Loading summary
Transcript20 lines
- [00:00]
Todd Picard
Foreign.
- [00:06]
Kim
Welcome back to the JAPA Podcast where we explore how PAs contribute to healthcare and the practice of medicine. Today we are honored to have a special guest, AAPA President Todd Picard, as we discuss his journey as a PA and PA advocate and get his take on what is next for a profession. Now don't forget, listeners can 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 at cme.aapa.org Todd, thank you for joining us today. Before we discuss your written works in japa, we would like to learn more about your journey. Can you tell us a little about yourself? How and when did you decide to become a pa? And we're also curious about your experience in the AAPA House of Delegates as speaker of the House. Then we would love to hear about your journey to becoming a APA President.
- [00:58]
Todd Picard
Well, thank you very much for the invitation to be here. It's always my pleasure to talk about PAs. I am an Executive Director of Advanced practice in Houston, Texas, in Danielson Cancer Center. I've been there for 27 years. I have responsibility for 1400 PAs and nurse practitioners. And helping PAs and NPs take care of patients without obstacles and with good policies is what I do for a living. It is my purpose, it is my mission. And so it's just natural that as a PA, I've also gotten involved in American Academy of PAs, association of PAs, Oncology, Texas Academy of PAs. I first learned about PAS when I was growing up. My family physician, his wife was a pa. Her name is Lily. I recall that whenever I saw one, my doctor, I listened to him. He had good information, but the way that he communicated was just, it was really harsh. And you know, as a kid struggling with being overweight and, you know, just the regular angst of growing up, you know, it was tough to have somebody who didn't listen as good as they could have and wasn't as supportive as they could. And so I remember her. And you know, when I graduated from undergrad, I thought about something in medicine I wasn't clear. Sure. I thought about medical school. I was an EMT for a while. I started nursing school. I mean, I really went in multiple directions. And about halfway through nursing school, I realized I'm going to be a terrible bedside nurse. There's lots of stories about mistakes that I made where I was like, this is not what I should be doing. But I remembered what PAS were. So I said you know what? I'm going to apply to PA school. I got in. You know, at my interview at Emory University, they said, we're going to offer you a position. We would like for you to tell us if you'd like to accept it. And I said, of course, absolutely. You know, I want to do this. And so I've been at MD Anderson Cancer center ever since, mostly working in urology. But again, after being there for 27 years, I've worked in a few different areas over time. So I had a variety of experience, but I just started getting involved in administration. The laws changed in the state of Texas around prescribing, and I went to my department chair and I said, how are we going to do this? And he said, I don't know, Todd. You haven't told us. So that's how I got started kind of on my administrative journey as people challenged me. And being in the House of Delegates as a PA is really an interesting experience. It's like the House of Representatives for the United States. It's really a bunch of people who come from across the country and have different ideas about policy. And so I've always been a policy nerd. Like, I read laws in the state of Texas and ask questions about them. There was a volunteer law in the state that I didn't like, so I got it changed. Same thing in the House of Delegates. Reading policy and understanding its implications is fascinating to me. You know, I'm one who always, as a pa, we always want to fix things and get involved. So that's how I got involved in the House. But that just is part of the whole journey that really got me to want to run for president because, you know, I always want to contribute. I always want to give back. I always want to leave things better than I found them. That's the short version. I know that was long. I hope that if I ever get the chance to meet you all in real life, we could sit down and have a drink and chat. We could talk more about lots of things.
- [04:15]
Kim
Oh, that sounds so fun. And as a fellow Emory PA Alum, I'm so grateful and, like, so proud of everything that our school has been able to help teach and accomplish.
- [04:23]
Todd Picard
Yeah. Great program.
- [04:24]
Kim
Now bringing it back to PA Week. Can you share a little bit about what PA Week means to you and to our profession as a whole?
- [04:30]
Todd Picard
PA Week is an amazing opportunity to recognize all the great work that PAs do over the course of each and every year, PAs participate in hundreds of millions of patient encounters a year in the United States. Which is incredibly impressive. And many times within our practices or institutions, we may not be seen, we may not be heard, we may just be taking care of patients and getting things done. And so I think it's important that everybody celebrates the accomplishments of what we do. My first PA week at MD Anderson, we got some and T shirts. I thought, I think the institution can do better than this. That was another thing that inspired me to want to be an administrator is really to recognize and celebrate and just take a moment to say thank you. You are seen, you are heard, you're important because the patients rely on us, they're dependent on us, and they recognize us. But it's always nice when your colleagues and the rest of your institutional practice also takes a beat to say, hey, thanks for what you're doing. It's incredibly important. So it is a great time to celebrate who we are, what we do, how we contribute, and how critically important we are to healthcare in the United States. But also just to give your friends and colleagues, people you work with every day, just take time for a high five, share a meal, have a drink, and really just take a pause and reflect about how important you are and what you do.
- [05:56]
Unspecified Host
It's interesting. I've learned quite a lot about your advocacy journey and speaking of PA Week, so PA Week truly really highlights how we as PAs are essential members of the healthcare team and reminds us that despite the challenges we face, we are at the forefront of providing high quality, accessible health care. Now. Speaking of challenges, in your September article in JAPA titled what We can do in the Waiting, you state that we are in a legislative waiting period but can still affect chant. You serve as a PA advocate at every level. What inspired you to write this piece?
- [06:29]
Todd Picard
The biggest thing that we can do for advocating for ourselves is what we do every day. And that's provide amazing, safe, quality care for patients and work in a team in a way that is professional, with emotional intelligence and supportive. Because then you build a reputation for PAs as being valuable and important and contributing and you never know who you're going to meet or serve. And so interestingly, we just had the AAPA Leadership and Advocacy Summit in Washington, D.C. and we were able to have Chris Colt, who is the director of CMS and he's an advisor. He works under Dr. Oz and RFP Jr and he told us a story about how a PA basically saved his life. That is an amazing piece of efficacy because now somebody who works at a high level that can change regulations, knows us, trusts us, and says things like none of the Doctors were as helpful as that PA who got me seen, made the right diagnosis and coordinated everything. Of course everybody's important. And ultimately he ended up having surgery. Of course he had a surgeon and a great physician. But the PA in that moment moved the rest of us forward. And so that's what I tell everybody is be the best PA you can be. Connect patients. Even if you can't change laws, you can change the lives of one patient at a time. And again, you never know who those patients are going to be or who they may know. If you have a reputation, it's much easier to say, let me do what I know how to do. And people say, oh yeah, I know what PAs are and I've heard all these great things about you. Yeah, this stupid supervisory rule or not getting reimbursed for that, let's fix that. That's not important. Advocacy, where you go to your state capitals and you go to Washington D.C. that's critically important. And making sure that you write the right laws, that is all very fundamental. It is very important. But that's not what happens on a day to day basis. What happens on a day to day basis is your leadership performing as the best PA you can be and developing that reputation. That is powerful advocacy that we live every day.
- [08:47]
Unspecified Host
Definitely. And I agree the way we present ourselves is how we are going to be known out there. It's not. The daily advocacy is as important as going on the Hill. And as a matter of fact, we look to AAPA to serve as our profession's advocates on the hill and beyond. Can you share some of our profession's big advances over the past year?
- [09:07]
Todd Picard
We have been doing a lot around name change and multiple states have had some changes there. Maine and New Hampshire have recently passed legislation to change the PA title to Physician Associate. We continue to make modernization in PA practice laws. South Dakota, North Carolina and Oklahoma have recently updated where they don't have to have a permanent specific relationship with the physician after a certain number of hours of practice. PAs are simply recognized as being healthcare providers that don't have to have any specific relationship. You know, that's ultimately what we want is we want patient centered practice modernization so that PAs can do the things that we know how to do that we can do and that are not based on 50 year old or 60 year old antiquated laws and regulations. You know, when PAS first came out, we probably needed some of the laws and the rules that we had, but those don't serve us or our patients anymore. We also have got 19 states now in the PA Licensure Compact, which is critically important for licensure portability. So if you're working in one state and have to move for whatever reason, it'll be easy and fast to get that license so you can keep working with as much speed as possible. That's critically important. Lots of work being done. There's always good fights to fight legislatively and regulatory, and we're making progress. So those are good things.
- [10:31]
Kim
Thank you for leading that charge. Now. I really enjoyed reading your September article, what We can do in the Waiting. And I found myself wondering as I read your article, what can I do in such a moment? And you called me out on it. In your article, you asked us to reframe the question what can we do? To ask what we can do to make a difference to our patients in our community. I love that outlook. Can you tell us how you came to that realization?
- [10:56]
Todd Picard
I live as a human being and as a PA every day, and I know that there's so many things that I want to change and so many things that I want to fix, but I can't do it all. Even though I aspire to do all those things, I know that anytime a teammate is in front of me and needs something or a patient is in front of me and needs something, I can make a difference right then and there. And in my own community, I can meet the people who make laws, legislators and regulators. I'll never forget Sarah Davis was a patient at MD Anderson. She talks all about this and she was a state representative. This is all public knowledge and she campaigned on it, so I'm not revealing any secrets or anything. And she was a representative for the medical center where I work. And I got to meet her through the Texas Academy of PAS because I was involved in my local PA group in the state. And of course we hit it off because first of all, she and I like to talk and we like to eat and have good drinks and we talked about cancer. And then we started talking about dogs. And the next thing I knew we were exchanging our cell phone number. Imagine I had a personal relationship with a person who can change the laws in my state and I could text her and ask her questions. And that wasn't because I was big and powerful or well connected. It was because I participated in my state organization. I showed up to things. I just connected. I mean, that's what PAS do. That is the power of PAS is connection. Not only do we connect with our patients, but we connect patients to the resources they need. We connect them to People who need to know what we're doing and why things are a problem and how to fix it. And so it was really just life and just saying, what can I do in the moment of where I am? Because, you know, I'm not always going to be in D.C. i'm not always going to be in the state Capitol, but I can make a difference wherever I am. That's what I call PAs to do. You don't need any special permission or training. Just do what you realize that you can do.
- [13:00]
Kim
It is amazing. And even in my own patient interactions, and you are like, oh, why did you like seeing the pa? And they're like, it's because of the relationship that we were able to make, that bedside interaction with the patients. And you've said that before, that we excel in making that connection and those relationships. So I'm very curious, through your work as the AAPA president, can you share more about the interdisciplinary work that the AAPA is doing, making those relationships to advocate during this moment?
- [13:25]
Todd Picard
It is really important that, you know, we know that medicine is a team sport. It's not just about pas. It is the nurses, the social workers, the pharmacists, the physicians, the physical therapist, the phlebotomist. I mean, honestly, everybody who helps us take care of patients is part of our team. So it only makes sense that we have open dialogue. We work with the American Medical association wherever we can, wherever we can agree, we do. The American Academy of Nurse Practitioners, our staff, our CEOs. I talk to their leadership and we figure out where can we all pull in the same direction to get things done. It's critically important that we recognize that in the next 20 years, we're going to be short millions of healthcare providers. That should be a wake up call. So there's really little time for competition. There are way more patients than we can care for. There's way more demand on our time. I mean, just think about your day. Do you ever see all the patients you should have seen in a day? No. Are there patients who are waiting sometimes weeks or months at a time to be seen? Yes. So we need all hands on deck. We need everybody working in teams at the top of their lives. It's the highest level of their skills and expertise and experience. And we need to get along because that's where we live. I mean, I don't go to clinic to, like, pick fights with anybody. I would go to clinic to serve my patients and to work with my team in a collageal and professional way. And hopefully at the End of the day we all feel good about it and we give each other a high five and say, hey, great work team. That's what healthcare really is. And so AAPA is all in on that. We spent all of our time trying to network, to collaborate, to say, where can we serve and do things together? That's just part of what PAs are. You know, we were team before. Team was cool.
- [15:20]
Unspecified Host
That is such a great way and eloquent way of putting it. And I agree so much that we have always been part of a team and it's great to be able to contribute at the top of our license within that team and that's a great way to put things. And you also describe how PAs are creative. Not only PAs are good team players, but how we are creative and innovative. We'd love to learn more about some of the incredible work of the PAs you've encountered and can you share some of those standout examples with us?
- [15:51]
Todd Picard
I'm fortunate that I work in a state and I work at an institution where there are lots of people PAs who are constantly doing innovative things. I'll never forget there was a surgical pediatric PA in the Anderson and her little kids that they had to operate on and put lines in. They were constantly pulling their lines out. So she created a onesie that you could tuck all the lines in and created a prototype and then had it mass produced so that all the kids who had these lines got this surgical onesie so they didn't have to go back to have lines put back in. She was a pa, she saw a problem, she innovated. Our institution has what's called clinical safety and effectiveness. It's where people can bring ideas how to reduce readmission rates, how to reduce ER visits, how to reduce chemotherapy in the icu where people really should be focused on palliative care and being with their families rather than last minute chemotherapy that's simply just gonna make them sick. And PAs have answered that call and are so incredibly creative. They're involved in how we do early recovery, getting people out, surgical patients out of bed and walking and eating faster than we used to do it. And PAs are right there. PAs are principal investigators and research protocols at my institution. But more than that, there recently was a pa, Jared Wallace, who opened a practice and then underserved rural community in Kenai, Alaska, providing family medicine and urgent care and occupational health services. One of the practices innovative programs Blood Sugars and Beyond, which takes comprehensive approach to managing diabetes with the goal of preventing future complications related to the disease. So again we See, our patients, we see the things that they need, and we innovate, and we are creative. I mean, sometimes that's just simply talking to patients. I'll never forget I was dealing with a bladder cancer patient earlier on in my career. And, you know, we do a complete metabolic profile. So I happened to notice that our glucose was almost 300. And I said, do you have diabetes? She said, yeah. And I said, well, are you taking your medications? Yeah. I said, when's the last time you saw your physician? About a year ago. Said, okay, what'd you eat for dinner last night? And she said, chicken and vegetables. And I said, man, that sounds good. How'd you cook the chicken? Oh, I fried it. Deep fried it. It was so good. And then I had gravy with it. Oh, okay. And how'd you make your vegetables? Well, I had greens. And I had greens and pot liquor. Pot liquor is a Southern way of saying, basically a lot of pork product that creates a lot of oil. And I said, man, that sounds really good. What else? I had cornbread. Oh, the kind where you put sugar in it? Yes. Sweet cornbread's the best, with lots of butter and honey. Oh, yeah. I said, man, I'm a Southern boy. I want to have that dinner. I said, however, the problem is not having seen your physician or that you're not taking your meds. Basically, you're eating high fat, high calorie, high carbohydrate, and then you're pouring sugar into everything you do. I said, why don't you grill your chicken? Why don't you steam your vegetables? Don't add sugar to things. Things are usually sweet enough, and just consider that. And then I said, what are you doing for extra? She said, oh, nothing. So I said, okay, try to do walking around your block. And she had dogs. I said, we'll take your dogs for 10 minutes outside. So just that. I mean, I didn't create anything new. I didn't open up a new diabetes clinic. But for that patient, I took time and I used my creativity to talk and question and listen. And I said, here's some simple things you can do that will make a change. Oh, and by the way, please go see your physician as soon as possible, because your sugar is not in a good place. Wow.
- [19:30]
Unspecified Host
So you basically changed this person's life by educating them on simple nutrition tips. And again, you just highlighted what. That's what PAs do. Like, PAs do that. Like our mantra. And I've learned so much. And I think the story about the onesie, the PA who created the onesie is one of my best. I've never heard any create such creative story and that just highlighted what PAS are capable of. And I hope this will inspire a lot of PAs out there, that there's a lot of things that we can do and not just in clinic. Our role expand beyond clinic. So Todd, thank you so much for joining us today for this special episode of the JAPA Podcast. It became almost like a tradition of the JAPA Podcast to always have our president, our sitting president on the episode, doing PA Week. And it's always a good time. I'm learning how we always learn a lot from the president, from their journey, particular journey. And there's always good, good highlights out there about the PAS at the encounter. So I hope we can keep this tradition going. So Kim and I, we are so grateful to have you. Can you share with us any closing thoughts or give us some hints about upcoming endeavors as a sitting president, now that you have in mind?
- [20:43]
Todd Picard
Absolutely. First of all, thanks for inviting me to the conversation. Really appreciate it. Happy PA week to all the PAs out there and all the patients and the teams you serve. Take a moment, celebrate, give your team a high five. Be proud of who you are and what you do. Knowing that you change lives on a day to day basis, which is I can't even tell you how critically important it is and how deeply impactful all that is. If you've got a story to tell, go to PAs, go beyond and go to our interactive map. Use the QR code, put in your story so other people can see what you're doing and how you're celebrating Right now. We are not only working hard at the American Academy of PAS to protect and advance the PA profession in the United States, we're also working with New Zealand and Scotland and United Kingdom to defend the PA profession Across the globe. There are attacks by organized medicine and politicians who want to take us backwards or who want to eliminate us completely. There's no reason for that. There's way more patients than can ever be served. So just know that the AAPA is glad to celebrate and to represent you and to advocate for you. And we are fighting for the PA profession not just here, but around the globe. And again, my pleasure to be here.
- [22:00]
Kim
Inspiring and thank you and thanks to all of our listeners for joining us. And Happy PA Week. Before you go, don't forget that the podcast is associated with cme. To receive your CME credit and access your certificate, you just listen to the podcast, then complete the post test and evaluation in AAPA'S learning central@cme.aapa.org until next time.