The more that new American Academy of Physician Assistants executive vice president and CEO Bill Leinweber learns about PAs, the more he feels that they are crucial to the future of health care in the United States.

Leinweber, who officially starts at the AAPA on Feb. 25, already knew quite a bit about PAs before becoming interested in the academy position. As an executive with the American Heart Association and with Research!America, Leinweber interacted with numerous representatives of the PA profession. He also took both of his children, now teenagers, to a pediatric PA when they were younger.

But Leinweber understandably sought a deeper knowledge of the PA profession when he began to consider working for the AAPA. During his research, he became convinced that PAs need to be an integral part of health care reform in this country.

"As time went on, and I went through the process (of learning about the profession) and talked to more people inside the PA world and outside (of it) but connected to the health care arena, there was a deepening passion for what PAs contribute to medicine in this country," Leinweber says, "and an even stronger belief in how important that role is going to be as we move forward in trying to come to grips with challenges the country is facing in terms of health care."

"Looking at cost, quality and access as the key pieces of the health care triangle," he says, "I think PAs in many ways can make significant contributions to addressing each of those points. As I learned more, I became more passionate about the increasing importance of the role of PAs moving forward."

The AAPA chose Leinweber in December to be the academy's new EVP and CEO. The hiring was the result of a nationwide search conducted by the academy and the executive search firm Russell Reynolds Associates to find a replacement for former EVP and CEO Stephen C. Crane, PhD, MPH. After more than 14 years, Crane left the AAPA in September to become executive director of the American Thoracic Society.

Leinweber has been the executive vice president of Research!America, a nonpartisan advocacy alliance for health and medical research.

"(Leinweber) has incredible credentials and his references were impeccable," says AAPA immediate past president Mary Ettari, MPH, PA-C, the chair of the search committee. "He has a history of development and fundraising. He has worked with advocacy groups. He has experience cultivating relationships. His philosophy has been building alliances and partnerships."

The search committee reviewed numerous candidates and interviewed six, after which the committee unanimously recommended Leinweber. The AAPA board of directors subsequently met and agreed to hire Leinweber, also with a unanimous vote.

"I'm thrilled that we have Bill Leinweber as CEO," AAPA president Gregor Bennett, MA, PA-C, says. "When you meet the guy and talk to him, you realize that he's a genuine person. He knows health care and what goes on inside health care organizations."

"He doesn't have any hidden agendas," Bennett says, "and that, coupled with his ability to focus his and our attention when and where they are really needed, will be a big plus for us. I think we have a great opportunity for growth with him as our CEO."

Interest in health care-and health care reform in particular-continues to increase, and Leinweber believes that it is imperative that PAs are visible and active in the ongoing discussions about potential health care policy changes.

"In my own mind, we're at a unique point in history. Sort of a tipping point in the country, in terms of the future of health and health care," Leinweber says. "And I really see PAs having an essential role in what that future might be. I feel it's important to elevate the voice of PAs and the contributions PAs can make to (contribute to the) shape and form of what the future of health care may look like in this country."

"I am excited about what (Leinweber) will bring to the academy," Ettari says. "(The PA profession) will walk together with him into the future of health care. That's what's really exciting."

PA Profile

PA Ensures ReachMD Reaches PAs, Too

Lisa D'Andrea, PA-C, MPAS, has come a long way in the radio business in less than a year, from zero on-air experience to broadcasting alongside Oprah.

D'Andrea, an Illinois PA, hosts a 15-minute program devoted to PAs, NPs and nurse midwives on ReachMD, a communications company created to convey medical news and information to health care providers.

ReachMD's content is broadcast on XM Satellite Radio channel 157?right next to Oprah & Friends Radio on XM channel 156. Each ReachMD show is 15 minutes long, and the shows are rotated regularly to different time slots.

D'Andrea, who practices in internal medicine and is the clinical director at Deerpath Primary Care in Libertyville, Ill., wasn't looking for a radio gig. This unique opportunity found her.

ReachMD founder David Preskill, MD, practices obstetrics and gynecology in Libertyville and was acquainted with D'Andrea. When ReachMD CEO Gary Epstein, the former chief marketing officer for the American Medical Association, wanted to increasingly target PAs, NPs and nurse midwives, the company approached D'Andrea.

Although her hectic schedule already included a full-time job and an adjunct faculty position at the Midwestern University PA program in Downers Grove, Ill., D'Andrea agreed to give radio a shot. She feels an obligation to contribute to the PA profession, and this was a terrific chance to do that.

"I'm truly way too busy. I can't believe this radio show is sneaking into my life," says D'Andrea, a 2001 graduate of the Midwestern PA program. "But I feel like I'm giving back to the profession. I think as a PA, you have to do that. I think it's our responsibility to push the profession forward."

Part of D'Andrea's motivation for the radio show is what she sees as a shortage of PA-specific professional and clinical information.

"We have ADVANCE. We have (PA-related) Web sites. We have JAAPA," she says. "But a lot of the other information out there doesn't help us to understand our role as PAs. I want to put that information out there. I want to bring in and interview thought leaders in the PA profession. It's an opportunity to move the profession forward."

While PAs, NPs and nurse midwives are a significant segment of D'Andrea's audience, she wants to use her satellite pulpit to reach physicians, as well. Even in the Chicago area, misconceptions and misinformation about PAs and NPs still are common among doctors, and by the end of this year, ReachMD will reach an estimated 500,000 physicians.

"(ReachMD) is a direct line to physicians' ears," she says. "They're sitting in their cars listening. A lot of them want to know what PAs and NP do. They don't know. Right now, they talk to their colleagues (about using PAs and NPs). They copy the (imperfect) models that other physicians have created. I want to educate them how to use advanced-practice clinicians properly. They should be using models that we set up."

D'Andrea already has interviewed several PA-related guests, including Association of Physician Assistants in Cardiovascular Surgery president and National Commission on Certification of Physician Assistants director-at-large Ed Lopez, PA-C; North Carolina PA and practice owner Bob Hollingsworth, MS, PA-C; ADVANCE for Physician Assistants managing editor Stephen Cornell; and longtime PA advocate and American College of Clinicians founder Dave Mittman, PA.

On future shows, D'Andrea also wants to interview exceptional PAs who don't receive the credit they deserve for their accomplishments.

"My focus is to find these folks, bring them forward and give them recognition," she says. "The medical community needs to know what PAs do, and they don't know right now. We are invisible."

PA PROFILE

South Pole Feels Like Home for PA

Heidi Lim, PA-C, decided she didn't want to settle in just one location after graduating from the Emory University PA program in Atlanta. So after working for a short time in Georgia, the Tucson, Ariz., native moved across the country to provide medical care for the Navajo Nation in Chinle, Ariz., then moved on to a string of locations in Alaska, including Dutch Harbor, St. George Island, Emmonak and Unalakleet.

"The more I worked out in the bush, the more I loved the remoteness and the challenges of the unconventional settings and populations," Lim says. "I loved the adventure of working in a remote area with a population in great need of medical care, and decided to do more."

So in October 2002, Lim packed her bags for a place that most would consider the ultimate in remoteness: Antarctica. The South Pole, to be exact.

For a full year on her first visit, and then for winters (February through October) in 2005, 2006 and 2007, Lim has worked at Amundsen-Scott South Pole Station, a U.S. research station. And in early February, Lim will be back at the South Pole for her fifth winter.

"This year, I'll be working with an Australian doctor who has wintered at another U.S. station (in Antarctica), so he'll have some ice experience under his belt, too," she says.

Lim, who chronicles her experiences as "Homeless Heidi" on her personal blog at http://www.homelessheidi.blogspot.com, is one of only five PAs who have worked at the South Pole, where temperatures can drop to minus 100 degrees Fahrenheit. This fifth season at Amundsen-Scott extends her record for most winters spent at the station for a woman.

Lim and a physician provide health care to the crew, which comprised 54 people last winter. Among her comprehensive clinical duties are seeing walk-ins for minor injuries, refilling prescriptions, removing skin lesions, draining abscesses and providing physical therapy.

The station clinic's main treatment area doubles as a trauma bay, a radio communications room and dental exam room. "We have to be dentists here, too, and be able to fix things like a chipped tooth," Lim says.

The clinic also has a two-bed patient ward and a lab, which houses the pharmacy. Among the station's equipment are an X-ray machine, an ultrasound machine, a crash cart, defibrillators, ventilators, monitors and IV pumps.

A standard workday is 7:30 a.m. to 5:30 p.m., six days a week, with Sundays off, although Lim and the physician alternate taking call on Sundays. She also gets one Saturday off a month. But her duties often extend beyond these hours. For example, the station's eight-hour satellite window slowly shifts forward in time, and Lim has to send digital X-rays to a radiologist in the United States even when the window opens in the middle of the night.

Lim treats the altitude sickness that crewmembers frequently experience after arriving on the 3 -hour plane ride from McMurdo Station. McMurdo is at sea level, while the South Pole has an altitude of 9,300 feet.

She also maintains the station's emergency medical cache, which is stored away from the clinic so that "in the event that we have a catastrophe and lose Medical, we would still have some supplies to use," Lim says. "It's a grim thought, but we have to be prepared."

Because there's not enough to keep two medical providers busy all the time, Lim's extensive nonmedical duties include managing Polemart, a small store that sells souvenirs, snacks and toiletries; serving as winter finance manager, reconciling funds on the station and acting as a human ATM; and monitoring flights to and from the station. She also serves as recreation coordinator, performs weekend power plant checks, washes dishes and bakes homemade bagels, served three times a week.

Most crewmembers have an 8-by-10 berth (Lim's seniority qualifies her for a double room), and crewmates are limited to two two-minute showers a week. "I know that sounds horrifying," she says, "but it's really not that bad!"

"The best part of my job is living the adventure that is Antarctica," Lim says. "We become a big family, and I've made lots of friends over the seasons, so in a way, it feels like home."

PAs IN THE LITERATURE

Study: NPs 'Better' Than PAs in Diabetes

Family medicine practices with nurse practitioners performed better than practices with PAs and better than physician-only practices with regard to some measures of diabetes care, according the results of a study published in the January/February 2008 issue of the Annals of Family Medicine.

"Family medicine practices employing NPs significantly outperformed practices employing PAs in key ADA-recommended assessments for HbA1c, lipids, and microalbumin for patients with diabetes," the study authors wrote. "As high lipids are a major contributor to excess mortality among individuals with diabetes, it is important that we found that patients in practices with NPs were more likely to be treated for high lipid levels and to attain lipid targets than their counterparts in practices with PAs."

The study (Ohman-Strickland PA, Orzano AJ, Hudson SV, et al. Quality of diabetes care in family medicine practices: influence of nurse-practitioners and physician's assistants. 2008;6[1]:14-22) looked at 46 family medicine practices in New Jersey and Pennsylvania and measured "adherence to American Diabetes Association diabetes guidelines via chart audits of 846 patients with diabetes."

Nine of the practices employed PAs and physicians, nine employed NPs and physicians, and 28 employed only physicians.

"Family practices employing NPs performed better than those with physicians only and those employing PAs," the authors concluded, "espcially with regard to diabetes process measures. The reasons for these differences are not clear."

The authors noted in the discussion that the study "had a number of limitations" and also stated that they were "unable to uncover literature that would support any particular explanation."

However, in the study's discussion, the authors included the following potentially controversial theory: "Practices wishing to improve quality of care or adhere to a more holistic approach to medicine may tend to hire NPs, whereas those that want to increase patient volume may tend to hire PAs."

In a Jan. 18 letter to Annals of Family Medicine editor Kurt C. Stange, MD, PhD, American Academy of Physician Assistants president Gregor F. Bennett, MA, PA-C, questioned some aspects of the study, including parts of the discussion.

"What we learn from this study is there is tremendous variability in the capability of practices to provide care to diabetic patients, nothing about the individual providers," Bennett wrote. "One needs a stable point of comparison between practices before the author can assess the members of the practice team.

"Studies on team practice of care need to be conducted on a variety of health issues to help guide providers to develop effective models of interdisciplinary care. But the authors of such studies should not try and twist the results to fit preconceived intentions," Bennett wrote.

Election year 2008

Robinson Is Sole AAPA Candidate for President

Paul S. Robinson, PA-C, of River Falls, Wis., is the president-elect candidate for the 2008 American Academy of Physician Assistants board of directors election.

Robinson is a PA in emergency medicine and currently is AAPA vice president and speaker of the AAPA House of Delegates.

Robinson has been involved in PA leadership throughout his career. He would be the first person to serve as president of the Student Academy of the AAPA and go on to become AAPA president. Robinson was the SAAAPA president for 1989-1990 while studying at the PA program at Kettering College of Medical Arts in Kettering, Ohio.

"(The AAPA presidency) is a huge commitment. I am looking forward to it," says Robinson, who points out that a write-in candidate could still defeat him in the election. "I feel I'm ready."

Health care reform in the United States is the most important issue facing the PA profession, Robinson says. No matter who wins the U.S. presidential election, he or she likely will preside over some major changes in the country's health care system. PAs need to be included in any plans for reform and involved in the policy discussions.

"Anyone elected from either side of the aisle will have to address what's going on in health care," Robinson says. "I think there is a different energy coming together. I have sat in on a lot (of physician organization meetings) and I feel an energy to get things done this time."

Robinson also feels it's important to be vigilant for potential threats to the advances PAs have made over the profession's 40 years. He cites as an example an effort by an osteopathic physician group in Missouri last year to significantly restrict PA practice in that state.

AAPA members will have only one choice on the ballot for president-elect for the first time in four years. There were two candidates for the office in 2005 and 2007, and three in 2006.

Although he says he is committed to developing and mentoring the academy's future leaders, Robinson doesn't think that having one candidate for president-elect is necessarily a negative, as long as the academy's nominating committee does a good job of identifying and endorsing quality candidates who are willing and able to volunteer for such a demanding and time-consuming three-year commitment.

Other candidates for AAPA officers include James E. Delaney, PA-C, of Claremont, Calif., and Bruce Fichandler, PA, of New Haven, Conn., for treasurer. Candidates for two open director-at-large positions are Linda L. Contreras, MPAS, PA-C, of Dallas; Kc Lovin, PA-C, MS, of South Charleston, W.Va.; and Patti Pagels, MPAS, PA-C, of Fort Worth, Texas.

Fichandler is a self-declared candidate. The AAPA nominating committee endorsed all of the other candidates. Delaney now serves as a director-at-large. Pagels and Fichandler are running for reelection.

Fichandler, a past president of the AAPA (1990-1991), is seeking his 10th consecutive term as AAPA treasurer. He has held the position since 1992 and also held the position from 1980 to 1984.