia Academy of Physician Assistants

Name _______________________________________________________

PA-C PA PA-S NP MD/DO Other __________________

PA License # __________________________________________________

Address ___________________________City _______________________

State _______________________________ Zip Code_________________

Phone (____) __________________ Fax (____) ______________________

Work Address _________________________________________________

City ________________________________________________________

State _______________________________ Zip Code_________________

Phone (____) __________________ Fax (____) ______________________

CAPA Member - $150 Non-Member - $240 PA Student - $50 Napa Conference and CAPA Membership through 4/30/14 - $275* Late Registration Fee after January 25, 2013 - add $20 Bring a Guest to Lunch - $37 (must be over 18)

Name(s)_________________________________________________

Vegetarian Meal Required or Gluten-Fee Meal Required

Total Amount $ _____________

Signature ____________________________CVV# _____Exp. _________

In accordance with the Americans with Disabilities Act, please check here if you have any special needs. You will be contacted by CAPA.

Mail Registration Form and make checks payable to:California Academy of Physician Assistants

2318 S. Fairview St. • Santa Ana, CA 92704Phone: (714) 427-0321 • Fax: (714) 427-0324

or Register online at: http://www.capanet.org

*New Fellow and Associates Members Only

Registration Form 8:00 a.m. – 8:45 a.m. Registration

8:00 a.m. – 8:45 a.m. Continental Breakfast and Exhibits

8:45 a.m. – 9:40 a.m. EKG Treasure Hunt - Using a Chief Complaint Based Approach to Reading 12 Leads

Jennifer Carlquist, PA-C

9:40 a.m. – 10:35 a.m. Pain Update Jeremy Adler, MS, PA-C

10:35 a.m. – 11:20 a.m. Break and Exhibits

11:20 a.m. – 11:30 a.m. Needy Meds Drug Discount Card Update Teresa Anderson, MPH

11:30 a.m. – 12:20 p.m. 5 Common Pediatric Sports Injuries James Ting, MD, FAAFP

12:20 p.m. – 1:10 p.m. A Primer for Working Up Anemia Brad Lewis, MD

1:15 p.m. – 1:25 p.m. Legislative and Public Policy Update Teresa Anderson, MPH

1:25 p.m. – 2:25 p.m. Lunch (not eligible for CME) Diabetes Update Speaker TBA

2:30 p.m. – 3:20 p.m. Legal Issues Update Robert Miller, PA and Michael Scarano Jr.

3:20 p.m. – 4:10 p.m. Guiding Principles for Diabetes Care for PAs Christopher E. Adler, MA, PA-C, CDE

4:10 p.m. – 4:25 p.m. Prize Drawing and Closing

6 Hours Category I - CME Credit Applied For

Application has been made to the American Academy of Physician Assistants (AAPA) for 6 hours of Category I CME credit. Approval is pending. Courses will be canceled if minimum number of registrants is not met. The planners and sponsors of this function claim no liability for the safety of any attendee while in transit to or from this event. The planners and sponsors reserve the right to change speakers and/or cancel the event due to unforeseen circumstances without penalty. The total amount of any liability of the planners and sponsors will be limited to a refund of the registration fees.

CAPA at NapaJoin us in Napa. We have developed an excellent educational program set in the beautiful, lush green Napa Valley and offer it to you at a very reasonable price. CAPA is coming to Napa and you won’t want to miss it!

One-Day Conferencein Napa at the Napa Valley

6 Hours of Cat. I CME

Program

16 CAPA NEWS

E very year at the CAPA Conference in Palm Springs we hear it said: “You guys have the best speakers. How do you do it?” The answer

is we hand pick them based on referrals, feedback and firsthand experiences.

Please help us identify the great speakers out there. Keep your ears open for interesting topics and excellent speakers. Please let us know what/who they are. You can email us, call us and/or fax us the information.

We have a new 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: [email protected]: (714) 427-0321Fax: (714) 427-0324

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

If You Can Only Attend One CME Conference in the West This Year – It Should Be the

2013 CAPA Conference!

• Attending the CAPA Conference helps to support the only organization working solely to promote and protect California PAs.

• The CAPA Conference is exactly the right size. Big enough to take over the entire Renaissance Hotel and, small and friendly enough to allow you to feel at home and part of this wonderful California Community of PAs.

• The CAPA Conference is the right price. If you reserve your hotel room early, you can stay at the Renaissance for just $189 per night or the Palm Springs Hilton for just $165 per night. Compare that to the room rates for other conferences. Save about $100 a night!

• The CAPA Conference includes 5 or more meals with no waiting in line for a seat. This is your conference and our goal is to make you feel welcome.

• The CAPA Conference has the best speakers, handpicked by PAs for PAs. We listen to what you want and bring back your favorites.

Heard

Any Great

Speakers

Lately?


Phase 4: Individuals residing in a county that is not a Medi-Cal managed care county shall be provided services under the Medi-Cal fee-for-service delivery system. In the event the department creates a managed health care system in the said counties individuals residing in those counties shall be enrolled in managed health care plans shall begin no earlier than September 1, 2013.

This major policy shift has raised several concerns among some legislators, providers, advocates and consumers. Provider network adequacy, continuity of care, mental health services, dental services, provider rates and monitoring are among the greatest of concerns. On October 16, 2012, a Joint Senate Oversight Hearing on the Transition of the Healthy Families Program to Medi-Cal in which members of the Budget and Health Committees convened to seek answers from the Department of Health Care Services (DHCS) on some very tough questions posed by stakeholders throughout the state. Senator Roderick D. Wright (Senate District 35 - Los Angeles County communities of Carson, Compton, West Compton, Gardena, Harbor City, Hawthorne, Inglewood, Lawndale, Lennox, West Carson, Watts, Willowbrook, and Wilmington) concisely summed up one of the most prevalent themes (network adequacy) throughout the hearing with the following question and comment:

Senator Wright, “In my district I have a lot of providers that don’t take Medi-Cal, so when you call and say I am on Medi-Cal, they say so(?). Is this going to expand the number of people

The Department of Health Care Services (DHCS), Managed Risk Medical Insurance Board (MRMIB) and the Department of Managed Health Care (DMHC) have been commissioned to work collaboratively to facilitate the transition of HFP children into Medi-Cal. The strategic plan outlines a four-phase plan intended to describe an approach to ensure a smooth transition with no disruption of services and continued access to coverage for the children in California served under this program. The phases are as follows:

Phase 1: Individuals enrolled in a Healthy Families Program health plan that is a Medi-Cal managed care health plan shall be enrolled in the same plan no earlier than January 1, 2013.

Phase 2: Individuals enrolled in a Healthy Families Program managed care health plan that is a subcontractor of a

Medi-Cal managed care health plan, to the extent possible, shall be enrolled into a Medi-Cal managed care health plan that includes the individuals’ current plan shall begin no earlier than April 1, 2013.

Phase 3: Individuals enrolled in a Healthy Families Program plan that is not a Medi-Cal managed care health plan and does not contract or subcontract with a Medi-Cal managed care health plan shall be enrolled in a Medi-Cal managed care health plan in that county shall begin no earlier than August 1, 2013.

who can’t receive care because there is an increase in the number of providers who don’t accept the plan?”

“…the challenge I have is you [he was directing comment to Toby Douglas, Director of the Department of Health Care Services as the Director acknowledged there would be a financial impact on providers] describe impact - I would describe it as a reduction in fee, that reduction in fee would suggest to me that there will be more people that don’t take the plan, which means there will be a greater number of people who can’t receive service.”

As required by law (AB 1494) a Network Adequacy Assessment Report was conducted by the DMHC to determine which plans and counties were most ready to proceed with the transition. The report was published on November 1, 2012 and key findings suggest a wide range of capacity issues across counties. Stakeholders are asking for increased oversight and accountability throughout the transition to ensure counties and plans are able to handle transition related enrollment without compromising care, especially in areas that are disproportionately affected. The report in its entirety can be found at: http://www.dhcs.ca.gov/services/Documents/HealthyFamiliesTransitiontoMedi-CalNetworkAdequacyAssessmentReportFinal11-1-12.pdf

Implications for ProvidersPhase 1 notices have already been sent out so it is likely that concerned parents will be coming to visits with questions about their child’s coverage.

What’s Happening with California’s Healthy Families Program?by Teresa Anderson, MPH, Public Policy Director


“This major policy shift

has raised several concerns

among some legislators,

providers, advocates and

consumers.”


18 CAPA NEWS

A Necessary Step in the Right Direction

Cal managed care, defines PCPs as only including primary care physicians. As discussed above, PAs routinely function in the primary care physician role in California; therefore, they should be legally designated as such.

A 2010 Legislative Analyst’s Office (LAO) report provides an overview of the impact PPACA will have on state health programs in California. The LAO acknowledges that successful implementation of health care reform in California will depend on the state’s response to access issues. The report further acknowledges that shortages already exist in some areas and that Medi-Cal expansion will likely create a surge in demand for health care services statewide, leaving many unable to find a provider to meet their needs.3 The LAO advises the legislature to consider the number, type and distribution of health care professionals and how well they can meet the current and future needs of Californians. The LAO recommendations focus in part on better utilization of existing health manpower resources. Permitting PAs in managed-care medical practices to manage increased panels as PCPs, under physician supervision, will help achieve this goal.

CAPA is pursuing legislation in which state law would be amended to define “primary care provider” to include PAs. CAPA is also seeking to change state law requiring – or at least explicitly permiting – Medi-Cal managed care plans to allow practices who employ PAs to increase the panel size for the practice. The panel size for a jointly designated physician led PA team would be somewhere between one and a half and two times the number of patients who can be assigned to a physician. These changes would be consistent with federal law as well as accepted common practice in California and nationally. Most importantly, these steps would help expand access to care.

1. Health and Safety Code, Section 1367.03

2. Patient Protection and Affordable Care Act, Section 5501 Expanding Access to Primary Care Services and General Surgery Services (A) PRIMARY CARE PRACTITIONER

3. Legislative Analyst’s Office, Mac Taylor, The Patient Protection and Affordable Care Act: An Overview of Its Potential Impact on State Health Programs (May 2010)

What’s Happening with California’s Healthy Families Program?

For the most part Medi-Cal covers all the same benefits that HFP currently covers including: medical visits, dental, visions, mental health, alcohol and drug treatment along with other behavioral health services. If your patients have questions about their Medi-Cal coverage www.benefitscal.com can help them find their local county office.

Phase 1 Counties scheduled to transition include: Alameda, Riverside, San Bernardino, San Francisco, Santa Clara, Orange, San Mateo, and San Diego.

Many providers expressed concern during the stakeholder process about the reduction of reimbursement as Medi-Cal rates are lower than HFP rates, this is of particular concern for several reasons: some providers may have a higher proportion of HFP beneficiaries and will see a significant drop in reimbursement, the U.S. Court of Appeals for the 9th Circuit rule in favor of the state giving authority to follow through with a 10% provider payment reduction and the DHCS reported that they will have to delay the primary care reimbursement

increase afforded by the Patient Protection and Affordable Care Act (although they say they eventually intend to pay it including retroactive payment).

Needless to say there are many complex issues associated with this transition and we will continue to monitor the state’s efforts to ensure network adequacy, reimbursement issues, state plan amendments and other issues of concern related to the transition.



I would also like to take this opportunity to say that I think we have made a good decision in hiring Teresa Anderson as CAPA’s Public Policy Director. She knows her way around the Capitol and has learned the nuances of working with peo-ple in this arena. The best I can tell, work-ing around the Capitol is like practicing medicine. If you don’t do it every day, you may very well miss something important and quickly get in trouble.

It is my intention to spend more time at the Capitol and hopefully build more relationships that will allow PAs to con-tinue to be part of the health care solu-tion in California. The next few years will be critical ones for our field. Many people will be frustrated at times, but with perseverance, a good attitude, and excellent medical practice, we will find our way and be everything we came to the profession to be.

As always, thanks for all you do. You make a difference every day, and your state and your nation are better places be-cause of you.

See you in Napa!

My Trip to the Capitol



“…the goal is to create

relationships with facilities

and specialist to create

systems of referral that are

best for patients.”

within San Bernardino County, we found that the process is far from uniform and varies from clinic to clinic. Some of the clinics we spoke with referred all their patients to the county hospital, others referred to private physicians within the community, some paid specialists to come to their clinic on a rotating basis to see patients and others had physicians that would volunteer their services at their respective clinics. Each of these different relationships had different “guidelines” that constituted or initiated a need for referral. In the case of our Specialty Care Coalition we focused on our county hospital since that was where the greatest number of our clinics seemed to send their uninsured patients for specialty care.

As I mentioned above, our county hospital is inundated with referrals on a daily basis and we needed to find an efficient and sustainable way of improving referral capacity. The specialty clinics within the hospital are contracted specialists or specialty groups that have agreed to provide specialty services. Therefore, each of these specialists has their own “guidelines” or “requirements” that constitute an appropriate referral. The goal of working with the hospital is to create uniform referral guidelines for each of the specialties. Community health centers and clinics would have access to the documented requirements when they are considering referral of a patient for specialty care.

Referral guidelines can be as simple or complex as you would like and are dependent on the facility and the specialist you are working with. Simple referral guidelines can simply indicate the suspected condition and

In the November/December 2012 issue of the CAPA News, I introduced the problem of access to specialty care for the uninsured and gave a brief overview of four ways in which the problem could be addressed. In this issue I will focus on the first way in which primary care providers, specialty providers and centers for specialty referrals can work together to improve patient access and increase capacity for referrals.

Embedding referral guidelines into the referral process is one way to create capacity within specialty referral centers by providing primary care providers with clear guidelines for what constitutes and completes a proper referral. In San Bernardino County we have engaged our designated county hospital to work on

developing referral guidelines to help decrease the number of unnecessary referrals. Our county hospital houses 23 specialty clinics which represent approximately 50 sub-specialties. The facility receives approximately 700 referrals to their specialty clinics each day and sees almost 250,000 patients each year. This number of referrals is overwhelming. Finding a way to decrease the overall number of referrals while ensuring that patients are being appropriately cared for is challenging. The county’s specialty care coalition has been working very closely with the hospital and has created a relationship that will foster the appropriate changes needed. Researching the referral process

the appropriate specialty to send the patient to. As the guidelines become more detailed they can include specific laboratory and diagnostic tests that need to be included with the referral. Referral guidelines can also include clinical requirements such as length of symptoms and specific medication treatment requirements before a referral can be approved. Regardless of the complexity of the referral guidelines created there are several key factors that contribute to sustainability and spread. They are:

1. Referral system improvements require initial investment to develop and implement. Continual updating and maintenance is needed, but does not require significant financial resources to sustain.

2. System improvements (both electronic and manual) are facilitated by engaging key stakeholders in discussions about current practices, making changes to workflow, and developing referral tools to address identified issues.

3. Existing guidelines and referral tools can assist in spreading successful referral processes. However, these tools must be customized to the local health care environment to be effective.

No matter how simple or complex of referral guidelines you choose to create, the goal is to create relationships with facilities and specialists to create systems of referral that are best for patients.

Specialty Care for the Uninsured: Building a Bridge to Better Access - Part 2by Matthew Keane MSPA, PA-C, Director-at-Large

20 CAPA NEWS

• Lack of public awareness of effective treatments

• Financial burden

• Societal stigma of having a mental health illness5

I also propose that the inability or unwillingness of family and friends to identify mental illness in loved ones to be a major barrier in accessing care. In addition, geographic, racial and socio-economic barriers compound the lack of access to mental health care. Unfortunately, even if a patient does access mental health care, the quantity is severely lacking. In one study, adult patients suffering from serious mental illnesses including psychosis typically spend only 10.5 hours per year with non-prescriber mental health professionals (e.g., LSW, MFT, etc.) and 4.4 hours annually with prescribing mental health providers.6

As health care providers, we should screen for basic mental health issues, just like we do for cervical and colon cancers. According to the American Academy of Family Physicians, 11 to 36 percent of primary care patients have mental disorders.7 Thus, including more psychiatric review of system questions in our exams is needed especially amongst our chronic disease patients. Failure to treat both physical and mental health conditions (e.g., asthma, diabetes, and heart conditions), has been shown to result in poorer health outcomes and higher health care costs.8

Currently, less than one-third of primary care providers routinely screen patients for mental illness.9 The United States Preventative Services Task Force considers routine screening for depression in adults

Mental Health Access in the United States

by Joy Dugan, MPH, PA-C, Secretary

In light of the recent elementary school shooting in Newtown, Connecticut, I was compelled

to research mental health statistics, barriers to access, and possible solutions for moving forward. No matter the specialty you may work in, understanding these barriers and making small changes in your clinical practice will hopefully lead to improved patient outcomes.

The incidence of psychotic, personality, mood, and other serious

mental disorders are highest in adolescence and early adulthood.1 Approximately one in four American adults 18 years and older suffer from a diagnosed mental disorder in a given year.2 In any given year, of those with a diagnosed mental disorder, less than one-half of children and one-third of adults receive mental

health services.3 In the United States, mental disorders are the leading cause of disability.4 The barriers to care of mental illness are extensive. According to Center for American Progress (2010), some barriers include:

• Shortage of mental health providers

• Primary care workforce’s ability to diagnose, treat, and manage mental health disorders

• Failure to link physical comorbidities with mental health care

a “B Recommendation,” as long as proper diagnosis, treatment, and follow-up are in place.10 Depression screening questionnaires, such as the Beck Depression Inventory for adolescents and adults or the Patient-Health Questionnaire 9 (PHQ-9) for adult patients, are easily performed in the primary care setting. (For a copy of the PHQ-9: http://www.phqscreeners.com/pdfs/02_PHQ-9/English.pdf or Beck Depression Inventory: http://www.cawt.com/Site/11/Documents/Members/Evaluation/BeckDepressionInventory1.pdf.)

All clinicians must be aware of the treatment options available in their community for mental health disorders. Creating a referral network is imperative in treating many mental illnesses. After the CAPA at Napa Conference, I hope you will consider attending the free, day-long CME mental health training seminar sponsored by Touro University-California on February 24, 2013. Reservations are required, contact Julie Charles at 707-638-5875 or [email protected]. Help reduce a barrier to mental health care access by increasing your ability to manage mental health disorders.

Resources1. Prevalence of Serious Mental Illness Among U.S. Adults by Age, Sex, and Race. (2008). National Institute of Mental Health. Accessed: http://www.nimh.nih.gov/statistics/SMI_AASR.shtml.

2. Kessler R, Chiu W, Demler O, Walters E. (2005, June). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6):617-27.

3. U.S. Department of Health and Human Services. (1999). Mental Health:

“As health care providers,

we should screen for basic

mental health issues, just

like we do for cervical and

colon cancers.”


Mental Health Access in the United States

by Joy Dugan, MPH, PA-C, Secretary

A Report of the Surgeon General. Rockville, Md., U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

4. The World Health Organization. The global burden of disease: 2004 update, Table A2: Burden of disease in DALYs by cause, sex and income group in WHO regions, estimates for 2004. Accessed: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_AnnexA.pdf.

5. Russel, L. (2010). Mental Health Care Services in Primary Care. Center for American Progress. Accessed:

http://www.americanprogress.org/wp-content/uploads/issues/2010/10/pdf/mentalhealth.pdf.

6. Konrad T, et al. (2009). County-Level Estimates of Need for Mental health professionals in the United States. Psychiatric Services. 60: 1307–1314.

7. American Academy of Family Physicians. (2001). “Mental health care services by Family physicians (position paper)”. Accessed: http://www.aafp.org/online/en/home/policy/policies/m/mental- healthcareservices.html.

8. Petterson et al. (2008). Why there Must be Room for Mental health in the Medical Home. Accessed: http://www.graham-center.org/online/graham/

home/publications/onepagers/2008/op52-mental-health.html.

9. Genrich J & McGuire L. (2009). Identifying Mental illness Early through Routine Mental Health Screening. Medscape Psychiatry and Mental Illness. Accessed: http://www.medscape.com/view- article/711264.

10. United States Preventative Services Taskforce. (2002). Screening for Depression. Accessed: http://www.uspreventiveservicestaskforce.org/uspstf/uspsdepr.htm.

Individualprofessional liabilitycoverage atcompetitive rates.

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

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 beavailable 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 policycan 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

CAPA0112_Layout 1 11/29/11 4:08 PM Page 1

Our condolences to the loss of our colleague (Robert Parker, PA-C)’s daughter, Emilie Parker (emilieparkerfund.com) and all those who died in Newton, Connecticut on December 14, 2012.

22 CAPA NEWS

In many instances, immigrant popu-lations may have limited access or no access to interpretation services. Many rely upon relatives or friends for interpretation but sometimes what is being relayed to a patient is lost in the translation due to a misunderstanding of terminology or cultural perceptions of a condition or ailment.

Too many health care facilities, health plans and clinics leave it to the clinician and the patient to use an untrained interpreter or to try and make do with English.6 This practice still exists in many health care clinics that cater to immigrant populations where health care providers are not fluent in any other language other than English. The diversity of lan-guages has created policy initiatives to address the language barrier in these populations.6

The legislation created for provi-sion of interpreting services relates to Title VI of the Civil Rights Act of 1964. The Policy prohibits dis-crimination of national origins and their limited English proficiency. It implies that federal and state gov-ernments are obligated to meet the needs of foreign language speaking legal immigrants. In fulfilling that obligation, the U.S. Department of Health and Human Services edu-cates and provides ways of obtaining language interpreters to entities that receive federal financial assistance so that in turn they could provide access to the services at no cost.4 Medicare, Medicaid and SCHIP re-cipients such as health care providers, hospitals, managed health care plans and pharmacies are obligated to offer interpreter services.3

The federal government created the National Standards for Culturally and Linguistically Appropriate

The Language Gap of Healingby Michael Estrada, PA-C, MS, DHSc, Committee on Diversity Chair

America is the melting pot of cultural diversity. Walk the streets in any suburban area

and you can see, hear and feel the many ethnic groups that make up its population. The overall U.S. im-migrant population grew about six percent between 1970 and 1980.1 Calculating this rate roughly cor-relates to about a 60 percent growth over the next 100 years. A big part of the U.S. population has limited English proficiency.2

23 million American people are at risk for receiving poor quality health care because they cannot

speak English very well.3 Federal laws have mandated that non-English and limited English speaking popula-tions, regardless of immigrant status, have access to lan-guage assistance in health care settings.4 The laws also man-date that hospitals follow the recom-mended guidelines established for the use of professional interpreters. Limited English Proficient populations (LEPs) are increasing and

are placing more demands on the integration of interpreters in hospitals, clinics and public ser-vice agencies.5 However, there is still limited use of interpreters in the clinical setting.4 The limited growth of language services has failed to meet the needs of a rap-idly emerging, culturally diverse population, therefore, creating opportunity for unique and inno-vative ways of providing language interpretation services.

Services in health care (CLAS) in 2001. The CLAS standards have been adopted by many health care facilities so that they can de-velop their own interpreter services. Despite the creation of these stan-dards, many organizations have con-sidered the guidelines voluntary and government agencies have had poor success in enforcing them.

Every state has at least two laws that clarify or broaden the federal government requirements.3 Some of the state laws are comprehensive and cover a wide range of issues such as accessibility to interpreting services while others might target a specific population in need of interpreting services.

The average incurred cost of face-to-face interpreter services might include an hourly rate, with a mini-mum of two to three hours, waiting time, and mileage.5 The federal poli-cies that require recipients of federal money, such as health care providers and health care agencies, to provide interpreter services have had dif-ficulty securing reimbursement and have obligated physicians to burden the cost. For example, in California, Medi-Cal (California Medicaid) pays physicians an average of 24 dollars for an established patient office visit which is far less than the expense incurred for interpreter services.3 The American Medical Association (AMA) has expressed concern about this issue and is opposed to physi-cians accepting responsibility for interpreter services.

The Office of Management and Budget (OMB) estimated that in-terpretation services would cost the United States 268 million dollars a year to provide interpretation ser-vices to hospitals, physicians and dentists.3

“Too many health care

facilities, health plans

and clinics leave it to the

clinician and the patient

to use an untrained

interpreter or to try and

make do with English.”


The Language Gap of Healingby Michael Estrada, PA-C, MS, DHSc, Committee on Diversity Chair

services is dependent on how well they communicate. The OMB argues that it will cost the American people too much money to pay for interpreter services. But studies have shown that the cost for interpreter services is far less than compared to the health care dispar-ity and limited accessibility the cur-rent system has created for diverse populations.2 Paying for interpreter services may help reduce racial dis-parity in health care by encouraging non-English speaking populations to visit primary care providers more regularly.

The use of an interpreter is too costly for the health care provider. An alternative to this approach is to contract telephone interpreters (TI). TIs are paid by minutes rather by the hour and they are paid only for their interpretation.5 This can be an effec-tive method of containing a cost that is often burdened by the health care provider.

Federal and state funding programs consider the reimbursement for pro-vider services enough to help pay for interpreter services. The average fee reimbursement is 24 dollars per visit. If there were a fee adjustment to the standard payment given for health care services on those patients that required an interpreter it could offset the expense the physician encumbers for interpreter services.

Cultural diversity is an important part of America. So is reducing lan-guage barriers. The legal and ethical obligation of health care providers to offer language services to patients with limited English has already been established by The United States.7 By filling the gap of language disparity we are building a stronger health care system and improving

Ten states pay for interpretation ser-vices through Medicaid and SCHIP, either through authorized reim-bursement or through contracted interpreter service companies. Private insurance companies are the most difficult to provide reimbursement for interpreter services, often refus-ing to pay for services. Health care systems such as Kaiser Permanente may hire interpreters, but third party reimbursement is not a common practice.3

The policies and legislation created to protect the rights of less than perfect English speakers has created a de-mand of interpreter services. Federal and state laws have all mandated that federally financed health care servic-es provide access to interpreters for their non-English speaking patients. Many states have created policies that reinforce federal guidelines. The availability, accessibility, and quality of interpreter services vary among institutions.2 The cost of interpreter services averages about 130 dollars per hour.3 Reimbursement for inter-preter services has been limited with 10 out of 50 states paying interpret-ers for their services in the health care setting. The AMA is opposed to physicians burdening the cost of interpreter services when the cost is far more than what is reimbursed for an office visit. Private insurers rarely pay for interpreter services and large health care provider companies often hire interpreters for their facilities.

The information presented in this article identifies that there is a lan-guage gap in health care that has to be filled. The number of limited English speakers has risen 50 percent in the last 10 years.3 Immigrants come to the United States to seek freedom from politics, to build a better life and prosper economically. Their right to access health care

quality of care. Recognizing that we have differences in ethnicity, cultural customs and views on health will allow us to better serve ourselves and provide treatment for culturally diverse populations with greater care and understanding.

ReferencesGalanti, G.A. (2000). An Introduction to Cultural Differences. Western Journal of Medicine. May; 172:335-336.

Galanti, G.A. (2001). The Challenge of Serving and Working with Diverse Populations In American Hospitals. The Diversity Factor. Spring; 9(3):21-26.

1 Clark, M. (1983). Cultural Context of Medical Practice. Western Journal of Medicine. Dec; 139:806-810.

2 Schenker, Y., Lo, B., Ettinger, K., & Fernandez, A. (2008). Navigating language barriers under difficult circumstances. Annals of Internal Medicine , 264-269.

3 Youdelman, M. (2008). The medical tongue: U.S. laws and policies on language access. Health Affairs , 27 (2), 424-433.

4 Chen, A. H., Youdelman, M. K., & Brooks, J. (2007). The legal framework for language access in healthcare settings: Title IV and beyond. Journal of General Internal Medicine , 22 (2), 362-367.

5 Gracia-Garcia, R. (n.d). Telephone interpreting: A review of pros and cons. University of Alicante, Spain: University of Massachusetts Amherst Translation Center.

6 Chen, A. (2006). Doctoring across the language divide. Health Affairs , 25 (3), 808-813.

7 Ku, L., & Flores, G. (2005). Pay now or pay later: Providing interpreter services in health care. Health Affairs , 24 (2), 435-441.

Students Students Students Students Students Students

24 CAPA NEWS

A New Year … En Route to Rotationsby Saloni A. Swarup, PA-S, Student Representative

H appy New Year everyone! I hope you had a wonderful and relaxing holiday season

with your family and friends. Now you are recharged and ready to at-tack the next sector of your physi-cian assistant education. Some of you are continuing on in your first year didactic education process. Keep up your routine and your persistent hard work will carry you through the rest of this didactic process.

The other half of you has started working through your rota-tions. This is a very exciting step wherein we get to implement what we have learned in our class in the real world. However, there are various oth-er roles and respon-sibilities we need to understand and em-brace in order to give our patients the best health care possible. This is where we learn to realize that the health and well-being of real human

beings are being put in our hands. These patients trust us to give them accurate information about their health and, given their diagnosis, pertinent treatment options.

In our earlier rotations, when we step into the room with our patient, we are so preoccupied with getting all the required information from the patient to get a correct diagno-sis; we tend to forget the basics. I re-alized that I was doing this myself. I

reminded myself of a few important “rules” which I now religiously prac-tice within my rotations when I am with my patients. I would like to share them with you:

Primum non nocere This is the first dictum, from the Hippocratic corpus literally trans-lates to “First, do no harm.” This is an extremely important rule that I believe we should all understand be-fore we even enter any room with a patient. If there is anything you are not sure about, ask your preceptor for help. Please do not try to “wing it.” Not only does this assure your patients the best care possible, but it also creates an exemplary learning opportunity for you. The informa-tion I have learned in such encoun-ters have stuck in my head each and every time I encounter another patient with the same problem.

Salus aegroti suprema lex Another important rule/dictum from the Hippocratic corpus that we all automatically follow is to “act in the best interest of our patient.” Even though this is an obvious rule, we sometimes tend to get too me-chanical in the history taking and physical exam process. As a result, we lose our “human touch,” caring and compassion required to treat our patients. So, I always remind myself this patient is someone’s mother, wife, sister or daughter before I go in and try to help my patient.

Cura te ipsum As health care providers we need to “take care/cure your own self.” We are going to work as primary or specialist health care providers

who will take care of and cure our patients. But an important question to ask here is how can we help our patients take care of themselves if we do not take care of ourselves? We need to make sure we establish and live healthy lives so that instead of telling a patient they need to start eating better and start an exercise regimen program, we can actually help them devise a plan that will suit their specific lifestyle. This is one way we can become optimum caregivers.

Voluntas aegroti suprema lex In our quest to do the best we can for our patient, we sometimes tend to forget to “respect our patient’s autonomy.” We get so caught up in healing the patient from their dis-ease, which is a portion of who they are; we tend to forget to consider the patient as a whole. In our quest to improve health care, I think it is imperative to consider the desires and needs of the patient along with the disease process that brought them into our office. In this man-ner, we not only take care of the disease, but we heal the patient as a whole.

You will be “PIMPED!” Yes, I know, I just used the word “pimped!” Your preceptors will be asking you various questions per-taining to your patient’s diagnosis. There will be times when you know the answers, and other times when you don’t. If you do not know the answers, do not let this discour-age you. When you get back home from your rotations, look up the specific diagnoses you saw in the clinic/hospital that day so you can remind yourself of the key points.

“This is where we learn to

realize that the health and

well-being of real human

beings are being put in our

hands.”



A New Year … En Route to Rotationsby Saloni A. Swarup, PA-S, Student Representative

Consequently, repeated exposure to this information will help you re-member the key points.

Informed consentPlease remember to introduce your-self to the patient every time you walk into the room. This gives the patient a chance to understand who you are and what your role is. For the most part, this is enough for the patient to give you consent to stay in the room as the doctor examines the patient. At other times the patient may ask you to leave. Do not take this personally at all! Sometimes patients are shy or just too embar-rassed to explain what is happening to them to so many people.

When your preceptor asks you to do a certain exam or test, always ask the patient if they are okay with you doing it. If not, tell the patient you understand their reservations and you will get the preceptor to do it.

ChaperoneThis is the one rule that will save you from many legal encounters. Whenever you are doing any exam or test that invades your patient’s privacy, please ask for a chaperone. This is especially important when the patient is of the opposite sex.

I know the information I have provided you with here is the basic know-hows of clinical practice. However, you will be surprised how quickly you forget some of these basic rules when you are elbow-deep trying to care for your patient. Even though your intentions are clear and noble, forgetting one or more of these rules would make it appear differently. Being cognizant and

following these rules will not only help you protect yourself and your patient, but it will impress upon the patient that you are a health care provider with a resilient work ethic. This practice will instill trust and respect in your patients and they will appreciate the care you provide

e-Resources for Pre-PA & PA Student Membersby Joy Dugan, MPH, PA-C, Secretary

WebinarsCAPA hosted the first webinar for Pre-PA members entitled PA School Interviewing 101 on October 30, 2012. Using the website Anymeeting.com, 29 Pre-PA members logged on to discuss interview types, common interview questions and professionalism. The purpose of this webinar was to ease the Pre-PA’s anticipation regarding their first interview. Participants were able to ask direct questions on how to best prepare for interviews. This webinar’s PowerPoint presentation is currently available on the CAPA website at: www.capanet.org/Pre-PA.

More interactive webinars will be developed in early 2013 to address topics including: The New Grad and Transitioning to PA School. We hope to also add webinars that will address practicing PA issues. If you have any ideas for a webinar topic, please contact me at [email protected].

Professional Practice Issues Video SeriesPA Student or New Grad? Have you watched Bob Miller’s Professional Practice Issues Video Series on the CAPA website? Be sure to check out the video “The New PA and The First Job.” This video has useful hints for negotiating your new job. As a recent grad, I can attest to how helpful this video will be when making the transition from student to PA-C.

Pre-PA? This video series is a great primer to prepare for PA school interviews. The series covers some hot topics effecting the PA profession in California. Access the videos at http://www.capanet.org/ProfessionalPracticeIssues/.

to them. This improves your rapport with your patient and helps you give them exemplary health care.

Please let me know if you have any questions or concerns regarding this topic or anything else. I would be more than happy to help.


26 CAPA NEWS

Congratulations to the 2013 CAPA Scholarship Winners!!!

Community Outreach ScholarshipRebecca Craft Hu, PA-STouro University, California

Ray Dale Memorial ScholarshipChase Hungerford, PA-SUniversity of Southern California, Keck School of Medicine

Ruth Webb Minority ScholarshipAlejandra Perez, PA-SStanford University, School of Medicine

2nd Annual USC PA Student Toy Drive Benefits Children’s Hospital Los Angeles!

On Thursday, December 13, 2012, first year USC PA students joined together to provide new, unwrapped toys to the children and teens in the Hematology/Oncology Outpatient Clinic at Children’s Hospital

Los Angeles. Spearheaded by Allyson Way, PA-S, classmates joined in some holiday cheer by distributing gifts, playing a bean bag toss game and providing holiday music. Through generous donations and a well-organized toy drive, the USC PA first year students helped brighten holiday spirits!

Attention: PA Program Directors, Class Presidents, Student Society Leaders, Faculty and Students

L et CAPA know what you are doing by submitting an article and include a photo if possible. Or, you may simply send a photo

with a descriptive caption. We want to let our readers know the wonderful things that are happening at our PA programs. We will print submissions on a space available basis. Send your article/photos, etc. to [email protected]. Thank you!

Find us on:


Welcome New Members

November 12, 2012 through January 14, 2013

Abraham AbraamyanNeil Adrian, PALucas Anderson, PA-SClaribell Aririguzo, PA-SMarisa Barber, PA-SMellisa Barnswell, PA-CSarah Batte, PA-SNadine BeltranDhara Bhatt, PA-SJeanelle Brick, PA-SNatalia Cardenas, EMT-B, PA-SSarah Clarke, PA-CKarina Cruz, PA-SNicole Daoud, PA-SJennifer Dengler, PA-SRichard DiBella, PA-CPatricia Doyle, PA-CChelsea DurningAshley Frew, MPA, PA-CEmily Gardner, PA-SChelsey Garrison, PA-SJim GatewoodRachel Ghiorso, PA-CJoel Grey, PA-C/RSamantha Hall, PA-SMelissa Hansen, PA-CMelissa Heyer, PA-CTodd Holt, PARobert Horner, PA-SCraig Jancay, PA-CAdrienne Johnson, PA-SBonnie Joy, PA-SLindsay Kennedy, EMT, PA-SLauren KimAshley Klaus, BAKevin KohIrina Kumar, PA-CHiruth Kumelachew, PA-CKelly Latham, PA-SAustin LeeJoshua Lee, PA-CWendy Lin, PA-SHolly LiuSabrina Liu, MA

Corina LopezDonna Louie, PA-SBrittany McGinty, PAMelody MerabiAlysse Michalosky, PA-CBennie-John Milan, R.T.(R)Marteen Miller-Hartmann, PA-CJamie MorrisonDaniel MuzikDemi Nava, PA-SClaire NguyenAlice Nguyen, PA-SMichael NicholasTravis Seung Oh, PA-CBryson Oneil, PA-SSayeh Partovi, PA-SShawna PosellLiliana QuiliciElizabeth ReischlEber Resendiz, PA-SJacquelyn SanderSusan Sasaki, PA-SLeigh Shafir, PA-CJanet Spagna, PA-CKristine Supple, PA-CZachary SymmesAlejandro TamayoMatt TanAleksandr Teleten, PA-CAlex Theiler, PAKatherine ThompsonMark Tilley, PA-CVictor TorrenteNgan Tran, PA-CJannie TranJason Unruh, LT, PALilia Vazquez, PA-CCatherine Wergin, PA-CFlanagan Whitsitt, PA-CKheng Xiong, PA-C

1. Redding Area PA/NP AllianceSummer Ross, PA-C; (530) [email protected]

2. Physician Assistant Society of Sacramento (PASS)Carlos De Villa, PA-C, PASS President; (916) 973-6185, [email protected] Sharma, PA-C, MMS, MPH, CHES; (916) 397-6035, [email protected]

3. Contra Costa Clinicians AssociationBrian Costello, PA-C; (925) 204-5406, contracostapas.com

4. San Francisco Bay Area Physician Assistants (SFBAPA)www.sfbapa.com, PO Box 14096, San Francisco, CA 94114-0096Martin Kramer, PA-C; (415) 433-5359, Fax: (415) 397-6805, [email protected]

5. Bay Area Mid-Level PractitionersRose Abendroth, PA-C; (650) 697-3583, Fax: (650) 692-6251, [email protected] Dillon, PA-C; (650) 591-6601, [email protected]

6. Bay Area Non-DocsLinda O’Keeffe, PA-C; (650) 366-2050, [email protected]

7. Northcoast Association of Advanced Practice CliniciansJohn Coleman, PA-C; (707) 845-6008, [email protected]

8. Stanislaus County NP/PA NetworkBrian Cormier, PA-C; (209) 605-4966, [email protected], www.nppanetwork.org

9. Stockton MidlevelsEmma Calvert, PA-C; [email protected]

10. Journal Club for PAs and NPs (Fresno area)Cristina Lopez, PA-C; (559) 875-4060; Fax: (559) 875-3434, [email protected]; 2134 10th St, Sanger, CA 93657

11. Central Coast Nurse Practitioners & Physician AssistantsKris Dillworth, NP; [email protected] Girard, PA-C; (305) 803-1560; [email protected]

12. So Cal PAsLinda Aghakhanian, PA-C; [email protected]

13. Orange CountyHung Nguyen, PA-C; (714) 846-8178; [email protected]

14. San Gabriel Valley Local GroupM. Rachel DuBria, PA-C; (818) 744-6159, [email protected]

15. San Fernando/Santa Clarita Valley GroupJonah Tan, MPT, PA-C; (818) 634-0007, [email protected]

16. Coachella Valley Physician Assistant GroupMatthew Keane, MS, PA-C; [email protected]

17. San Diego AreaJeremy Adler, MS, PA-C; (619) 829-1430, [email protected]

Local Groups

California Academy of Physician Assistants2318 S. Fairview St.Santa Ana, CA 92704-4938

Address Service Requested

PRSRT STDUS POSTAGE

PAIDSANTA ANA, CAPERMIT NO 949

CAPA’s 37th Annual ConferenceOctober 3-6, 2013

Optional Workshops, October 3 and 5

Controlled Substances Education CourseOctober 2, 2013 – Prior to the CAPA Conference

There is quite simply nothing like the CAPA Conference. The setting: PAlm Springs and the beautiful Renaissance Hotel and Palm Springs Convention Center offer a wonderful, community-building gathering place. And, the group dynamic created

by all of you makes the CAPA Conference a one-of-a-kind conference experience.