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- [00:00]
Host 1
Foreign.
- [00:05]
Host 2
Hello everyone. Welcome back and Happy PA Week. In celebration of PA Week, we have a special guest on this month's episode and we'll discuss his recent JAPA publication and work surrounding PA advocacy. Also, don't forget listeners can now earn CME by listening to the podcast. To receive your CMA credit and access your certificate, you just need to listen to the podcast, then complete the post test and evaluation in AAPA's learning central@cme.
- [00:34]
Host 1
Aapa.Org but before we get started to introduce our very special guest, I want to take a moment to celebrate the PA profession and highlight some of our accomplishments. There is an 87% increase in board certified PAs from 2013 to 2023. PAs interact with 10.8 million patients a week. That's over 560 million patient encounters every year. As per the NCCPA, PAs are crucial in supporting the healthcare workforce shortages that were exacerbated by the pandemic by expanding workforce. So we're projected to have a 31% increase in employment by 2030 and 43% of PAs now participate in telemedicine. PAs go beyond by increasing patient access to quality and equitable care, advocating for our patients, and pushing the profession forward through advocacy efforts. The Harris Poll provides patient perspectives on healthcare found that 91% say PAs provide safe and effective care, 90% say PAs increase access to care and make it easier to get a medical appointment, and 89% say PAs improve patient outcomes. And not to mention that US news and world Report has named the PA profession one of the top five best jobs overall in the country and one of the best healthcare jobs for the seventh year in a row. So please take a moment to celebrate yourselves this week because we deserve it. Thank you to all of you out there, whether you're in the clinic, the classroom, conducting research or in the grind to become a pa. We see you and we appreciate you.
- [02:00]
Host 3
October is indeed an exciting month for the physician associate profession. From coast to coast and beyond PA students To very experienced PAs celebrate Pa Week. We are so impressed by all of the work our colleagues do and want to highlight some exciting initiatives within our profession. Joe Kim and I are thrilled to introduce our guest for this episode. You probably have read his recent emails and communications and now we get a chance to chat about his most recent article in japa. We graciously welcome our current AAPA President Jason Prevellege to the podcast before we dive into discussing and solving the major problems in healthcare in particularly for the PA profession. Jason, can you tell us a little about yourself, how and when did you decide to become a PA and what was the path to becoming a APA president? Also, tell us how you plan to celebrate PA Week this year.
- [02:54]
Jason Prevellege
Sure. Thanks for. Thanks for having me here. This is such a great opportunity and I think my first video podcast I've ever done, actually. So this is a cool experience. So a little known fact about me is that I was originally going to become a kindergarten teacher. My bachelor's degree is actually in history, and it was somewhere about halfway through college when I just had this epiphany of sorts and decided that I wanted to go to medical school. So at that point, I had no intention or desire to start over with a new major, and I really enjoyed history. So I continued on and just added the necessary prerequisites where I could. I graduated and then still had a few courses left to take before I could begin that medical school process. But I found along the way I needed to be an adult and pay some bills. So I began working in an inpatient alcohol and drug detox facility. And that was a really impactful experience for me for multiple reasons, but a significant one is that while there, I worked with the pa. He introduced me to his experience and the profession, and I quickly knew that was the path that I wanted to take. And so from there, it was just sort of off to the races, you know, what do I do now? And started, you know, looking at the programs I had available to me here in the Northeast and finished up the Prereqs and Quinnipiac here I came. So I had a great PA school experience, and that really set me up for everything else I did, and then my professional life, you know, as for my path to AAPA presidency, that one really, truly began in 2007 when I entered the PA program at Quinnipiac. From the first day, our program director, Cindy Lord and the other faculty members imparted upon us the importance of giving back both to the profession and the larger world around us. She also happened to be a PA President at the time, or actually President elect at the time. And we were so fortunate to be able to be there in San Antonio when she was presented to the world as the new president. We also had many other legends within the profession as faculty for us, including Bill Kohlhepp, Bruce Fitz Chandler, Patrick Lean, Shepard Stone, and so many more. You know, with several AAPA presidents to influence us, in hindsight, it's really natural that our program, our program graduates were going to go on to do many great and interesting things. And I Always say to be careful what favors you do for people. Because that was really what began my involvement. A great friend of mine became involved with the Connecticut Academy pretty quickly after we graduated. As PATH leadership was being created for him. He pulled me in and he said, hey, I'm doing this annual CME conference. Why don't you come help me with that? And from there, it just snowballed. Before I knew it, I was a director on the board. I was involved in pretty much every committee that we had. At some point in time, I became vice president. I was in the House of Delegates representing Connecticut. And then I served two terms as president of the Connecticut Academy. Subsequently, we had a past member of the AAPA Board of Directors who was presenting at our Connecticut conference at one point. And she approached me and said, hey, when are you going to become involved at the national level? And to be honest, the thought had never crossed my mind to be involved in any other way other than the House of Delegates. However, she encouraged me and she guided me. And before long, I was chairing a brand new commission for the aapa and it all just continued from there. A few years later, I was elected to a term on the Board of Directors and really enjoyed that experience. Unfortunately, I lost my reelection bid to maintain that seat. And so I began to consider other ways that I could stay involved with the Academy. I returned to the House of Delegates. I joined the Judicial Affairs Commission, which I subsequently chaired for several years. And as I really love being in the House and all that happens there, I thought my next path through the leadership journey might have been through the House. Unfortunately, that was not meant to be either. I lost another election there, but utilities losses has set me up to grow and to learn from my experience and figure out, you know, what can I do differently, how else can I serve? So it's always been fine. That's happened to me. And then early last year, I had some close contacts that were also engaged in the Academy in various ways. They suggested that I run for president. So I hemmed and I hawed and I was like, ah, I don't know. It's not really for me. I'm not the best person for the role. I've lost a couple of elections. You know, I'm not sure how this is going to go. Ultimately, it all worked out and here I am today. I'm surrounded by a magnificent board that's engaged and thoughtful, and I'm really enjoying my time with them and helping, helping to direct the Academy and do all that we're doing right now. As for PA Week, since you brought that up, it's going to be a busy one for me. October is a really hectic month for me. I have lots of travel going on, lots of different appearances and events and meetings going. On the weekend that kicks off PA Week, I'm actually returning home from an international PA Educator conference. I'm going to kick off PA Week that weekend at a golf tournament hosted by the Connecticut Academy of pas. That golf tournament is actually the second edition of it started last year and it's actually just a fundraiser. It does nothing more than just raise money for good purposes. They raise money for PA student scholarships and for a wonderful organization called the Hole in the Wall Gang. Hole in the Wall Gang Camp. And they're a nonprofit organization and they provide medically supervised camps and programs at no charge to medically complex children through Northeast. And then I'm going to coach my son's hockey team and work clinically a little bit before I go down to Washington, D.C. for the PAEA forum where I'm going to continue to celebrate the week surrounded by fellow PAs. I'm trying to rearrange a few things since I'm so close to New York City. We're basically a New York City suburb here. And so I'm trying to see if I can rearrange a little bit and try to get down to Pas on the plaza on the 11th after I come back home.
- [07:40]
Host 2
Wow, you are a busy man.
- [07:43]
Jason Prevellege
Definitely.
- [07:45]
Host 2
And thanks, you know, thanks so much for sharing all of that. I mean, it's so good to hear like, hear like in your words about your story. I always, I always enjoy hearing other PA stories. So what I want to switch gears just a little bit. I want to talk about your article. So there's a recent article that you authored in the September edition of japa. It was titled Building Bridges with Physicians. In the article, you highlight the value and importance of team based practice. You referenced the article titled Physicians Working with Physician Assistants and Nurse Practitioners, Its Perceived Effects on Clinical Practice. It was published in Health Affairs Scholar this summer and explored the findings of the national survey of 5,823 physicians. Among the respondents, 59% worked directly with PAs and or NPs. The survey found that more than 2/3 of physicians said working with PAS positively affected their clinical practice. Based on these results, can you please tell us how you see the future of the PA profession in a team based model and the future of modernized PA practice laws?
- [08:50]
Jason Prevellege
Yeah, you know, really, that article underscores the fact that PA contributions to healthcare do not go unnoticed by the majority of physicians. While common sense would tell us the same, the article really showcases how practices and patients benefit from enhanced deficiencies, which in part occur when PAs and physicians work collaboratively and not in a supervisory manner. Now, regardless of the AMA's efforts to maintain hierarchy in healthcare, we can build more support for modernizing PA care among physicians who understand the old ways of delivering medical care can't meet patient demands today as PAs. I'll suggest that the majority of physicians with whom we work on a daily basis would support reduced barriers to practice so that patient access to care can be improved. Anecdotally, we all know that our physician colleagues appreciate and respect us. Our recent efforts to push back on the false rhetoric from the AMA has found a number of physicians sharing their feelings on our social channels. And I'll say they were supportive. It's really great to see some of these, you know, physicians coming on board and saying, ama doesn't represent me. That's not how I feel. We support collaborative care. We support team based practice. Patients deserve access to care. So it's been really, really heartwarming to see that from them. You know, every healthcare provider must be able to do what they're educated and trained to do. That's what team based care is really all about. The old ways have to cease to exist. Medicine as we know it has truly come to be only in the last hundred years or so, with the most significant advances in the last 50 years, and even more, I'd say, in the last 10 or 20 years. Which means that the system around the practice of medicine needs to advance and we can't continue to live in the past. And really, that's the future that PAs are fighting for.
- [10:12]
Host 2
Yeah. Thank you. So the current growing issues we face in the field, like growing provider shortages, prevalence of burnout, alongside increasing prevalence of chronic diseases like diabetes, obesity, mental health disorders, and substance use disorders, create a strain on healthcare teams. The PA profession was born to address a similar crisis, and our profession has grown to provide solutions in our current crises. In fact, according to a recent Harris Poll, the U.S. health care system is stretched thin. The public is worried about how this will impact their care in the future. Can you take a moment to elaborate how you feel PAs are qualified to address the crisis?
- [10:50]
Jason Prevellege
Yeah, you know, as you pointed out in the introduction, we're one of the fastest growing professions. We've nearly doubled the number of PAs in the last decade with about 95,000 PAs in 2013. So nearly 180,000 in 2023. And we expect to see actually about a 28% increase over the following decade through 2033. And as you said, also PAs have more than 500 million patient interactions a year. And the Agency for Healthcare Research and Quality found PAS are more likely to practice in rural and remote areas than physicians. And initially, PAS just care. Right? You know, when we look at the issues that you just mentioned, those are areas of focus for our academy and our members, and we're well positioned to make impact on those areas and many others through our engagement, our efforts and research led by pas, each and every day.
- [11:28]
Host 2
Yeah, definitely. You know, so there was also the new survey from the Harris Poll published in May of last year, revealed that 73% of U.S. adults say their healthcare system fails to meet their needs in some way. Now, in the last month's article, you also discussed how vital that we, as a profession and within our state organizations double down our efforts to foster allies. Patient advocacy groups, healthcare organizations, and physicians. Can you elaborate on how frontline PAS can build relationships with these organizations?
- [11:58]
Jason Prevellege
Yeah, great question. You know, really, it's less about individual PAS building relationships with those organizations and more about building relationships with those that are around you. We need to encourage PAS to find allies and partners within their own communities, and that can be fellow providers, patients, community leaders, and ultimately, that's going to help connect those organizations with our profession through firsthand exposure via their own members. Through those connections, those various organizations can be connected with the PA organizations that represent all of us, and together they can work to enact the change. We should strive to grow a network of people who gladly stand up to support PAs. Those networks are actually really tough to cultivate if anyone's worked in that space before. Hard to convince people to stand up and speak against the norm, especially when those folks perceive that the impact may not be directly beneficial to them. Though, as we know, we're all patients, and so improvements to patient care are good for all of us, you know, and the AAPA is also having conversations with partners in other organizations. At the macro level, this is a daily occurrence that happens at various levels of the organization, with most of our senior staff members dedicating the vast majority of their time to such efforts. The partners that we have are incredible players in the healthcare landscape. Our CEO, Lisa Gables, does a fantastic job of making new contacts, building new business efforts, and ensuring that we have partnerships that are going to continue to make the organization MPA sustainable into the future. But as I said a few minutes ago, you know, we need PAS to also have those conversations and spread the word that PAs go beyond at the micro level. And I constantly tell my students that the best branding for the profession that we can do is actually just go out there and be the best PA that we can be. You know, each and every day our patients know us, they love us. And then it's come through nearly 60 years of PAs going out there and providing exceptional patient care.
- [13:31]
Host 3
PAs go beyond for their patients by improving access to care. According to that same Harris Pool survey previously mentioned, patients who have seen a PA recognize the value that PAs bring to healthcare. A new study published earlier this year in the Journal of Medical Regulation affirms that removing barriers to PA practice improves patient access to high quality care. According to the article, medical malpractice payment reports of Physician Assistants related to state practice laws and regulation, after a 10 year examination of medical malpractice payment reports data compared to the laws and regulations of states for the same period, removing those barriers to PA practice improves access to high quality and cost effective care while maintaining patient safety. Do you believe it is a lack of this understanding, as you mentioned in your article, that interferes with the lawmakers support for PA bills? How can PAS and our supporters help eliminate the negative narrative regarding modernized PA practice?
- [14:29]
Jason Prevellege
Yeah, you know, in some cases I think it might be a matter of needing to educate lawmakers about who PAS are and the high quality care that we provide. You know, I see this all the time with legislators that have really no healthcare experience in our state legislative body. Here in Connecticut, we have some healthcare providers of various specialties that, you know, are on the various committees, but majority of them are, you know, real estate agents, attorneys, business people, and they don't have that healthcare knowledge. But the reality is that we're not just working to educate them, we're working to reeducate them. And in my experience in my own state capital, this is something that I have repeatedly seen over the years. The AMA has invested millions of dollars to defeat PA supported bills by spreading misinformation about PA care and qualifications, including that patient's safety is at risk. The AMA may not specifically weigh in, you know, in all capitals, but their investments are granted to hundreds of physician organizations that do weigh in and work to oppose our efforts. Now we're working to push back against this narrative. Now this summer we sent a letter to the AMA calling on them to end their divisive campaign aimed at discrediting PAS and other healthcare providers and asked for a meeting. It was really no surprise, but they ignored our request for a meeting. So we sent a follow up letter and we amplified the voice of the PA community. We saw over 8,000 PAs and pa students sign an open letter condemning the AMA's misrepresentation of PAS. And over 4,900 PAS took part in a survey about the impact of the AMA campaign on their practice and their workplaces. Making our collective voice loud and clear in moments like these is really the best way that we can combat that negative narrative along with continuing to be a good representative of the PA profession within your own community. And I'm so proud of the response that I've seen in this campaign. It's really about fighting for patients and putting them first and PAS have recognized that and are really stepping up in this whole campaign.
- [16:08]
Host 3
So Jason, you bring up a new perspective in PA advocacy, doubling down in our efforts to foster allies, particularly physicians. According to the survey published in Health Affairs Color this summer, physicians will agree that working with PAs and I quote working with PAS increased patient volume and said collaboration with PAS fostered more efficient time use. You noted, and I quote Again, these results, combined with additional research highlighted in the article, support the author's conclusion that practices benefit by enhanced efficiencies and increased patient volume when PAS and physicians work alongside one another collaboratively rather than in a supervisory manner. What are some of the modern advocacy efforts that you offer to bridge that gap in PA practice laws on a national level?
- [16:59]
Jason Prevellege
You know, advocacy comes in many different forms. You know, yes, I did reference that we need to be building relationships with allies, and that holds true. But that's just one form of advocacy. There's plenty of others, like being able to understand and communicate research. For example, a new study published in the Journal of Medical Regulation this year affirmed that removing barriers to PA practice improves access to high quality care. The authors found that states with permissive practice environments compared to restrictive states had no increased risk of PA medical malpractice payment reports, which is completely counter to the narratives that are often used in opposition of our efforts. Research like this demonstrates the need for advocacy. Change is what we're pushing for, and if we can communicate it effectively, it gets us closer to bridging those gaps in PA practice laws at both state and national levels. Advocacy also takes the form of building relationships, contributing to research, and staying engaged. Traditionally, we've not done a great job at assessing what we do in a scientific way. We've often relied on evidence from others that either may include PAS or we can extrapolate their information to our own practice. But it makes me really excited to see that PAS are now recognizing the need to increase the amount of research and publications that come from within the profession. And ultimately with every other profession out there having their own issues, no one else is going to do it for us. So we need to ensure that we're guiding those narratives. Talking about Staying Engaged the engagement I've received since the start of my presidency has been incredible. Everywhere I go, I have PAs coming up to me, excited for our efforts and wanting to know more. I often hear things like, wow, I just had no idea that all that was out there like that. And I'm really not surprised because unless one is really engaged in the legislative arena, it's not surprising that the Scope Creep campaign hasn't filtered down to them. You know, it's really geared at shutting down legislative modernizations for many healthcare professions that are not physician oriented. And so if someone's not engaged in that arena, they may not have heard about it. I just came back actually from the Leadership and Advocacy Summit in Washington, D.C. it was so inspiring to see so many PAs and PA students engaged and excited about advocacy zombie all over the US Capitol and informing our lawmakers about the needs for our patients and how PAs are part of that solution. It was really great to be so well received by those legislative offices, but that engagement needs to be consistent. LAS is an opportunity to learn about advocacy, best practices, exchange ideas within with other PAs, collaborate, and so all of that is advocacy and it's going to help us to bridge that gap.
- [19:00]
Host 3
Day in and day out, PAs work to improve access to quality and affordable healthcare while addressing social determinants of health. Becoming an advocate for optimal team practice and policy change can seem daunting at times. Can you share an example of how a PA advocated for optimal team practice? And Also, what can PAs learn from this example?
- [19:24]
Jason Prevellege
Sure, there's examples across the country of PAs who've advocated for modernizing PA practice laws. The examples are really endless. PAs are out there fighting the fight every single day, doing what they can to ensure that patients have optimal access to high quality care. For example, the Tennessee Academy of pas. In recent years they've been hosting lobbying days, and when they first began several years ago, they had about 10 attendees coming up to the Capitol. This year, they had over 300 between students and practicing PAs. As a result, it garnered media coverage that resulted in great conversations with lawmakers. And this is something our entire profession is working towards, having an engaged PA community that can have productive discussions with lawmakers. And I think what we can learn from this is that advocacy efforts like these take time. We can't expect everything to play out perfectly the first time and it requires patience. And trust me, from years of experience, you know, the waiting can be very frustrating. We've been working on efforts here in Connecticut for many, many years and just can't seem to get the traction that we need. But it's a cumulative effort over time that does build a success eventually.
- [20:18]
Host 3
Jason, I think it's safe to say that every PA who has been in practice quickly encounters antiquated legislation that limits scope of practice. And I think that we live in a very political world where we are constantly encouraged to go vote and become involved in grassroots in grassroots efforts, the number of advocacy groups can be overwhelming. What are some resources you would recommend for IPAs? How can we get more involved and contribute to move these efforts forward?
- [20:46]
Jason Prevellege
Well, of course I always recommend membership. Become a member of both the AAPA and your state chapter and you know, if you have the means or the need. The specialty organizations, the caucuses, there's so many great organizations that are out there that are standing up for PAs every single day. Get involved in your state chapter, right? Everyone has something unique to offer and I can tell you from experience that the organizations need you. Being involved does not mean much work necessarily. You know, there's something for everyone and the organizations will appreciate anything that you can offer. As well as your state chapter, along with aapa, there are plenty of resources to help guide your efforts. There's AAPA's Advocacy Central email newsletters, Leadership and Advocacy Summit. Your state chapter likely has a website with plenty of resources on it as well. If they're local meetings, engaging them in conversations. Whether the meetings are in person or virtual now doesn't matter. They're happy to chat with you. Just simply reaching out and saying hey, what can I do? I guarantee that they will pull you in and find something for you to do. There's so many ways to contribute to the advocacy efforts. Even if you can only do one thing, it's still a value. Advocacy is really customizable to the amount of time that you have to give. If you have something, somebody will happily take it. Now if you have five minutes, register to vote, identify your legislators, engage in an AAPA or co call to action. Call or email your legislators, share a post on social media. You have a few hours. Maybe attend a legislators town hall or an event or attend your state chapter events. Maybe go to a committee hearing on a priority bill or register to testify in support of a bill. You can attend a candidate event, meet with your legislator or Invite your legislator to your practice so they can see what you're doing on a day to day basis and see how PAS really are making an impact and going beyond you have a whole day, maybe attend a lobby day, meet with legislators there, attend your state chapters conference or specialty conference, volunteer for a campaign event like Canvas in a neighborhood. There's really a whole menu of options that one can choose from.
- [22:27]
Host 1
So I have heard y' all mention so many different ways that PAs make a difference not in inpatient care, but also in being advocates for our patients. So I know I started out the podcast with a couple of stats, wanted to share a couple more. 92% support utilizing PAS to address the healthcare workforce shortages and 91% support updating PA practice laws in states to fully utilize their healthcare workforce. So Jason, in that wonderful article last month in September, you mentioned that PAs strengthen their alliances and to quote, give a megaph to the physicians and other allied voices who share our desire to ensure PA practice the full extent of our education, training, experience and benefits of patients. Couldn't identify with this more. Some of the biggest champions in my practice have been my collaborating physician that we work with very closely and the nurses and the physical therapists and everybody else. So how can we equip those of us who aren't PAs that are also on the, on the same idea of wanting to expand access to patient care to start to tackle these big challenges along with us?
- [23:24]
Jason Prevellege
You know, ultimately it's up to each of us to stay informed and aware. Right? It's important to keep up with healthcare policy issues in your own state. Stay up to date on news coming from the AAPA about advocacy and professional issues nationwide. But again, at the individual level, tackling the challenges we face is all about relationship building. And that begins with conversations you're having in your community and whatever form that may take. Whether you're involved in a local organization or a board, a youth sporting event, parent teacher associations, I'll tell you, our PTA loves to have folks come in and, you know, give talks on some topic relevant to them. I've gone in and talked about, you know, winter illnesses and injuries and things like that. So anytime you can get out there and just expose the world to PAs, it's, it's a necessary and a great thing. But of course, then on your workplace, with your patients as well, as I brought up earlier, I'm a believer in the idea that the best way to advocate, to just be the best PA that you can possibly be, build relationships with patients, physicians, other healthcare providers, anyone that you can demonstrate the power and the impact of the PA profession at your level. It's really a whole house effort. And if PAs across the country build supportive communities around them, we'll be better positioned to face the challenges head on.
- [24:25]
Host 1
Thank you. Those are inspiring words. So we have so enjoyed getting to talk with you. For our last question, can you tell us about a recent experience that made you stop and think? Man, I am so glad that I'm.
- [24:35]
Jason Prevellege
A pa. You know, honestly, as an emergency medicine pa, I think this every day. You know, I work in an environment that allows me to impact lives each and every day. Sometimes it's a great save and a critical patient, but many times it's just doing the small things for someone that really makes a difference. Finding them a meal, helping them connect with social resources, finding them a pair of socks, or just listening to them when they really need someone to talk to. You know, as well, these sorts of opportunities that I'm in now, right, talking with all of you made me so glad to do what I'm doing. Just so rewarding to be able to go out, advocate for our profession and our patients and make a difference in a less clinical sort of way. So just thank you for having me tonight. I've really enjoyed this experience.
- [25:09]
Host 1
Well, thank you for talking with all of us and for really making it about those interpersonal relationships and interactions that we all have. Because at the end of the day, that's what we take forward with us. So thank you.
- [25:19]
Host 2
Yes, thanks, Jason.
- [25:20]
Host 1
Happy PA Week.
- [25:21]
Host 2
Yes, Happy PA Week, everyone.
- [25:24]
Host 1
Thank you listeners. And as always, be sure that you are one following us on JAPA social media. That's @jaapa online and.