|front line|

Filling gaps on medicine's front line

By Stacie Carpenter

“Our one-of-a-kind didactic curriculum places PA students into the medical student curriculum for 65 percent of the PA students’ first-year coursework. This allows us to prepare some of the best PAs in the country.” David Asprey, director

Greg Watson (’05 MPAS) longed for a career in health care but not four years of medical school, at least three years of residency, depending on his specialty, and a career of 80-hour weeks.

As a physician assistant in a private pulmonary practice at Mercy Hospital in Iowa City, Watson primarily treats patients with chronic obstructive lung disease, or emphysema, as well as lung cancer patients. Outside of work, he enjoys traveling, hiking, and camping with his family. Watson also volunteers at the Iowa City Free Medical Clinic and is an active member of his church.

“I realized the opportunity to work as a team, specialize quickly, be starting my career in two to three years, and have more freedom to balance work and family was too good to pass up,” Watson said. “For most physicians, their career demands some level of being on call, which is not the case with many PAs. I think that is a big reason the profession’s demographics have changed to where a majority of new students are women.”

In the UI Carver College of Medicine Physician Assistant Program, 14 of the 25 first-year students are women.

Students in the UI PA Program practice their casing techniques.

Photo by Susan McClellen

The U.S. Bureau of Labor Statistics predicts that by 2012 more than 31,000 new PAs will have entered the workforce in the previous 10 years—an increase of 49 percent, making physician assistant one of the fastest growing occupations in the U.S. This growth reflects the expansion of health care industries and an emphasis on cost containment—attractive reasons to employ PAs.

“PAs regularly fill gaps in the health care shortage areas as
well as help decrease substantial wait time for patients to see specialists,” Watson said. “PA programs are opening in the United Kingdom and the Netherlands, and PAs are being trialed in the Australian health care system. PAs are going to be a significant part of the future of health care not only in the U.S. but across the globe.”

The best PA training program in the country is at the UI. The College’s program tops the list in U.S.News & World Report’s rankings among graduate school programs at the nation’s public and private universities. Prospective students seem to agree: 510 applicants competed for 25 seats in the UI’s current first-year class.

“The unique resources that exist for our program here allow us to recruit exceptional students who then complete very rigorous courses,” said David Asprey, PhD, PA-C (’87 PA), UI program director. “Our one-of-a-kind didactic curriculum places PA students into the medical student curriculum for 65 percent of the PA students’ first-year coursework. This allows us to prepare some of the best PAs in the country.”

In fact, many students choose the UI program for the opportunity to train alongside medical students.

“The interaction between PA students and medical students allows all of us to develop that teamwork attitude from the start,” said Luke Hammer, 2009 class president. “This experience is unique for all of us in that it exposes future MDs to PAs early and allows them a chance to learn more about our profession and the level of training we receive.”

Since 1974, UI PA graduates have performed in the top 5 percent to 10 percent on the Physician Assistant National Certifying Examination (PANCE). In addition, UI graduates have a PANCE first-time pass rate greater than 99 percent, compared to the national average of 85 percent.

Greg Watson ('05 MPAS), left, reviews a chest X-ray with Alan Moy, MD ('92F, '93F), at Mercy Hospital in Iowa City.

Photo by Susan McClellen

As members of the health care team, PAs can relieve physicians of routine duties and procedures. The care PAs provide with physician supervision—examining patients, diagnosing conditions, prescribing medications, assisting in surgeries—is of comparable quality to care by physicians alone, Asprey said.

“PA salaries are less than that of a physician, so in a health care system striving to maintain quality while decreasing the cost of delivering care, PAs are an excellent fit,” said Asprey.

The profession has been a good fit for Angela M. Cooper, PA-C (’93 MPA), who grew up wanting to be a doctor but believes
her PA position allows an easier work-family balance. She
sees a variety of patients, from newborns to nursing home
residents, as a PA at a small rural health family practice clinic in Lansing, Iowa.

“As a mother of four, I think this profession has provided a little more flexibility to change my work hours as needed or even change positions, to do what works best at this time in my life for my family. Even though I have always practiced in family medicine, I like the fact that I could choose to change specialties at any time and am not committed to one specialty forever,” she said.

The flexibility to practice in a variety of areas helps explain the profession’s growth, said Tony Brenneman (’96 MPAS), associate director of the UI program. “A PA can easily transition from one general medicine area to another, or one specialty to another,” he said.

At the Blood and Marrow Transplantation Program at UI Hospitals and Clinics, Director Roger Gingrich, MD, PhD (’77 R, ’78 F), professor of internal medicine, has worked with PAs for the past 25 years.

“A PA can bring medical knowledge and training and a finely honed skill set to a specialty area such as bone marrow transplant, which enhances both the efficiency and quality of the care provided,” said Gingrich, associate director for clinical affairs at Holden Comprehensive Cancer Center at the UI.

Nancy Heerens-Knudson (’89 PA) is a former mental health counselor who enrolled in the UI program while raising two children. She started her PA career in gynecologic oncology but now works in a family practice clinic in Tomah, Wis., where husband Ralph Knudson (’72 MD) is one of the physicians.

“There are so many more specialties PAs can go into. PAs are really partners on the front line of medicine today,” Heerens-Knudson said.