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JAAPA Podcast
Meet Joe + Discuss the JAAPA article on Esophageal Cancers
00:23:19
Join us as we welcome the newest JAAPA podcast team member, Joe Harrison. Kim and Martine discuss Joe’s background, interests, and why he joined the podcast. They also discuss their “why” of medicine and “why PA”. Finally,...
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- [00:00]
A
Foreign.
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B
Welcome back to the podcast. We have some exciting news regarding the podcast. You can now earn CME by listening to the podcast and to receive those CME credit and access your certificate, you must complete the post test and evaluation in AAPA's learning central@cme aapa.org do you this is free for AAPA members and available to non members for a small fee.
- [00:30]
A
So go online and check out the available cme@cme.aapa.org today we'll be speaking with our newest podcast team member, Joe Harrison. You'll learn about him and his career. We'll review an article from JAPA's April edition, Esophageal Treatment Advances and Need for Screening, authored by PA Daniel Ice. Joe, welcome to the podcast. Go ahead and introduce yourself and tell us a little about you.
- [00:57]
C
All right, thank you guys. I'm so excited to be a part of the team. So a little bit about me. I graduated from at Still University in Mesa, Arizona, have been practicing as a PA since 2004. Since then I worked mainly in primary care urgent care, but the majority of the last 15 years has actually been spent in the emergency in Emergency Medicine. I currently am also an Assistant Clinical professor with the Department of Physician Assistant Studies at Northern Arizona University in Phoenix, Arizona. That's my current full time role and I work as a Clinical Coordinator there. I still do work some part time in the Emergency department, but mostly in a telemedicine role. I also currently co chair our Department Wellbeing Committee which focuses on the overall well being of students in the PA program. I serve on multiple other PA department committees including like our Community Outreach, Admissions and Curriculum Committees. I'm also involved with our like State association asapa and I'm a member of the CME and Jedi Committees. I'm also an alternate for the House of Delegates there.
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A
Joe, we have to know what's the JEDI Committee?
- [02:09]
C
That's our like our dei. So that's that Diversity, Equity Inclusion for asapa. So it's basically what are all the other committees? Whenever they have some kind of question regarding diversity, equity inclusion, they come to us to make sure that they've kind of covered all their bases.
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A
Good to know. So no Star wars connection, but equally.
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C
Important, no Star wars. No Star Wars.
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A
Well, you're certainly very busy. We're glad that you've joined us here on the podcast. Tell us a little bit more about your interest and what you would like to bring to our listeners.
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C
So basically I work with Rick Dean at nau. He's the founding Director of the NAUPA program. He's also the editor in chief of joppa. He approached me a few months ago with the opportunity and at first I was wondering where I could fit in the time, but then I thought about it more and I realized what an amazing experience this would be to meet so many professionals in our community and be able to be a part of the conversation. As for content, I think my interests have changed as I've matured in my career and I've got no doubt that I'll continue to grow and learn more about my own interests. Currently with my academic position, I have an interest in student wellbeing. That's the well being committee that I'm on, and obviously equity and education too. I think that given that I'm a clinical coordinator role, I'm a little sensitive to the lack of clinical preceptors that are out there in a time when there's such a great need for more healthcare providers. And you know, honestly, I know that you guys are very busy with your own careers. I've seen that over the last couple of months being with you guys. What do you feel are some of your special interests that you have and would like to bring to the podcast?
- [03:53]
A
Kim Jo that's such a good question. I love how you said how you've grown in your interest of changing your careers, because I feel like the same is true for me. I've moved from being purely clinical to having a part clinical position and then also a leadership position within my organization. And what I enjoy most about the podcast is getting to talk to the researchers who looked into our workforce, especially as our workforce grows, and so that we can understand some of the challenges that we face and how to overcome them. Like what you mentioned with the lack of preceptors. We have a couple of wonderful conversations about postgraduate clinical training, peer review, all sorts of things that I think PAs need to be prepared for and preparing for as our profession develops and then we all develop individually. Martine, I'll pass it to you.
- [04:39]
B
I kind of follow Kim's line on this and to tell the truth, I like educating, not necessarily the medicine part, like the education we get about medicine in school. I think they do a great job at that. But I think what is lacking in the PA profession is to know everything, all the, all the space where PAs can work and the leadership. So I want to learn through other PAs with their work, their research, their publications, all the other areas where PAs can work in leadership opportunities. There are a lot of things that we can do, but we don't know or we don't have enough PAs doing it. So every time I find something unusual, a PA in an unusual position, I like to highlight it. Because we need more PAs in the leadership space, even in government, in every area. Because when I was getting into PA school, I didn't know anything about the peer profession. I learned a few months before I applied and until I graduated, when I first started working like UJo, I was really clinical, specifically for many years until I started getting interested in other areas. I'm like, well, I can do more than this. We can create, we can be in leadership positions. So I started looking more into that. So that's what I want to bring to the podcast. Really shining a light on all the other areas of practice other than clinical, that PAs can really thrive. And that's what I want to do.
- [06:07]
C
I think that's so important. You know, I've noticed that with my job change over the last couple of years, changing into academia, which, you know, seems like for a lot of people you would think, well, you're still a PA and you're, you're just in PA education, you know, that should be an easy transition. It's completely different. And it's made me realize all the other avenues that are out there for PAs, all the leadership opportunities, not only within education, but within, within all of our professional organizations that are out there, our institutions there. There's so much available to us as PAs. I am one of those people that, you know, I, I went to work, I went to, you know, I did my job, I worked my shift, and I went home for years not realizing how important it was for my own profession to be a part of the conversation. And fortunately, I've, I've had this job change to be able to, to become more of. And I, I, I appreciate that so much.
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B
I totally understand. I stopped working shift, I stopped doing the shift work and work more steady hours. That's when I started. I have more time now to get involved in committees, in boards and all. I'm, I've been doing a lot since. I totally understand that. And I, I felt I had to be part of the conversation. So that's why I'm like in HOD with Florida. So I, I do a lot more. But then when you were working, you know, seven 12 hour shifts and weeks at a time, it was hard, but totally understand. So now tell us something fun. We would love to learn something fun, Joe, that you bring to work with you every day, not including your phone, pen, stethoscope, your White coat. Anything else that's fun that we would not expect you to bring to work?
- [07:49]
C
Well, so currently I actually bring this wonderful wrist splint to work. I know that people can't see it listening, but I've got a wrist splint on, so. I fell snowboarding a coup months ago. I got a scaphoid fracture. Luckily, I think it's in a good spot, it won't cause me any issues. I've got a follow up coming up and so hopefully I will be cleared of that and won't have to do anything else for it. So I guess my fun thing is actually maybe snowboarding. I don't get to do it often and I'm obviously not great at it, but I do enjoy it and I'm just actually just trying to keep up with my 10 year old daughter who loves skiing, so. So that's been kind of my fun thing, trying to keep up with her, definitely. So Kim, at least once in our lives we're asked, why medicine? What is your why? And why did you choose to become a pa?
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A
This is such a good question. My why is, you know, deep down I value caring for my family and my community. So naturally being a PA extends to all of that. But I think the longer story, my mom is a nurse and you know, she is my motivation, my inspiration and she made me start thinking about healthcare. And then I was very fortunate to shadow a fantastic PA who did ortho hand surgery and she completely changed my life. I thought, man, I want to be just like you when I grow up. So that's my why. I'm so lucky to have had that opportunity to shadow. And I think this is a nice plug for everybody listening that either if you're in school when you're done to definitely keep that door open for anyone who's thinking about becoming a pa. And if you're currently a PA to, you know, reach out to those prospective PA students, you could definitely change your life in an amazing way.
- [09:34]
C
Martine, same question.
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B
Well, my story is a little bit different. As you guys know, I graduated, I went to medical school in my native country. So since I was a kid I always wanted to be a pediatrician. Actually I always said I loved kids and even in medical school I did a whole year of internship in Belgium in pediatrics. So I, I've always been dedicated to medicine. My father is a physician in public health. My avenue uncle was an ethologist. My cousin became also a physician. So I've been really surrounded by physicians and like, so my My godfather was a physician, but I've always wanted medicine. So when I moved here, that's all I knew to do. And I learned about the PA profession and it was. It fit perfectly with what I wanted to do. And I figured out, oh, I could do any specialty. I still could do pediatrics and started out like that, actually, until I switched, but it's been all my life. I've always liked, since I was a kid. I don't think I've ever wanted to do anything else.
- [10:33]
A
Jo, it's your turn. Same question. Why did you choose to become a pa?
- [10:37]
C
So I grew up in Mississippi, lived in a very small rural town. I was also a pretty sickly child with a lot of, like, respiratory issues, allergies. So I was actually pretty familiar with the local clinic. My local provider there, the town physician was a friend of the family, and I could see how the community respected him and looked to him for all sorts of advice, not only in medicine, but just kind of just community type questions as well. He in turn, also cared so much for the community. But then fast forward several years and Mississippi PAs weren't licensed actually until I think about 2000, and I believe it was actually the last state to license pas in the U.S. when that happened, I was working as an ER tech. And one of those, one of the nurses told me that he was leaving his job to be a pa and it turned out that he'd actually been previously licensed as a PA in another state. But then due to some like, family issues, he had to end up moving back to Mississippi where he couldn't practice as a pa, and he had previously been an rn. So he just was starting, he was working under his RN license at that point. So thanks to him, you know, it seemed like, you know, basically just fate. Everything kind of worked out and it was kind of at a, at a crossroads in my own life where I was trying to decide my direction. I did my research about, like, what is this PA thing? And it just clicked for me and I just knew that this was the right path for me at the right time.
- [12:11]
A
Wow, that's an amazing story. Thank you for sharing. So I know you also mentioned that you're working on your doctorate. How has it been and how do you fit that in with everything else you're doing, all of your other activities?
- [12:22]
C
Yeah, so NAU where I work, they started a Doctor of Medical science program last year. And given my faculty position, I kind of felt like I should probably further my education, especially given that it focuses on equity in health care and the role of PAs in healthcare delivery operations leadership. It's been so challenging, but so worth it. I spent a lot of time reading in the evenings and weekends and working on papers, discussion posts. But honestly, it's just there's been so much that I've learned. You know, I fortunately have a very supportive significant other that's afforded me the time to complete the program, which has been super helpful. I feel like even though I've worked in the medical field, like I've been in the medical field for probably like 30 years, there's been so much about healthcare and the healthcare system that I still feel that. I don't know, it's really been eye opening for me and I think that it's helped me to foster like this focus on creating more equity in healthcare for the population. It's been challenging, but I can see that it's gonna be so worth it in the long run for me to have that greater amount of information. So I know you guys are busy too. I like to know what sorts of committees involvement with like maybe your employer, local, state, national committees. I know, I see you guys all over the place. So tell me a little bit about what you guys are involved with. Martine, you want to start?
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B
Sure, yeah. So many things and it's only in the past year or so I am involved. So I represent. I'm not in an AAPA committee per se. I represent APA International committee, which I cannot disclose now until the work is done. So more to come on this in the future. I'm not allowed to say I'm on that committee. I am on the board of PAS for Women Empowerment. I am their, if you want their public relations director. I am also on the board of PAs in obesity medicine. I am one of the directors at large. We were the initial. We inaugurated that board for PASITY Medicine and we became a CEO and with aapa, which is wonderful also. So we became a caucus. I'm sorry, with aapa. I am one of the delegates for Florida with hod. So I will be at AAPA representing Florida in hod participated. Oh, I'm also in. In the DEI committee of Obesity Medicine Association. There's that. I think. I don't know if I have covered everything to think about all the meetings.
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C
That's a lot.
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B
Yes, yes, I am. Yeah. So yeah, I am part of the DI community there and actually I am go right after apa. I. They invited me to. To be on other round table regarding obesity medicine, the cardiovascular space with ACC as well. But that's just. Yeah, so, yeah, that's. That's some of the things that I've been involved with. So it takes all my time. Every month, I have at least two, three meetings. Every week I have a meeting.
- [15:27]
A
Martin's pretty impressive. You know, Martin and I have something in common in that we both have volunteered for the NCCPA and contributing to some other CAQ exams. So I think what is fun is we've, you know, podcasted, and it's usually all virtual, but we've met each other in person, too, which is fun.
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B
I know.
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A
I was like, finally, I get to meet Martine.
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B
It was a pure coincidence. We didn't even know until she saw me traveling to nccpa. She's like. I'm like, yes. You just saw my name on the list. We didn't even know that. Yeah, it was such a coincidence. And we met in person that year. That was so fun.
- [16:06]
A
Yeah, I do love it because once you start doing things, you start to see the same people. There must be something about our personalities type that just. You keep saying yes to things, in part because it's fun and enjoyable. Yeah, so I do. I've done some stuff with our state organization, and then also our physician state organization. Our PA and our physician organization work pretty closely together. I think a lot of my time is spent through my employer, and I think one opportunity or one committee that I like to highlight is our shared governance committee. So I have to admit, as a pa, I had no idea what shared governance was, because it really comes out of the nursing world. But it's this amazing concept where, you know, you empower your frontline providers to be able to contribute, to be the change that they want to be within the organization. So I think that's really what started me out on my pathway to becoming a leader in my organization was participating in this shared governance council. They call it the Committee of Apps. So it's both MPs and PAs working together. We've done some really fun things like celebrating App Week, and we're working this coming week. It's Hospital Week, and so we've coordinated with our local nurse practitioner and PA programs to do a little celebration event for all of our preceptors, which has been a lot of fun to work with both the NPS and pas at the hospital, and then the schools and the academic clinicians and the administrators.
- [17:31]
B
It's a lot of fun.
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C
That's so interesting. I love that. The shared governance aspect. I mean, that's. That's a. I. That is one that I haven't really explored a lot of so that that's good to know. So I feel like we could sit here all day and chat. But I I did want to. I didn't want to take a I do want to take some time and let's let's talk about One of the in JAPA this month was the article the Esophageal Cancer by PA Eisner that you mentioned earlier. The article points out the importance of knowing risk factors and symptoms of esophageal cancer as this type of cancer is becoming more prevalent in the U.S. yes.
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B
Joe, thank you for bringing up this important article. The article further gives an excellent review of two main types of esophageal cancers, squamous cell carcinoma and adenocarcinoma, which according to the article, account for 95% of all cases of esophageal cancer, 90% being related to squamous cell carcinoma. The author does an excellent job of reviewing epidemiology, physiology, and risk factors of esophageal cancer.
- [18:37]
A
Yes, they discuss specifically that men over the age of 50 are three to four times more likely to develop esophageal cancer, and in the US White, Native American and Blacks are at higher risk, white patients being more likely to develop adenocarcinoma and Black patients being more likely to develop squamous cell carcinoma. The concern brought up is that esophageal cancer only accounts for 1% of all cancer in the United States, so overall awareness and understanding of screening is lacking.
- [19:08]
C
Yeah, so I found it interesting that almost 80% of cases occur in the lower socioeconomic areas, which they they discuss are ranked based on what they call the HDI or Human Development Index, which is a score based on life expectancy, education and gross national income. They specifically note that esophageal adenocarcinoma is more predominant in Western countries with a with a high H D I score.
- [19:34]
B
Yes, and the most important risk factors mentioned were separated based on adenocarcinoma versus those risk factors for squamous cell carcinoma. The author advises that the most important risk factors for scc, which is squamous cell carcinoma, are tobacco smoking and alcohol use. And for adenocarcinoma risk factors, they are obesity, Barrett, esophagus, and gerd.
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A
All right, so what do we do for a patient with these risk factors?
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C
So typically these patients will present with a complaint of dysphagia, although they may have some weight loss, night sweatshirts, painful swallowing, chest pain or heartburn possibly even hemoptysis, some persistent cough or hoarseness. One of the initial evaluations that was recommended is a bedside swallow evaluation where the patient sips on water and they are monitored for any issues. I did attach a link to the video from Stanford Medicine showing a process of a bedside swallow evaluation for those listeners that want to see that the screening test has 95% sensitivity for dysphagia. Additionally, they discuss lab testing, but ultimately this patient will need an upper endoscopy since this is considered the gold standard for screening during the endoscopy. Biopsies can be taken to further assess for esophageal cancers.
- [20:52]
B
Yes, and the article further discusses more non invasive imaging such as CT, PET scan and MRI, all those CTs most commonly used to evaluate these patients. The author gives a concise review of current treatment options, including the use of precision medicine or precision oncology to individual treatment, stating that this is now considered the standard of care for the treatment of many types of cancers.
- [21:17]
A
I also read the recommendations of palliative measures, which I feel is important to note, especially given that the author mentions that at the time of diagnosis, patients usually have a poor prognosis and a low five year survival rate. So ultimately, early diagnosis and screening for esophageal cancer in these patients with risk factors are symptoms of is very important in improving outcomes. Joe, thank you for bringing this article to our discussion this week. And thank you to Pa Danielle Eisner for such an important article. Joe, welcome to the team.
- [21:49]
B
Yes, thank you Joe and welcome.
- [21:52]
C
Thank you for allowing me to be a part of this team and I'm really looking forward to our future conversations here.
- [21:57]
A
So as always, please be sure that you are one Following JAPA on social media that's J A A P A online and then two don't forget you can now earn CME by listening to the podcast. To receive your CME credit and access to your certificate, you just listen to the podcast, which you've done. Congratulations and then complete the post test and evaluation in the AAPA's Learning Central at cme.aapa.org let us know your thoughts about the topics we went over today and until next time.
- [22:31]
C
Hello Jump up podcast listeners. We have some exciting news for the Podcast listeners can now earn CME by listening to the podcast. To receive your CME credit and access your certificate, just listen to the podcast, then complete the post test and evaluation in AAPA's learning central@cme.aapa.org this is free for our AAPA members and available to non members as well. We're looking forward to bringing you more exciting content with more discussions and author interviews. Follow us on social media by following japa. That's a P A online. Talk to you soon.