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Alumni Anniversary Series: 5 Years

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Joy Adams, PA-C and Kelsey McFarlane, PA-C outside on patio Joy Adams, PA-C, and Kelsey McFarlane, PA-C are both 2014 graduates of the Augsburg PA program. After graduation, they found themselves at Bluestone Physician Services. Bluestone is onsite integrated primary care for individuals with disabilities living in assisted living and group homes. Before applying to PA school, both alumni worked as direct support professionals at group homes at ACR Homes, so this was a perfect fit for their passion. In the Bluestone model, our alumni travel to the resident to provide care on a monthly or quarterly visit schedule. The patient’s care team is able to communicate with their providers on a 24/7 basis via an online platform. The practice employs patient care coordinators who are able to share resources with patients to manage care.

Joy and Kelsey each have their own patient panel ranging between 150 to 200 patients. At the first meeting, Joy shares that as a provider she needs to be vulnerable and open with the patient. Through relationship development, the PA is able to know every in and out of their patient. When a patient care coordinator receives a message about an issue, the provider is able to determine if it is an episode or ongoing issue versus an emergent problem. Because the providers are so in tune with the patients, it reduces the overutilization of emergency departments.

Two of the most challenging aspects of being in practice are navigating insurance and the patient’s social and emotional needs. Joy acknowledges, “The patients we manage are very sick and it is challenging to manage multiple conditions.” Because of the nature of their disability, each patient is so different and unique that they may present differently than others. Due to the diversity of patient conditions, the profession really does involve lifelong learning. A provider can make a recommendation, but the patient needs to be ready to try it. If a patient is not ready, Joy and Kelsey can only encourage and wait until they are ready. Kelsey shares that she herself becomes excited when a patient is motivated to take control of their health and shares the progress they’ve made.

More often than not, a visit is much more than medicine. Kelsey and Joy could spend their whole visit conversing about the patient’s psychosocial needs. Because the Bluestone model focuses on the frequency of visits and openness of communication, both Kelsey and Joy have learned “if you do not make any changes in a visit it is considered a win because the patient’s care is managed well overall.” The most fulfilling part of the work they say “is making a connection with the person in front of you.” The patient is appreciative every time they show up.

Alumni Anniversary Series: Serving Veterans in the Twin Ports

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Miranda Schoenecker in an exam roomMiranda knew during freshman year of college that she wanted to pursue a career in healthcare. Although registered as pre-med, she was unsure of which profession. For a while, she thought physical therapy but it didn’t seem to be the right fit. During this time of indecision, her uncle was being cared for at the Fargo VA for esophageal cancer.  He asked her what she wanted to do and Miranda mentioned she had not yet decided. He said, “Be a PA! They treat me better than any of the physicians here.” Her immediate response was, “What is a PA?” After returning home, she researched the profession and realized “this is it, this is what I want to do.”

After deciding that PA school was the next step, she needed to prepare her application. Fortunately, she had been accruing patient care hours as a certified nursing assistant for quite some time. During high school, the local nursing home was desperate for help so she received a crash course from a family friend. When she turned sixteen years old, she signed up for the exam, passed and began working immediately.  By the time she applied, Miranda had six years’ worth of experience. Her degree in cell biology was a testament to her academic readiness.

Miranda applied to about 8 schools across the country, but Augsburg was her first choice. She was thrilled when she was accepted as she wanted to remain close to family. During her second rotation, she was placed at the Twin Ports VA Clinic in Superior. Even though this was only the beginning of her clinical education, her preceptor encouraged her to reach out if she was interested in a job. Throughout the clinical phase, Miranda constantly compared other rotations to her experience at the VA.

At the time of her PA graduation, the 2008 economy had crashed leaving few options for employment. Miranda wanted to return to the Northland but jobs were limited there as well due to the local health system laying off employees. Her options were a posting at a convenience care clinic and one at the Twin Ports VA.  Miranda was hopeful she could return to the VA and serve the patient population she fell in love with.

Even after ten years in the same clinic, Miranda finds joy in being a PA serving veterans. Working with this population inspires her and gives her a purpose to serve patients who Miranda says have all been brave enough to do something she couldn’t. She appreciates the real sacrifice her patients have made so that she can live her life in the United States. Every day she is able to establish rapport, gain trust and surprise people. She loves when a new patient is referred to her and they decide to transfer their care.

Veteran medicine is challenging, but it is so rewarding. She believes she is able to practice medicine in the most ideal way. Patients do not need to worry about prior authorization which translates into patients receiving prescriptions, surgeries and referral services.  Miranda is able to control her schedule and has incorporated telephone clinics, secure messaging, group visits along with various patient panel management tools. She can pull specific lists based on patient populations such as diabetics with an A1c greater than 9 and then implement ways to improve their overall health. In October, COPD patients attend an annual group appointment and Miranda can do the same for patients diagnosed with hypertension, DMII, or prediabetes. The Twin Ports VA Clinic has integrated mental health within the primary care setting as well as operates a “medical home” model that is called Patient Aligned Care Teams (PACTs). All of these capabilities lead to nearly 100% continuity of care.

Throughout her tenure she has seen great strides in the roles PAs occupy including a clinic director, as well as in upper management and administration. Miranda was promoted to chief status in the fall of 2018 and she appreciates the recognition that her clinical skills have grown and the administration noticed.

When asked what advice she would give current students, Miranda says, “Know that it is okay not to know everything.” When a patient comes in with a question, concern or new condition she is honest and says “I don’t know, let’s look it up together.” This helps to establish rapport with a patient and the relationship-building can begin.

 

Hoshmand Las – Living the Mission

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The blog has recently featured anniversary stories from alumni and we are starting a new series focusing on alumni that are living out the Augsburg PA mission of providing medical care to underserved populations. Hoshmand Las, PA-C has been practicing for 5 years since graduating from the Augsburg PA Program in 2014. He currently works for Advanced Practice Solutions, a contract staffing agency of several local correctional and government facilities including, Ramsey County’s workhouse, juvenile detention center, jail, and prison. A few times a week he also provides primary and urgent care services in North Minneapolis at NorthPoint Health and Wellness Center where the patient population is characterized as mostly refugee and immigrant.

alum Hoshmand Las, PA-C sits in his white coat and scrubs in his office

Hoshmand knew he always wanted to pursue a career in medicine because he is fascinated with how the body functions. The PA profession was first introduced to him during high school. As he pursued an undergraduate degree at Metropolitan State University, he enrolled in core science courses to prepare for PA school. “I leaned toward the PA route because it allowed me to practice medicine but also have a work/life balance.”  

There was no gap in between high school, undergraduate and graduate school for Hoshmand. He applied to ten schools during his last year at Metropolitan State University. A program in Pennsylvania accepted him but a week later he received an invitation to participate in a phone interview with Augsburg. Augsburg accepted him shortly thereafter! He was excited that his first choice extended an offer and he could stay in Minnesota.

The highlight of the didactic phase for Hoshmand was the hands-on skills workshops including casting and suturing. He recalls, “You were around a bunch of other adults, but yet we had the chance to act like kids again because we were all learning something new.” He remembers it being so interesting as it was a glimpse of his future. A challenging moment came during his first rotation where the political side of medicine was exposed. Hoshmand learned that sometimes you need to take out the umbrella in order to weather the storm. Throughout rotations, he remembered to always stay humble and really focus on the true reason he went into medicine.

After graduation, Hoshmand and two other classmates applied and were accepted at Emergency Physicians Professional Association (EPPA). EPPA was hiring new PA graduates so that they could train them in the EPPA model. Essentially, the first 7 months was a fellowship where Hoshmand worked directly under a physician and staffed every patient. Hoshmand recalls that he learned so much during his time there; “It was the best decision I could have made after graduate school because it made me more confident.”   Continue reading “Hoshmand Las – Living the Mission” →

Augsburg Physician Assistant Studies 23rd Commencement

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The twenty-third cohort of the Physician Assistant Studies program graduated at the end of August. These students have successfully made it through 27 months of didactic and clinical training. The ceremony took place at Hoversten Chapel on Friday, August 23rd and was an excellent commemoration of the students’ path leading them to this point. Graduates were addressed by several individuals including Commencement Speaker Vinh Dang, PA-C and Student Representative Nathan Kleppe.

Class of 2019 group photo

Continue reading “Augsburg Physician Assistant Studies 23rd Commencement” →

Alumni Anniversary Series: 22 Years in Practice

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Peter Lindbloom, PA-CAs part of our alumni anniversary series, we go all the way back to the first graduating cohort. The inaugural cohort graduated in 1997, which means our featured alumni, Peter Lindbloom, PA-C, will have been practicing for 22 years. Over the course of his PA career, Peter has worked in various practice areas and settings. Peter has been at North Memorial for the past 5 years in Trauma, Emergency General Surgery, and Surgical Critical Care. In his free time, Peter keeps active with his growing family. He has 4 children and 5 grandchildren. Peter precepts Augsburg PA students during their general surgery rotations. The Minnesota Academy of Physician Assistants recognized Peter in 2008 as their PA of the Year.

As a freshman at the University of Minnesota in Morris, Peter attended a Sports Medicine Club meeting that had invited a PA guest speaker. Until that point, he was unfamiliar with the PA profession. Peter was an EMT with an ambulance service during his undergraduate years and obtained his paramedic license following his undergraduate studies. His decision to apply to PA school was driven by a desire to have a bigger scope of practice, more stable hours, better compensation and more responsibility in patient care.

Peter worked in family medicine for five years and had a full scope practice, excluding obstetrics. It was a good chance to practice the full breadth of medicine from infants all the way to geriatrics. The practice ran the whole gamut from dermatology to orthopedics. When he first started, it was at the time of health maintenance organizations (HMO) so the practice had a set number of insures. As time went on, there came to be increasingly more time commitments but fewer hours in the clinical workday to complete those tasks. He began a per diem position in a level II trauma emergency department. He subsequently left family medicine to practice emergency medicine full time with Mille Lacs Health System. They had just started staffing the night shift with PAs so that physicians would have the opportunity to sleep and then attend to patients the next day. Peter remembers receiving one of the best compliments while at Mille Lacs. The Chief of Staff at the time noted that since implementing E.D. staffing with full-time PAs, the amount of complaints decreased while the overall quality of patient care increased. Mille Lacs decided to permanently staff its emergency department 24/7 with PAs.

In the years since Peter graduated, there is significantly more access to information. He says that many students are not aware of how quickly, almost immediately, information can be available. Students should proactively be reading and staying up to date on the latest in technology and medicine.

Peter advises soon to be graduates to not sell yourself short! The nature of your clinical education is to give you a well-rounded experience. These rotations are an opportunity for both yourself and the health system to “kick the tires” and see if this might be a good fit. Often connections made during a rotation, or a preceptorship, can lead to a job, even if it is years down the road. For example, a mentor had called Peter to start up an emergency general surgery service at North Memorial 17 years after he had completed an elective rotation at North Memorial in Trauma and Surgical Critical Care.

The nature of healthcare is quickly changing. In the coming years, health systems will be grappling with the aging baby boomer population as well as a physician shortage, among other healthcare factors. Due to these pressing issues, the PA role may further evolve and develop. Peter notes that it is still up to PAs to recognize and understand their limitations while employers demand more autonomy of PAs. The practicing PA needs to be confident yet humble enough to ask for help when necessary. He would encourage PAs to develop expertise in a specific area and be the “go-to person” in their practice for questions in that area. This is value added to the health care team and benefits the patient. Pete says “we can’t lose focus of patient care. While patient satisfaction is the buzzword, we need to be evidence-based and measure outcomes all the while providing quality, cost-effective care.”

Healthcare is a team-based profession and there are various avenues to realize a career in this field. It is detrimental to the team to speak ill of another profession. When we recognize the value and merit of each health profession, the team succeeds and so does the overall care of the patient.

EdTalk – How PAs Think: A Glimpse into PA Education

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As part of Augsburg’s EdTalk series through the Center for Teaching and Learning, Professor Jenny Kluznik spoke on how students are trained within PA education to step into the role of health provider, advocate, and leader. Jenny Kluznik is an Assistant Professor and the Academic Coordinator for the PA Program and joined the faculty in 2014. She serves as the course director for the Clinical Medicine course series in the didactic phase of the program. In addition, she is a graduate of the Augsburg PA Program and excited to be back teaching. Below you can watch the full EdTalk!

Alumni Anniversary Series: One Year in Clinic

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This year we are highlighting Augsburg alumni that are celebrating their first, five, ten and twenty-year anniversaries! In the first blog post in this series, we talk with a graduate from the class of 2017, Omar Fernandes. Omar recently celebrated his first-year work anniversary with HealthPartners as a PA in family medicine. He currently practices in Eagan, MN in an outpatient clinic with two physicians, two other PAs, an ob-gyn/midwifery group, a chiropractor, a pharmacist, a certified diabetes educator, and a dietitian. With one year of experience under his belt, Omar has quite a lot to share with currents PA students about the first-year transition.

Why did you decide to pursue family medicine?

I chose family medicine because I thrive on patient and disease variety, and understanding human development holistically. I see a lot of different signs and symptoms playing out in various and sometimes, very complex rhythms. In clinic, there is not always the classic presentation of a case. I also get to work with an amazing range of patient personalities. You also get to establish amazing relationships. The lessons I’ve learned, especially from older patients, can be life-changing. Your patients are just as much of your teachers as you educate them about their health. Being a PA means lifelong learning that happens every day.

My advice for pursuing family medicine is to know that it is constant and never ends. There will always be something needs to be addressed. After the patient leaves, they should feel assured their concern has been addressed and there is a plan in place.

What was the biggest transition between PA school to your first job?

It was scary having a 3-month break between school and starting my job. You feel like you are forgetting what you learned and that can cause some anxiety. However, once you start, the knowledge comes back fast and you eventually find your stride! At HealthPartners, I ramped up to a full schedule within about five months.

What was a major challenge in your first year?

Staying on time is still my biggest challenge. There is a whole separate world of “electronic patient care” that is closely intertwined, yet also very independent from face-to-face care. You always need to keep a handle on your EMR in-basket because you can really get behind; there’s always a million labs, patients, and forms to address.

Coming up on your first-year anniversary, what are areas you feel more comfortable in now compared to when you started?

Procedures! I’ve gotten to do quite a few, and learned some new ones, too. They tend to come in waves, and there are always opportunities to learn more.

I also love managing certain conditions. Hypertension is one of my absolute favorites!  It is chronic, multifaceted and can sometimes be tricky to diagnose. There are so many moving parts to hypertension including various treatment options and still, it can be very difficult to manage.  It also requires a lot of patient cooperation.

What tips do you have for students on applying and interviewing for their first job?

Use your networks from school and rotations to advise you on jobs and contract negotiation. If you have multiple eyes look at your contract, you have that many more ideas on what type of compensation package makes sense for you.

While you should apply broadly, be sure you are applying to practice areas you enjoy.

Now that you have more spare time, what activities do you enjoy?

I’ve been doing some traveling and going to different national parks around the country.  I was in Death Valley, California over the New Year and that was really spectacular. I also really loved Zion in Utah. I joined the Twin Cities Gay Men’s Chorus last September and our next show is this weekend. I also love doing CME stuff. My next conference is in Santa Fe, NM on wilderness medicine. In general, I think it is important to have a professional advancement goal to work towards.

On a side note, you can catch Omar singing in action at Unbreakable showing March 29th and 30th at the Ted Mann Concert Hall on the University of Minnesota West Bank campus! Purchase tickets to attend the show.

But it matters to them . . .

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Brady Griffith, PA-CBrady Griffith, PA-C graduated from the Augsburg PA program in 2016. He is now working as an Emergency Medicine PA at Ridgeview Medical Center. Before PA school, Brady was a ED Technician at Ridgeview and loved it so much that he knew he wanted to return there after graduation. He recently penned the following reflection and permitted us to share it: 

But it matters to them . . .

That short, simple phrase has had a profound impact on my practice.

Working in emergency medicine for the past 2 years has generated plenty of opportunities for introspection. On my late drives home from an evening shift, I found myself reflecting on the day. Did I sign that chart? Will that 88 year old do ok at home that I felt warranted admission but declined? Will the 5 month old with RSV do ok with just supportive cares? Will that dog bite that needed repair get infected? The list goes on.

One of my favorite parts about the emergency department is the variety of patients that walk through the door. While there are plenty of true emergencies on a day to day basis, there are plenty of… not so true emergencies. At least from our standpoint.

I remember driving home one night after a shift reflecting back on the day. It was a busy shift with high acuity patients. Trauma, stroke, heart attack… you name it. One MD and myself trying to manage the chaos. There were sobbing family members for a patient who had a serious head injury, screaming babies, an intoxicated patient yelling at nursing staff, and a distressed family of a young child whose j-tube had dislodged. We were doing our best to frankly stay afloat and safely practice medicine.

In the midst of the chaos, more ambulances were on the way heading our direction and the waiting room was filling up. A middle aged patient with the chief complaint of “personal matter” registered. Due to his overall stable clinical appearance and vital signs, the patient was triaged as low acuity and therefore waited about 2 hours until I saw him. He did not divulge any specifics of his concern to nursing staff and instead wanted to wait for a provider. He seemed very concerned explaining his problem to me although in my mind there was nothing concerning about his story. He had plantar warts.

I gave him some recommendations, provided reassurance, and discharged him home. In my mind, I was thankful for a patient that didn’t need a massive work-up. I couldn’t help but think at the time, why didn’t you just make a clinic appointment for this? This is not an emergency.

But it mattered to him.

As I was driving home that night, reflecting on the shift, I found myself thinking about the guy with warts more than the critical patients we served. It was the perfect juxtaposition in the context of that particular day. He frankly didn’t need to be there, but there he was.

Because it mattered to him.

That profound phrase has had a meaningful impact on my practice, friendships, and even my marriage. How often in life do we hurt someone unintentionally and then selfishly put the blame on the other person for getting hurt? Too often. Bottom line is that if it matters to the other person, it should matter to us.

Empathy must be at the foundation of medicine and life.

My realization that night was that if I ever stop caring about what matters to patients, I should step away from medicine, no matter how big or small the concern may be. Because, ultimately, it doesn’t matter what matters to me when I come to work…This is the beauty of medicine.

-Brady Griffith, PA-C