By Deborah Reed, PA-C, Regional APC Director, TeamHealth West Group
At the corner of U.S. rural highways 70 and 81, sits Jefferson County Hospital, a critical access hospital, amidst an expanse of farming and cattle ranches near the Oklahoma/Texas line. As I drive the 120 miles to my new clinical home, I had the opportunity to reflect on my career as a physician assistant (PA) and the road that has brought me to this place. My last clinical position was in a busy metro community hospital that had volumes of 100,000 patients per year. Here the daily average is closer to 10. Certainly, the patient volume is less, but basic emergency medicine is still the same. People still have heart attacks, strokes and trauma but managing complex medical problems with less staff, equipment and resources can be a challenge. Even with many years in, I am still learning new clinical tricks – like giving intra-articular lidocaine for shoulder dislocations and hematoma blocks for fracture reduction as opposed to procedural sedation.
Certainly, having physician assistants in rural emergency medicine isn’t a novel idea – the PA profession was built to increase access to medical care in rural communities. From my perspective, however, it was sometimes “cowboy medicine’” in that you had little physician collaboration and you had to beg, borrow or steal to get your patients transferred to larger facilities with specialty resources. I have had the opportunity to affect change in this arena by creating supervision guidelines and structure for solo advanced practice clinician (APC) practice while at TeamHealth. We identified best practices for APC training and skills, transfers and physician collaboration. I’ve had the privilege to participate in the evolution of APC practice from my first job as a new graduate where I was literally the first physician assistant my original emergency medicine group had ever hired, to now – where there are over 3,000 APCs practicing within TeamHealth.
In my career, I have witnessed the true integration of advanced practice clinicians (APCs) into emergency medicine. Our practice models range from treating lower acuity patients in a carved out “fast track” model to sitting second chair on the majors’ side, to managing an APC only, solo practice model. We have evolved from being the “outsider” to becoming an integral part of the facility’s clinical and leadership team.
Opportunities for regional and national leadership and representation for APCs have also evolved. Postgraduate fellowships for emergency and hospital medicine have been developed and are growing with success. This physician assistant trajectory has been quite a ride, and I believe it’s really only the beginning as we move forward. As many hospital systems become larger, their footprints expand into rural communities where there will be an increased need for experienced physician assistants who are comfortable and competent to work in this advanced, albeit solo, practice model.
As I pull into the parking lot after my 2-hour commute to start my 72-hour shift, I can’t help but think that this is both literally and figuratively the new frontier.
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