Calif. PA Is Family Practice PA of 2009

Three years ago, the Shalom Free Clinic opened in Chico, Calif., with a mission of providing underinsured and uninsured children and adults with health screenings, primary care interventions, health services and education, including physical and mental/behavioral health services, all free of charge.

Karen Kushner, PA-C, says a "cosmic coming together of three people" resulted in the opening of the free clinic. For her role as one of those founders, Kushner has been named the 2009 Family Practice Physician Assistant of the Year by ADVANCE for Physician Assistants and the Association of Family Practice Physician Assistants. Sponsors of the competition are Medelita and Brymill Cryogenic Systems.

Kushner, along with Frederic Jones, PhD, who had been a pastor at the Congregational Church of Chico, and church member Nancy Morgans-Ferguson, sought to put together a medical mission to help the congregation and the community and came up with the idea of a free clinic. "Nancy had the connection in town because she'd been a pharmaceutical rep, the pastor had tried to do a free clinic in the past in another town, I had the medical background, and voilà-clinic!"

Located in the education building next to the church, the Shalom Free Clinic is open on Sundays from 1 p.m. to 4 p.m. All ages are welcome, and patients do not need an appointment.

Morgans-Ferguson nominated Kushner for the Family Practice PA of the Year competition, and a panel of AFPPA board members chose Kushner to receive this year's award. Morgans-Ferguson wrote in the nomination, "She spends time getting to know each client and their situation. Our patients are without insurance or are underinsured, and most also have a mental health problem. Karen brings years of finely honed skills to see that our clients are treated in a loving and accepting environment. Our many physician volunteers love working with Karen because her skills in family practice care are outstanding, and her compassion for patients goes beyond what is usually seen in most practices. Karen truly cares about our clients and their families, and the patients know it."

The clinic is funded solely by donations; two to three large fundraisers are held each year. Plus, patients often return and donate either money or time. "They're very loyal to our cause, and very, very appreciative of what we do," Kushner says.

The medications provided to patients are from samples or donations from private offices. And all of the clinic's equipment is donated, says Kushner, except for two portable sinks that were purchased through a grant from the United Church of Christ's Neighbors in Need program.

In addition to the uninsured or underinsured, patients include people who have insurance but who can't afford their large co-pay or who can't afford medication after discharge from a hospital or a mental health/psychiatric facility.

"People are told to come to our clinic to see what we can do for them," Kushner says. "Oftentimes, it's not medication that these folks need-there are other social issues that are not being addressed, and typically these are folks who are discouraged, disenfranchised and just disappointed at the entire health care system for one reason or another and need a place to be heard."

Kushner encourages her patients to tell their stories as many times as they need to, so that they are heard and some sort of resolution occurs.

While Kushner's official title at the clinic is medical coordinator, she provides much more. "Whether it's through a medical intervention, a psychiatric intervention, a legal intervention, sometimes it's getting people heard, housing, clothes," she says. "So that's what we do at the clinic."

Over the years, the Shalom Free Clinic has provided services to thousands of patients. On average, 50 patients seek care each Sunday. Kushner notes that the clinic is getting busier as a result of the extreme budget cuts in California. "I think that if we consider health care for all, perhaps our little clinic wouldn't be so busy," she says.

Kushner typically comes to the clinic on Wednesday nights, along with any other times necessary to catch up on paperwork such as medication refills, chart reviews and other correspondence.

When not at the clinic, Kushner works for various programs in the Butte County Department of Behavioral Health, including the Drug Endangered Children Team, where in partnership with local law enforcement and child protective services she provides medical and mental health services for children who have been removed from hazardous environments. She also participates in the Connecting Circles of Care program, a multidisciplinary team for at-risk youth and their families.

Kushner is a 1982 graduate of the Lake Erie College/Cleveland Clinic Foundation PA program in Ohio. Throughout her career, she has worked with numerous patient populations-including developmentally challenged young adult and geriatric patients at a center in Massachusetts, outpatients at an Air Force clinic in Arizona and teenagers at a high school-based clinic in Oregon-that have prepared her for where she is today.

The native New Yorker also offered her services for three weeks in Manhattan as a Red Cross volunteer immediately after 9/11. "It was a life-altering experience, a time when caring for people and coworkers who were shell-shocked forced me to take stock of my own life, and I felt I needed to do more somehow," she says. "Feeling the city come together without reservation or judgment tapped my soul and inspired me to go forth with a long buried dream: a free clinic," she says.

Kushner offers this advice to all family practice PAs: "Try to remember why you became a family practice PA, what it was that attracted you to teaching and healing others, and find that passion and go for it. This clinic is my passion, and this is what I'm doing for the rest of my life."

Kushner received a plaque, a cash prize and a gift certificate to the ADVANCE Healthcare Shop, along with airfare, two nights' hotel stay and registration for the AFPPA conference in Phoenix, to be held Nov. 4 to 7.

ADVANCE for Physician Assistants is the official publication of the AFPPA.

-Terri Schaefer

Visit the clinic's Web site at www.shalomfreeclinic.org.

2 New Research PhDs Offered to PAs

The PA program at Wake Forest University School of Medicine in Winston-Salem, N.C., and the College of Allied Health and Nursing at Nova Southeastern University in Fort Lauderdale, Fla., have announced new doctorate programs for PAs.

Neither program will offer a clinical doctorate; both are traditional research doctorate programs.

Just as U.S. Army and Baylor University's PA-specific clinical doctorate degree remains the only one of its kind, Wake Forest's proposed MMS-PhD program will be the first of its kind, too. The program would combine the PA program's master of medical science degree with a PhD in clinical and population translational science. Ralph W. Rice, MPAS, PA-C, associate professor and associate director, estimates that at most three to five of each class of 56 PA students could be accepted each year for the MMS-PhD program.

"They would have to apply to PA school, be accepted, apply to the graduate school and then be accepted into that," Rice says. "You'll need to be accepted into both programs to start down this track." Prospective students also must identify an area of research and plan to work under a mentor and a mentor's grant. After completing the first full didactic year with the rest of the PA class, students then would complete two or three full-time, month-long clinical rotations, after which they essentially would "drop out" of full-time PA training to start PhD research. Program officials estimate that completing this phase would take three to four years.

During PhD research, students would work one afternoon two to four times a month, so that when PhD coursework is done, they'll also have another two to three rotations completed.

"It's sort of like a decompressed clinical," Rice says. "We can't have a student stop and do no clinical practice for four years, because it's a use-it-or-lose-it type thing. They would be required to take the same end of rotation tests that regular full-time students would. We would do site visits on them whenever they were at their clinical sites, so they're treated like normal PA students on clinical rotations, except that their work schedules would consist of several afternoons per month."

Upon successful defense of their thesis and receiving their PhD degree, students then would complete their remaining rotations full-time in order to graduate with an MMS degree.

Rice predicts the program could be a hot topic at the Physician Assistant Education Association's Annual Education Forum in November in Portland, Ore., where he'll present a poster on it.

At press time the MMS-PhD program awaited final approval from the university's board of trustees. It has already been approved by Wake Forest's graduate school, medical school and graduate council.

Nova Southeastern University's new online PhD in health science program is accepting student applications, and the first class will begin this January.

Since 2002 the university has offered a doctor of health science (DHSc) program, more than 100 of whose nearly 300 graduates are PAs. Patricia E. Kelly, PA-C, MHS, EdD, director of the DHSc program, says that 10% to 15% of those graduates expressed a deep interest in going on to research. To do so, students would need a core of additional credits that the DHSc program didn't offer.

"(About three years ago) our college started to standardize research courses that would be used for the PhD in nursing, occupational therapy and physical therapy, and then later on in pharmacy and in optometry and visual sciences," Kelly says. "So, there was going to be a core of research courses that would be available to almost anyone at the health professions division."

NSU has used these core courses as the underpinnings for the new PhD in health science program, of which Brianna Kent, PhD, RN, is the director. No major changes will occur in the admissions procedure, since all PhD students will be admitted as doctoral students and must first complete six DHSc core courses and two core summer-institute courses.

"During that time, they can refine their interests and decide whether they want to take a program that's heavily research-based, which our PhD is, or whether they want a program that's more practice- and hands-on education-oriented, which is the DHSc," Kelly says. "They have at least a year and a half to two years to make that decision."

In addition, graduates who already have earned a DHSc degree can return to NSU to obtain the PhD with no coursework repeated. "They'll need between 29 and 33 additional credits, and those will be entirely research courses and the dissertation," Kelly says.

Kelly hopes that PAs who want to do cutting-edge research will enroll in the PhD program, and that new workforce research emerges.

"In order to actually help the profession produce more of that (PA research), those people are going to have to be at universities that will support them while they do their research," she says. "Our research core courses will provide them with the tools to do that kind of high-level research."

-Terri Schaefer

Go to www.advanceweb.com/pa for updates on the approval status of the Wake Forest MMS-PhD program. For more about the NSU PhD in health science program, go to www.nova.edu/cah/phdhealthscience.

AAPA Pres. 'Blessed With Opportunity'

Even though AAPA president Stephen Hanson never imagined that he would ascend to the highest leadership level of his profession, he knew early on what type of career he would pursue. His grandmother, Ana Mae Garcia, set a strong example of determination and commitment to service that encouraged him to enter medicine.

In the 1930s, Garcia applied to Fresno General Hospital's registered nursing program and was the only Hispanic applicant. The program's administrators nearly turned her away, insisting that nobody would agree to share a room with her, until a nursing student stepped forward and declared that she would be Garcia's roommate.

"My grandmother persevered, dedicated her life to her patients and continued to volunteer with the Red Cross well after her retirement," Hanson says. "Her example of service inspired me to enter the medical profession as a paramedic and continue my education to become a physician assistant."

As a PA-a career he calls "a blessing"-Hanson has practiced in many specialties, including public health, obstetrics and gynecology, urgent care and emergency medicine. The Bakersfield, Calif., resident has held leadership roles for the California Academy of Physician Assistants and for the AAPA, where he has served in the House of Delegates since 1992.

In 2005, Hanson ran for AAPA president but lost to Mary Ettari. At that point, he believed his tenure on the board of directors was up, so he switched gears and established a successful PA staffing corporation. But a few years later, tragedy changed the course of Hanson's life: His best friend and AAPA president-elect Paul S. Robinson, of River Falls, Wis., died suddenly on Nov. 12, 2008, leaving a void that colleagues and friends encouraged Hanson to fill. He ran in the special election and won, and on Dec. 22, 2008, he assumed the position of AAPA president-elect to complete Robinson's term.

ADVANCE recently spoke with Hanson about his unique career path and his experience so far as 2009-2010 AAPA president.

What was it like to run for and accept the presidency on Paul's behalf, and how does his memory inform your role as AAPA president?

Paul and I had a deep friendship over two decades. We shared the same leadership track (in our state chapters and the House of Delegates) and developed a strong bond with each other that extended beyond professional life to our personal lives. When he died, it was as if a piece of me died, too.

Running for president was the furthest thing from my mind in the weeks following his death, but I slowly came to realize that there was a certain symmetry to the concept of me stepping into Paul's shoes and carrying forward his passion for the profession we both loved. Paul and I were very different people, but we shared much experience in life as PAs, leaders and fathers. He taught me that leadership is simultaneously an honor and a privilege, as well as the repayment of a debt that accrues from all the good things being a PA has brought me and my family.

You've worked in various settings and held a variety of roles, including at Planned Parenthood and now at the Grossman Burn Center. How did you get to this point in your career?

I have been blessed with the opportunity to be a PA these past 29 years. I can honestly say that I have never looked for a job since I became a PA. Every PA job that I have held has found me.

I absolutely love my current position in plastic and reconstructive surgery with the Grossman Burn Centers, which is the largest private burn center in the United States. I have known the Grossmans for 13 years and had been a referral source for them during that time. They contacted me in the spring of 2008 to see if I would assist in opening the new Grossman Burn Center in Bakersfield, and I jumped at the chance.

Burn surgery is a special calling, and you forever share a lifelong bond with the patients you care for. The Grossmans have built the model of their burn centers around PAs, and we are treated as full clinical and surgical partners in the care of our patients. Working in the Grossman Burn Centers is the best job I have held in my entire adult life.

How would you describe an average day in your life?

It begins early! A typical day for me starts in the pre-op department at the San Joaquin Community Hospital, where I make sure consents are signed, orders are written and patients are ready for our morning of surgery. Between surgeries, we make rounds on our patients in the burn unit who are not having surgery that day, caring for a variety of grafts, wounds, infections and medical problems. Before and after lunch, we see patients for follow-up in the outpatient burn department and respond to the emergency department for initial evaluation of new burns.

I'm also president of the AAPA, so I have to squeeze in a steady stream of phone calls and e-mails related to the many ongoing activities of the AAPA, not the least of which are advocacy efforts on behalf of the profession related to health care reform. It is a very full day.

How has this year been different?

Stepping into the role of president has been a challenge, but I am blessed with great colleagues on the AAPA board of directors, a strong AAPA leadership team and the best association staff in the business. The biggest adjustment for me has been the proper allocation of time to meet all responsibilities. Chief among them, of course, is attention to the needs of my patients. But from early on in a PA's career, we are taught to use our time effectively and productively. So you could say that I'm just being a good PA.

That said, I have always aspired to serve my profession in repayment for all the opportunities and good things in life the profession has given me and my family. To serve at any level in leadership is an honor. To serve as AAPA president is a dream come true for me.

-Heather Simons

Go to www.advanceweb.com/pa to read the full interview with AAPA president Stephen Hanson.

Program Aims to Bolster AAPA-Specialty Group Ties

Leaders of the AAPA's 24 recognized specialty organizations met with academy staff at a specialty summit in Alexandria, Va., on Sept. 25 and 26 to discuss a new business model designed to strengthen the relationship between the academy and its specialty groups.

The summit's broader objective was to reach consensus on short- and long-term goals and strategies to support the growth and development of specialty groups as components of AAPA. The summit was in accordance with academy's 2010-2012 Strategic Plan, approved in February, a primary goal of which is strengthening relationships with constituent chapters, specialty organizations and caucuses.

AAPA-recognized specialty organizations in good standing will be eligible for the program. AAPA vice president of communications Howard Glassroth stresses that participation is optional, and that at first the program will be a one-year pilot, so that the organization and the academy both can weigh the merits of the arrangement.

Each participating specialty organization would become a "specialty section" of the AAPA and would retain its voting delegate in the House of Delegates. The organization's board of directors would be renamed a "leadership council."

A participating PA specialty group also would work closely with the academy staff to manage its general operations and finances, membership development, meeting planning and communications. For specialty organizations that choose not to participate or decide not to continue after the one-year pilot, Glassroth says, the current relationship structure with the AAPA will continue.

The new arrangement would allow specialty groups and the academy to better use the resources the two offer each other, to better meet the challenges that face specialty PAs.

"We've set this up to be a win-win situation" for the organizations and the academy, Glassroth says.

-Michael Gerchufsky

2 Programs Give Up Accreditation, 5 Get It

The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) voted at its mid-September meeting to award provisional accreditation to five new PA programs. Meanwhile, two established PA programs have voluntarily surrendered their ARC-PA accreditation. These changes bring the number of accredited U.S. PA programs to 148, an all-time high.

The new programs are at Keiser University in Fort Lauderdale, Fla.; the University of Pittsburgh; the University of the Cumberlands in Williamsburg, Ky.; Franklin Pierce University in West Lebanon, N.H.; and South University in Tampa, Fla.

The University of Pittsburgh program brings Pennsylvania's total number of accredited programs to 16, second only to New York's 20. The two new Florida programs bring that state's total to nine, ranking it fourth among states. California is third, with 10 accredited programs.

Our Lady of the Lake College in Baton Rouge, La., and Alderson-Broaddus College in Philippi, W.Va., have surrendered their PA program accreditation as of Sept. 25.

ARC-PA also voted to award accreditation to two postgraduate programs: the Mayo Clinic Arizona Postgraduate PA Fellowship in Hospital Internal Medicine in Phoenix, and the Orthopedic Surgery PA Residency Program, a joint effort of Arrowhead Regional Medical Center in Colton, Calif., and Arrowhead Orthopaedics in Redland, Calif.

-Terri Schaefer

PA-Owned Clinic Opens 2nd Location

Stu Jones, PA-C, and Brant Bell, PA-C, in August 2006 opened their own clinic, Seven Springs Orthopaedics and Sports Medicine, in Brentwood, Tenn. Just two and a half years later, they opened their second practice-the Spring Hill, Tenn., location opened Feb. 6-and they're already thinking about more.

"We wanted to go to an area that was growing that didn't have a hospital," Jones says. Spring Hill fit this requirement. "Now there's talk of building a hospital in four or five years, which is great. We can take this time to build up our patient load," he says.

Jones and Bell prepared for about a year before opening the new location, which is in a medical building with two primary care practices, a dentist and a physical therapist.

The PAs' supervising physician, Jeffrey Lawrence, MD, of Premier Orthopaedics and Sports Medicine in Nashville, owns 1% of the Brentwood clinic while Jones and Bell own the other 99%; each of the three owns a third of the Spring Hill location.

"It's a little different than last time, and we felt like it was a good incentive for him," Jones says of Lawrence. "He's been through the process here (in Brentwood) of co-owning a clinic, and he's seen what can be done. He really is a great advocate for our profession."

When Jones and Bell opened their first clinic, many local physicians and other health care providers told them they'd never succeed. Few believed a PA-owned specialty practice clinic could thrive. But in just over three years, the clinic has opened a lot of eyes-and minds. "We really did change their mindset, which is pretty exciting," Jones says.

For instance, physicians now ask Jones and Bell for help in opening PA-run clinics. "We're getting some of these docs calling us from all around, asking us to show them how we did it and let us be their partner," Jones says. The PAs say they'd like to open another Seven Springs location in 2010 and eventually have four or five clinics.

Jones credits recent medical school graduates with helping the physician community understand the crucial role of PAs in health care. "I think we're starting to see younger physicians coming out really knowing what we're capable of doing as PAs and starting to really embrace us as partners in practice," Jones says, "and not just someone who can modify their lifestyle, but someone who can truly modify their practice."

The two PA-owned practices have flourished despite the economic downturn. In fact, 12 patient visits were booked for the Spring Hill location's opening day in February, and each location now sees more than 20 patients a day. The two clinics' total number of patients recently surpassed 5,100.

"I think in the right situation, you can be recession-proof," Jones says, "and I think a big part of that is by controlling your own destiny." Jones and Bell routinely work 14-hour days, which they never anticipated. To keep up with the patient load, they've hired more medical assistants, X-ray techs and other support staff and brought in their own billing department, and they've switched to electronic medical records and digital X-rays.

Even as the practices grow, both PAs still want to see patients at least four days a week. While they so far have resisted hiring an office manager, Jones admits it soon might be necessary because of the time the two PAs put into managing the practices.

"We would feel better at some point hiring someone to do that for us," he says. "What we don't want is to start this great thing of PAs owning their own practices but then not working at them."

-Terri Schaefer

Visit the practice's Web site at www.sevenspringsortho.com. For a collection of information on PA-owned clinics from ADVANCE, including our previous coverage of Seven Springs Orthopaedics and Sports Medicine, go to www.advancweb.com/pa and click "PA-Owned Clinics Center" under "Resource Centers."