NewsNewsOfficial Publication of the California Academy of Physician AssistantsOfficial Publication of the California Academy of Physician Assistants

November/December 2010

Disaster Health Care Volunteers: 507 Sign-Ups!By: Larry Rosen, PA-C, Vice-President and Public Relations Committee Chair

The Magazine\

Physician assistants at CAPA’s 34th Annual Conference saw the need and made the commitment. More than 500 from all over the state signed up to be Disaster Health Care Volunteers. That is so good!

Signing up also made you eligible to win three Red Cross Emergency kits, a $25 and $50 iTunes card…or an iPad. Congratulations to Tam Le, PA-C for becoming a disaster health care volunteer and taking home a brand new iPad.

Lectures, presentations, exhibit hall booths all told of the enormous need to have a roster of health care volunteers should a catastrophic event visit our state. And CAPA PAs listened.

• On January 9, 1857, an earthquake hit Fort Tejon killing two and leaving a 220 mile surface scar.

• On April 18, 1906, an earthquake devastated San Francisco, leaving 3000 dead and causing $524 million in damages.

• The next earthquake of major significance is predicted by 2032.

When that happens, the state Emergency Preparedness Programs will need hundreds, even thousands of medical personnel to call upon. MRC’s, Medical Reserve Corps, are county repositories for listing names, specialties and personnel locations. Highly qualified staff initiate training programs and compile lists of medical and non-medical volunteers who will be called upon based on location, skill-sets and need.

In a time of crisis, health professionals calling on their own asking where to go and how to help causes more chaos and confusion. And this is of paramount importance; if an MRC calls you and you are otherwise occupied and cannot report, there are no questions asked. They will move to the next name on the list.

The MRC’s are charged with organizing an effective, coordinated response. They know their job well. They will need volunteers and they must know how and where to find us.

Tragedies in China, Haiti, Chile, New Orleans, North Carolina and recently in San Bruno remind us that there is no substitute for being prepared. Preparedness is a culmination of training, resources and personnel all made ready at a moment’s notice to save and protect human lives.

“We’ve never had such an incredible response…!”

Sheila Martin, EMT-1Disaster Healthcare Volunteers CoordinatorStatewide MRC Coordinator

“Over 500 PAs! That is wonderful news! Thanks for all the work you and your team have done to increase PA participation throughout CA.”

Jee Kim, MPHCounty of Los Angeles Department of Public Health Emergency Preparedness and Response Program

“Thank you for providing the Red Cross with access to your conference and for really making a strong outreach effort. I was very impressed by the human qualities within your membership.”

Charlie Sardou Chief Communications & Volunteer Officer American Red Cross Los Angeles Region

Continued on page 4

2 CAPA NEWS

Editor

Gaye Breyman, CAE

Managing Editor

Denise Werner

Editorial Board

Eric Glassman, MHS, PA-CBeth Grivett, PA-CBob Miller, PA-CLarry Rosen, PA-CMichael Scarano, Jr., Esq.

Proofreaders

Paula Meyer, PA-C

CAPA Board Of Directors

President

Eric Glassman, MHS, PA-Cpresident@capanet.org

Vice President

Larry Rosen, PA-Cvicepresident@capanet.org

Secretary

Cherri Penne-Myers, PA-C, MSCSsecretary@capanet.org

Treasurer

Bob Miller, PA-Ctreasurer@capanet.org

Directors-At-Large

Beth Grivett, PA-Cdirbeth@capanet.org

Matthew Keane, MS, PA-Cdirmatt@capanet.org

Adam Marks, MPA, PA-Cdiradam@capanet.org

Greg Mennie, PA-C, MSeddirgreg@capanet.org

Student Representative

Jenn Baltazar, PA-Sstudentrep@capanet.org

The CAPA News is the official publication of the California Academy of Physician Assistants. This publication is devoted to informing physician assistants to enable them to better serve the public health and welfare. The publisher assumes no responsibility for unsolicited material. Letters to the editor are encouraged; the publisher reserves the right to publish, in whole or in part, all letters received. Byline articles express the opinion of the author and do not necessarily reflect the views or policies of the California Academy of Physician Assistants.

The CAPA office is located at:3100 W. Warner Ave., Suite 3Santa Ana, CA 92704-5331Office: (714) 427-0321Fax: (714) 427-0324Email: CAPA@capanet.orgInternet: www.capanet.org©2010 California Academy of Physician Assistants

NewsNews At The Table

October 6, 2010 – CAPA supported SB 1395 (Alquist) signed into law by Governor Schwarzenegger, which establishes and maintains the Altruistic Living Donor Registry. The registry shall contain information regarding persons who have identified themselves as altruistic living kidney donors. The donor registry shall be designed to promote and assist live kidney donations, including donor chains, paired exchanges, and nondirected donations.  Cama Garcia, PA-C was there to witness the signing of this historic bill.

October 20, 2010 – Beth Grivett, PA-C serves on the Advisory Committee on Physician Responsibility in the Supervision of Affiliated Health Care

Professionals. At its October 20, 2010 meeting, Steven Klompus, PA; Chair of the Physician Assistant Committee, addressed the Advisory Committee to give an overview of the PA Practice Act.

At the bill signing ceremony for SB 1395

SB 1069

(Pavley/Fletcher) will become law effective January 1, 2011

SB 1069 will allow PAs to do the following, unless otherwise indicated in the physician assistants Delegation of Services Agreement (DSA):

• Order Durable Medical Equipment • Approve, sign, modify or add to a plan of

treatment or plan of care for home health services (PAs are still unable to order home health and hospice care for Medicare beneficiaries and solutions to this problem are being worked on at the federal level)

• Certify that certain school district employees, including educators at community colleges, are

free from communicable diseases for purposes of employment

• Provide the statement attesting to the need of an Epi-pen to be carried by pupils while at school

• Order medications and provide the statement attesting to the need for medications to be available to a student during school hours

• Certify the parent’s request to waive a school-based visual acuity test

• Perform physical examinations required for participation in interscholastic athletic programs

• Certify the needs of an individual who has been diagnosed by a physician and surgeon as being deaf or hearing impaired to retain a telecommunications device for the deaf or hearing impaired

Be sure to update your Delegation of Services Agreement if this law allows you to do anything not already covered in that document. To read the bill in its entirety, please go to https://www.capanet.org/pdfs/SB1069Chaptered.pdf.

Another Big Win For California PAsby Beth Grivett, PA-C, Legislative Affairs Coordinator

NOVEMBER/DECEMBER 2010 3

At The Table.........................................................................2Another Big Win For California PAs .......................................2New CME Requirements for California PAs .............................3Disaster Health Care Volunteers: 507 Sign-Ups! ....................4The Cost of Signing a Disability Form is Uncovered ................5For Love of Gaye Breyman . . ..............................................6CAPA’s True North ................................................................8The Brave New World of Rural Medicine .............................10PA Education and the Global Imperative .............................11Switching Specialties: A Recipe for Change ..........................12New CME Requirements for California PAs ...........................13Cosmetic Services Performed Through Medical Spas ............14What’s a PA…So you think you know your profession? ......15

We Want You!!!! ................................................................16CME Program Development Committee Members ................17Patient Education and the Importance of Health Insurance Coverage for Smoking Cessation ........................................18CAPA’s 2010 Annual CME Conference ..................................20We Were Tickled Pink With the Turn Out! ............................22CAPA Honors Harvey Lesser, PA ..........................................22Talking “Physician Assistants” on KNEWS FM 94.3 ...............23CAPA at Napa ....................................................................24Controlled Substances Education Course ..............................25SOS Poster Project .............................................................26Farts and Diarrhea .............................................................39“Who Wants To Read About Snot?” .....................................39

PAC is Back ........................................................................40Thank You to Our 2010 CAPA Conference PAMarketPlace Vendors .........................................................412010 American PA Idol ......................................................41PA Week at Santa Clara Valley Medical Center .....................42New Post Graduate Program ..............................................42Congratulations .................................................................42The Ruth Webb Minority Scholarship ...................................43Thank You Student Ambassadors ........................................43Days of Our Lives ..............................................................44Welcome New Members .....................................................47Local Groups......................................................................48

Inside This Issue

I see that I got your attention. You are probably aware by now that there is a new continuing medical

education (CME) requirement when renewing your California PA license that went into effect this year. Before your blood pressure starts rising, let me reassure you that if you have your NCCPA Certification, your “C,” at the time of license renewal—you’re covered.

At last count, out of the nearly 8,000 licensed PAs in California, there were approximately 15% who did not maintain their Certification, and as such, had no mandate to seek continuing medical education. Remember that to initially obtain a California PA license, you need to graduate from an approved program and have NCCPA Certification. However you are not required to maintain your “C” for practice or for license renewal. Most do maintain their “C” for a variety of reasons – one is the growing trend for employers and other health related organizations to require the Certification as a criteria for employment or malpractice insurance for example. The “C” also allows

the flexibility to travel to practice in other states which may require it.The CA Business and Professions Code (B&P Code) now includes Section 3524.5 which states that, “The committee may require a licensee to complete continuing education as a condition of license renewal ...” This section establishes a limitation in that, “The committee shall not require more than 50 hours of continuing education every 2 years.” It also allows the Committee to accept current Certification by the NCCPA as evidence of compliance with these requirements.

Once a new law is established, the next step is to promulgate regulations which describe the nuts and bolts of how the new statute will be applied. These regulations are written by the appropriate governmental agency — in this case the Physician Assistant Committee (PAC). I was happy to be invited to sit on the task force to develop the new regulatory language.

This new language evolved over a series of meetings and the result is found in Tile 16 of the California Code of Regulations

(CCR), Sections 1399.615 to 1399.618. These sections cover the continuing medical education to be required, the Category I accrediting organizations, the mechanism for potential audit and possible sanctions for non-compliance. There is also the possibility of a waiver of this requirement for a renewal cycle for reasons of health, military service or undue hardship – all determined at the discretion of the Committee.

The following bullet points highlight this new CME requirement:

• 50 hours of Category I CME will be required every two years for PA license renewal.

• Your 2-year period to obtain the 50 hours of required CME BEGINS when you renew your license after June 12, 2010.

• At the time of license renewal, if you have current NCCPA Certification, you DO NOT need the additional 50 hours.

New CME Requirements for California PAsby Bob Miller, PA-C, Professional Practice Committee Chair

Continued on page 13

4 CAPA NEWS

For further information about Emergency Preparedness Programs…

Jee Kim, MPH County of Los Angeles Department of Public Health Emergency Preparedness and Response Program 600 South Commonwealth Ave, Suite 700 Los Angeles, CA 90005 Tel. (213) 637-3636 Fax. (213) 381-0006 jeekim@ph.lacounty.gov

Sheila Martin, EMT-I Disaster Healthcare Volunteers Coordinator Statewide MRC Coordinator Response Personnel Section Disaster Medical Services Division Emergency Medical Services Authority (916) 322-4336, ext. 465 sheila.martin@emsa.ca.gov Lisa Holcomb (assistant) (916) 322-4336 ext. 458

Millicent Wilson, M.D. Disaster Training Specialist Emergency Medical Services Agency 10100 Pioneer Boulevard Santa Fe Springs, CA  90670 milwilson@dhs.lacounty.gov Tel. (562) 347-1646 Fax. (562) 944-6931

Charlie Sardou Chief Communications & Volunteer Officer American Red Cross Los Angeles Region 11355 Ohio Avenue Los Angeles, CA 90025 (310) 445-2663 (Office) (213) 247-2340 (Mobile) sardouc@arcla.org www.RedCrossLA.org 

Disaster Health Care Volunteers: 507 Sign-Ups!

Continued from page 1

Please, if you haven’t volunteered, do so. There will be a time when your skills will be needed. Be an integral part of the California Emergency Medical Services Authority by signing up with an MRC in your area. Access this web page:

https://www.healthcarevolunteers.ca.gov

Use the links to the “EMSA Home Page” and the “Healthcare Volunteer Resources Page.” There is a wealth

of information here to guide you through the simple sign up process and to answer your questions related to volunteering your services.

CAPA began its planning to promote PA disaster volunteering several months ago in conjunction with the California Medical Association. Our hope is to engage our physician colleagues along with us in taking an active role in volunteering their services should disaster strike. Encourage your supervising physicians to join you in this vital process of saving and protecting lives.

And to better prepare yourself, your family and your patients to deal with emergency situations, download the free EMERGENCY SURVIVAL GUIDE and direct your patients to do the same. The Guide is filled with information about emergency kits, how to protect yourself in an earthquake, how to arrange for out of state contacts, what important documents

you will need access to, where to call for help, special needs for the infirmed, baby care, pet care and much more.

http://lacoa.org/PDF/EmergencySurvivalGuide-LowRes.pdf

I’d like to take a moment to thank everyone who volunteered at the conference. I wish I could do it personally, to each and every one of you. We at CAPA put scores of hours into this project because we believed it to be that important. To have had the response we did, far beyond our expectations, is what makes working for CAPA a joy. It continually reaffirms that this profession has more than earned its rightful place in the health care system. The caring shown by my colleagues putting themselves on the line to be first responders when California might need them most makes me proud of this profession. That’s a feeling I intend to hold onto.

NOVEMBER/DECEMBER 2010 5

The Cost of Signing a Disability Form is Uncoveredby Beth Grivett, PA-C, Legislative Affairs Coordinator

portion about disability in order to save the remaining items in the bill and avoid a veto.

So, why the big price tag? Apparently, we are all affected more than we realize by the economic realities and the lack of funds and resources available at the state level. In a recent meeting with representatives from the Employment Development Department (EDD), we learned that the computer software program which processes disability and unemployment claims is so old that it cannot be altered. The programming is based on antiquated language in which programmers are no longer trained. The program cannot accommodate the necessary addition of the new fields to allow PAs to be recognized as a provider group, to accept that license type and to import licensing data from the Physician Assistant Committee. An upgrade to this software is anticipated shortly, but until this is in place, we are faced with the EDD office’s inability to process forms submitted by PAs even if legislation were to pass. This was billed as a costly undertaking, but really it was not even possible despite the cost due to lack of knowledgeable

programmers and limitations with the current software.

Why did the nurses NOT have this problem? The field for “registered nurse” is already included in the old program because the nurse midwife and nurse practitioner have been able to certify disability for a normal pregnancy and childbirth for many years. The EDD imports the RN licensing data already to verify those claims. There was no need to change the software just because the type of disability they can certify was expanded. They already existed in the program as a provider who can certify disability.

I assume you are probably about as frustrated as I am about this discovery. But, I do not feel that the cause is lost. Like I mentioned, the software upgrade needs to occur anyway and this needs to happen relatively quickly. So, we start again and look toward reintroducing legislation to address the issue with consideration for the programming costs to add PAs to the future newly upgraded software, but allow for a delay in implementation until the upgrade is complete and these programming changes can be made.

While working toward the passage of SB 1069, which initially included the ability

for PAs to sign California State Disability forms, we encountered opposition from the Department of Finance who indicated a significant cost associated with this task. Clearly, many PAs are seeing patients with disabling conditions and can provide additional help to their supervising physicians if they didn’t need to bother them to complete and sign these forms. CAPA and the legislature (the bill was getting through the Senate and Assembly Committees without opposition) understood this to be another form for which the law just needed to be updated to include PAs. Up until this legislative session, the only persons allowed to sign the disability forms were physicians, surgeons or other “practitioners” meaning a person duly licensed or certified in California acting within the scope of his or her license or certification who is a dentist, podiatrist, or as to normal pregnancy or childbirth, a midwife, nurse midwife, or nurse practitioner. Since doing the appropriate physical exam and determining with our SP the length of disability is well within our scope of practice, it was not difficult to convince others of the obvious need to include PAs as a “practitioner.”

Additionally, the nurse practitioners in California had just passed a bill in 2009 and now a clarifying bill in 2010 which would allow them to certify all disability, not just be limited to the disability associated with a normal pregnancy or childbirth. They did so without the opposition of the Department of Finance, which interested us. Unfortunately, the opposition we received came very late in the session and we had no choice but to pull the

Karen Bass Becomes First PA Elected to Congress

6 CAPA NEWS

For Love of Gaye Breyman . . .by Larry Rosen, PA-C, Vice President and Public Relations Committee Chair

I got lucky.

For conference, the CAPA Board of Directors asked me to write the presentation to commemorate Gaye Breyman’s 25 years with CAPA. Writing about Gaye Breyman? That’s like putting me in an Apple store with a blank check; so many wonderful things to choose from, so many incredible innovations to celebrate. But only nine minutes? I could talk about Gaye for hours, even days if anybody’d let me. For a couple of weeks, I did struggle, trying to find a theme to hang it all on. Then I saw Kristen Chenoweth on a rerun of “Glee” and it all came together.

Gaye loves WICKED (she’s seen it more times than its producers.) In the second act, the female leads sing to each other about love and hope…

“People come into our lives for a reason,

Bringing something we must learn,

And we are led to those who help us most to grow,

If we let them.”

They end with the words, “Because I knew you, I have been changed for good.” The lyrics resonate the message of WICKED. They are also a metaphor for Gaye Breyman.

In 1985, Gaye came to CAPA. CAPA’s membership numbered 500. She was hired to work only 20 hours a week. She worked 40, every week. She knew what had to be done to grow the organization. Time and salary were never an issue. Today, largely due to Gaye’s doggedness, CAPA has more than 4000 members and a budget which exceeds $1,000,000. She gets a little more time off now and a little more salary, but she’s earned them both.

Gaye Breyman is all about celebrating the PA. Look at some of her projects and conference themes: “Windows of Opportunity,” “It’s All About You,”

”Teaming With Pride,” “Shoeboxes of Love,” “Honoring a Community of PAs,”

“Speed Consulting,” “A PA Experience,” “Sharing Our Selves.” Inspired ideas, all of them hers.

And, during conference, Gaye works with speakers, exhibitors, attendees and honored guests. She plans the food, the beverages, the exhibit times, the Dance, the poolside Challenge Bowl. She is CAPA’s incomparable hostess. And, at conference, “The PA is never wrong.” Gaye genuinely believes that. “PAs are here to learn and have a great time,” she says. “Nothing should get in the way of either”… and she makes sure nothing does.

Anywhere you look on the CAPA landscape, you’ll find evidence of her gifted innovations; PA Law Seminars, Controlled Substance Courses, legislator visits to PA offices, uniquely effective membership drives; a consistent Midas Touch for success; for nobody loves PAs more than Gaye.

I like to believe, as she does, that “..we are led to those who help us most to grow if we let them…” God knows, we’ve let her and she has grown CAPA very well.

Under Gaye’s leadership, membership continues to climb and even in tough economic times, conference attendance increases every year.

Her concepts are timeless. The “American PA Idol” was conceived by Gaye to provide a venue of celebration and laughter where we honor and poke good-natured fun at our brave, talented colleagues.

The “Doc-to-Doc” and webinar events we produce to educate the physician community about team practice

bear her comforting touch. They’d be impossible to put together without her oversight and

enchanting smile.

Every edition of The CAPA NEWS is produced, edited and published under Gaye’s guidance. We who write the articles welcome her red pen and her collaboration.

Gaye travels to Sacramento with CAPA leaders to represent the interests of the

California PA and to maintain a “PA presence” after we depart the Capitol. Ingenious reminders and the personal impressions she leaves behind keep the physician assistant and team practice

medicine always in the legislative foreground.

Gaye Breyman, CAE CAPA Chief Operating Officer

NOVEMBER/DECEMBER 2010 7

For Love of Gaye Breyman . . .by Larry Rosen, PA-C, Vice President and Public Relations Committee Chair

For 25 years, the most beloved name in CAPA history has been Gaye Breyman. She is our parent, our playmate, our voice but always, our protector. Her counsel is sought everywhere in the PA world for she is a visionary, a wizard of ideas and imagination. Everyone wants Gaye Breyman but, thankfully, she is ours.

Gaye is magic and light and like “WICKED”, the more you see her, the better she gets. She is for sure the music of CAPA and often the lyrics of our proud organization. It is with loving pride that we present her with honorary membership in CAPA and CAPA’s most prestigious award, our PRIDE OF THE PROFESSION.

Gaye Breyman…

“Because We Know You, We Have Been Changed For Good.”

Bryce Docherty (CAPA’s Legislative Advocate); Eric Glassman, PA-C; Cyndy Flores, PA-C; Larry Rosen, PA-C; Gaye Breyman, CAE; Bob Sachs, PA-C; Beth Grivett, PA-C; Wendell Wharton, PA; and Wendy Ard, PA-C

My child is home sick. Barely get to the office on time. Waiting room ispacked. The office manager is out on vacation. Meet with supervisingphysician to discuss patients. Grab stethoscope. In first room is 3-year-old Emma. Pink eyes, a cough and ear infection. “Gifts” from daycare.Record on chart. Next room. A pleasant 55-year-old woman in noacute distress. She describes a new cough and onset of chest pain.Order EKG, chest x-ray and labs. Minor emergency of the day –16-year-old Sammy fell off his skateboard while ‘performing an Ollie.’

Suture knee and write prescription for the pain. Fifteen minute breakspent getting caught up on paperwork. Supervising physician e-mailed

an article titled, “In a courtroom, your documentation can be your bestfriend or worst enemy.” Good thing I have HPSO!

Make sure your story has a happy ending.

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8 CAPA NEWS

CAPA Founder, Rod Moser and his colleagues created an organization with one purpose in mind: to give this wonderful new profession some legs and work to sell it. The founders forged CAPA’s TRUE NORTH.

CAPA will be 35 years old in June of 2011. I have been with CAPA 25 of those years. It certainly doesn’t seem that long. Think of your own job and what it would be like to stay there for 25 years. What would cause you to do that? What would that be like?

For me, it’s a dream job, a perfect fit from the beginning. I think you have to admire the people you work for to be happy in a job. I do. To work for driven people who have a true north and who never waiver from that path, is incredibly fulfilling. No ambiguity here. I know exactly what my charge is.

Your CAPA leaders have never faltered from CAPA’s purpose: take care of the members, give this wonderful profession some legs and sell it. Those were my marching orders when I was hired 25 years ago and through 25 elected Boards of Directors, my orders have never changed. It is not about the leaders, it has never been about them. It has always and will always be about you,

CAPA’s True Northby Gaye Breyman, CAE, Chief Operating Officer

A s I sit down to write

this article it is November 3, 2010, the day after the mid-term elections. Last night and this morning, the television was full of election news

(so much better than the political ads we have been forced to deal with for months).

This morning, one of the pundits on ABC opined that in this digital age where we all expect everything to happen instantaneously, the voters tend to elect the opposite party every two years (in his estimation since 2000). They have no patience for giving their elected officials time and continued support to affect real change. The fact that there is a new party in the majority every two years can almost guarantee no real change because it just can’t happen that fast. It takes preparation, time, alliance building, education and loyalty.

Whether I agree with his opinion or not, it made me think of CAPA and how incredibly focused we are on a united goal for PAs in California. Our cohesive leaders have served us well. I thought of other state and national organizations and how often they are as fractured as the United States government. Leaders and the staff lose site of what they are really there for.

Admittedly, CAPA’s scope is much narrower than the US and California governments. However, I am proud to say that even as we have experienced tremendous growth, we have stayed true to our vision.

the membership. That is CAPA’s TRUE NORTH. And, it is my joy to share in doing the work of CAPA.

The legacy of the first board of directors lives on with the current board of directors. Keep in mind that Eric Glassman, our current President was born one year after that first CAPA gavel fell on June 26, 1976 in Fresno, California. Three other members of our current board were born in 1980 (2) and 1983 (1). The gavel we use at board meetings today has been passed down through all CAPA Presidents. That is more than a symbolic gesture, it is a constant reminder to honor and respect the legacy of the founders.

CAPA’s Mission Statement:The mission of the California Academy of Physician Assistants is to represent and serve physician assistants statewide. As an advocate of its members for quality health care, and for their valued, unique alliance with supervising physicians, CAPA will enhance, educate, and empower physician assistants for the ultimate benefit of their patients

For the ultimate benefit of their patients. This we always remember. It is not about leaders and it isn’t totally about you, the CAPA member. After all is said and done, it is about providing quality care to the patients. And PAs do that very well.

As we approach our 35th Anniversary, think about those who have come before you. The PA graduates of the mid 70’s didn’t have jobs waiting for them. They had to talk to doctors to

“Your CAPA leaders have never

faltered from CAPA’s purpose:

take care of the members, give

this wonderful profession some

legs and sell it.”

NOVEMBER/DECEMBER 2010 9

CAPA’s True Northby Gaye Breyman, CAE, Chief Operating Officer

explain what it was they could do and how they could do it. They had to tell them what PA meant. They had to sell the profession and themselves. They were pioneers and they taught us well. They knew change is painful and often people don’t embrace it. Health care was much different then. Today, change is scarier than ever for all health care providers.

As we continue to work toward enhancing the PA Practice Act in California, remember that we have made huge strides because we remain true to our focus. We are united and we’re in it for the long haul. We are well-respected by legislators and regulators and

physician groups. As one lobbyist told us, “You wear the white hat.” We are the good guys. That, along with an incredibly capable team to guide us, including the incomparable and very tough, Mike Scarano, Legal Counsel and the very effective Bryce Docherty, Legislative Advocate, we will continue to do great things for California PAs.

If you support CAPA each and every year by being a CAPA member, you can rest assured that the PA leaders, consultants and staff who represent you will do so with enthusiasm and a clear focus – a TRUE NORTH – and you will always be part of a winning team.

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CAPA FACTDid You Know?

2,978 California PAs have completed CAPA’s Controlled Substances Education Course (as of 12/1/10).

10 CAPA NEWS

A s we enter into this brave

new world of health care, the PA profession proceeds with an optimistic outlook on our role as mid-level practitioners. Over the course

of our profession, we have spent time as well as monetary resources educating the public, physicians and ancillary staff on a PA’s role in medicine. We have found and are continuing to find niches in which PAs can effectively be used in America’s health care system.

One area which expects an influx in patient volume is America’s rural health care system. In most areas, rural health care centers are understaffed and stretched on resources, but they are finding new ways to provide services. Alta Family Health, a small rural clinic in central California, has begun offering Tele-dermatological services which has drawn patients from across the valley. It has been a difficult process to get started in the San Joaquin Valley, where Medi-Cal and uninsured patients make up a majority of the rural clinics clientele. Getting Medi-Cal patients to see a dermatologist can take weeks to months, while patients without insurance struggle to pay for sliding scale services offered by specialists.

Alta’s approach to Tele-dermatology is a way to solve problems faced by those who have Medi-Cal and to those who are uninsured. The program is headed by Dr. Thusu, the clinic’s director, who has spent countless hours developing ways to fund such a program in a relatively

rural and sparsely populated area. The program is still in its infancy but it has developed a solid foundation built on team practice and centered on the patient’s needs.

Alta’s Tele-dermatology program follows a similar format to its predecessors. Patients are referred to the clinic from the surrounding areas, where their initial visit is with the physician assistant, Jason Sanchez, PA-C, who performs a thorough history and physical exam, documenting dermatological concerns with photos of the lesion and measurements. Upon completing his documentation, he formulates an assessment and a plan for the

patient. On the initial visit, the patient’s provisional diagnosis is treated by the physician assistant and the patient is given a follow up appointment with Mr. Sanchez. Each patient’s SOAP note and photos are sent electronically to Dr. Golding, a dermatologist who works out of UCSF. He reviews the visit and makes recommendations

based on the diagnosis and treatment outlined by Mr. Sanchez. When the patient follows up, he adjusts the treatment and diagnosis based on recommendations given by Dr. Golding. The patient continues to see the physician assistant who updates the specialist on the patient’s condition. It’s a long distance, symbiotic relationship which helps provide much needed specialty care to a rural area in California.

Alta’s success in telemedicine has led to the addition of two more dermatologists out of Stanford. Along with the steady growth of their program size, they have begun investigating other avenues in which telemedicine can be utilized in rural health. The clinic is considering the addition of Tele-neurology and Tele-ophthalmology in the near future. With the increase in these telemedicine programs, clinics will be looking for more mid-level providers to take part in a different kind of team model. This team model will span over great distances and be built through the use of technology with the goal of increasing access to specialists and improving patient care.

This brave new world of medicine is upon us. Telemedicine is just one more niche where the PA profession can showcase its solid foundation built on flexibility and team work; the same groundwork which has permitted the profession to thrive in America’s health care system.

If you have any good stories of PAs, Physician-PA teams or clinics who are paving a new road in America’s health care, CAPA would love to hear from you. Please feel free to e-mail me at DirAdam@capanet.org.

The Brave New World of Rural Medicineby Adam Marks, MPA, PA-C, Director-At-Large

Dr. Thusu and Jason Sanchez, PA-C

“This brave new world of medicine is upon us. Telemedicine is just one more niche where the PA profession can showcase its solid foundation built on flexibility and team work; the same groundwork which has permitted the profession to thrive in America’s health care system.”

NOVEMBER/DECEMBER 2010 11

PA Education and the Global Imperativeby Michael De Rosa, MPH, Ph.D., PA-C, PA Program Relations Committee Chair

M any thanks to the

folks who plan and produce CAPA’s Annual Conference for another wonderful experience!

As Chair of the Program Relations Committee, I look forward to this and other PA conferences for the opportunity to reconnect with my program faculty colleagues. I once said at a white coat ceremony that working in health care is a noble calling, second only to that of the teacher. I am privileged to interact with innovative and dedicated educators, a number of whom have or will be profiled in this space. California’s PA educators have taught and guided, inspired and cajoled so many of us to be the best providers we could be. And, they certainly share of themselves. Those of you who participate in the education of our newest colleagues as clinical preceptors also regularly share the profound and fulfilling experience education provides. With Health Care Reform demanding more of the education community and PAs positioning ourselves to provide needed care; we will need the support of preceptors willing to give of themselves more than ever.

This year’s theme, Sharing Our Selves, was evocative for the many ways the phrase was interpreted. It is first and foremost a reminder of the richness and diversity of our profession and those who practice it. It evokes thoughts and images of all the ways in which physician assistants give of themselves, and of the varied environments in which physician assistants can be found. As I viewed the many posters lining

the Exhibit Hall at the CAPA Conference, I was also struck by the number of references to global health and international medicine. The interest in global health will not be short lived. And like many important changes in higher education, this change will be driven by student demand. We now train students who barely remember a time before the advent of the DVD, who use “Google” and “friend” as verbs and routinely interact with people the world over using the technology with which they are evolving. The world is much smaller for our students than it ever was for the faculty teaching them. And, as they frequently are, on the issue of global health, our students are right.

In the Spring of 2009, we all learned a lesson in how our world is shrinking as we watched H1N1 spread from isolated cases in rural Mexico to a worldwide pandemic in a matter of weeks. In August 2010, I participated in my third trip to rural Panama with students, faculty and alumni from a number of Samuel Merritt University programs. Among the nearly 1300 patients we encountered in 3 days of health care, we saw numerous patients with symptoms suggestive of Dengue Fever during what has been a very serious outbreak of the endemic disease. On the return trip, I took an opportunity to check my email

from the airport in Tegucicalpa, Honduras. I discovered a message from the president and founder of the private primary care practice in Northern California where I conduct two sessions each week. He was writing to let us know that one of our pediatricians had treated a young patient for fever and rash after the child returned from a family vacation to Honduras. The child had later been demonstrated to be suffering from Dengue. Indeed, the global has become local and understanding of the global burden of disease will improve the care we provide at home.

As the physician assistant profession is growing and we see training programs now on multiple continents, the shrinking globe, ease of travel and increased interpersonal contacts are creating a global imperative. The global imperative will not be addressed by more narrow minded and stifling standards in an accreditation manual and it will not be addressed by a new course about the global burden of disease. As King Holmes, Chair of Global Health in the School of Public Health at the University of Washington, posited at the Global Health Education Consortium meeting in Cuernavaca, Mexico in April: the global imperative demands change in the very culture of the academy. We will not prepare graduates to function in a 21st Century world with 20th Century curricula. Global health is about economics, engineering, architecture, environment and, yes, medicine. Consequently, the global imperative demands globalization of higher education. By responding to the global imperative we will prepare a new generation of physician assistants prepared to share their talents, commitment… selves with an ever-shrinking global community.

Mike DeRosa shares a moment with Panamanian boy

12 CAPA NEWS

“Most people will change

careers or jobs at some point

or another and as PAs, our

flexibility as practitioners

allows us to do so with

relative ease.”

One of the best benefits of being a physician assistant is the flexibility that it offers. As

PAs we have the luxury of not only working in specialty practices, but changing specialty at any time. It’s been just over a year since I graduated from PA school and I have already had to go through the transition from one specialty to another. While I was finishing my clinical year, I had an amazing opportunity to do a three month preceptorship in emergency medicine. It was a good experience and at the end of my three months there, I was offered a job as soon as I graduated and had passed the

boards. As a new graduate, it was a great opportunity and with a family at home, I was very grateful to be able to work so soon after getting my license. However, after about six months of commuting an

hour each way to work and working a lot of nights, my wife and I finally sat down and decided this was not going to be best for our family. I began looking for a job close to home and after a few days of searching, I found a job posting for an orthopedic PA at the hospital just down the street from my house. It was perfect, and thus began my transition from emergency medicine to orthopedics.

Making a transition from one job to another can be difficult and everyone will face their own obstacles when doing so. As I tried to figure where I would go and what I would do, the first question I had to answer for myself was, “Why?” Why did I

want to leave Emergency Medicine? For me, the medicine had nothing to do with it. I loved the people who I worked with, the patients who I treated and the ER provided a great learning environment, exposing me to so many things in such a short period of time. For me, my “why” was my family. With a five year old at home and thoughts of more children, my wife and I simply wanted a more predictable lifestyle that would allow me to be home at night and on the weekends. When changing jobs, everyone’s “why” is going to be different, however, it should be for reasons that are well thought-out and rooted in important individual and family values. So now that I knew why I was leaving, I had to decide where I was going.

In my decision making process, “where” was a logistical question. I was commuting an hour each way to work and when I decided why I was going to make a change, the “where” was easy. I wanted to be closer to home and work in the community that I had been a part of for so many years. When deciding to make a change, where you are going to go can be an important factor. As PAs we are able to work in all 50 states and in practically all specialty areas of medicine. You may have an interest in a certain region of the country or want to work at a teaching facility that offers research opportunities or a certain hospital that is participating in ground-breaking study or is the only facility offering a new treatment for a certain disease. Whatever that case may be, as PAs, we have the luxury of being able to live and work where we want.

Another essential question in the decision making process is “what” are you going to do? Again, PAs are able to work in every field of

Switching Specialties: A Recipe for Changeby: Matthew Keane, MPAS, PA-C, Director-At-Large, Student Affairs Committee Chair

medicine and the areas of specialty are constantly growing and evolving. When I decided I was going to leave the ER, I knew that the only other specialty that I would want to do was orthopedics. As a new graduate, you may have dreams of working in plastic surgery or general surgery or one of the many other specialties. However, as a new graduate you may not find that job right away or may not have enough experience needed for the position. Therefore, you may have to take a job that may not exactly be your “dream job.” This isn’t necessarily a bad thing. While I was working in the ER I was exposed to all kinds of medical conditions and interacted with doctors in a variety of specialties. As I saw and treated more patients, I found myself always being drawn to the orthopedic cases. I have always thought of myself as a hands-on type of person and orthopedics seemed to fit my personality. The ER, like primary care or the urgent care setting, exposes you to a wide variety of specialties and as a new graduate gives you an opportunity to get a feel for what each specialty does. This exposure gives you a chance to see whether or not a certain specialty creates enough interest that maybe one day, if or when the opportunity comes along, you would be ready and able to make that transition into the specialty of your choice. So now that you have decided why you’re going to change specialty, where you are going to go, and what you want to do it seems appropriate to ask yourself, “Who I am I going to work for?”

An extremely important factor when considering any job is your supervising physician. As part of a Physician/PA team your supervising physician is key to how you will function as a PA in that practice. The Physician/PA relationship can be extremely varied from practice to

NOVEMBER/DECEMBER 2010 13

practice. You may be in a primary care practice with only one doctor or a larger group practice with multiple doctors and multiple PAs. You may have a supervising physician who has multiple practices and isn’t in the same office every day. At the practice that I chose, I have two supervising physicians as well as two veteran PAs who have been in orthopedics for 16 years. Fortunately for me, both of the PAs I work with understand I am new to the field and they have been very willing to teach and answer questions making my transition much easier. Every situation will be different. The most important thing is that you are able to find a supervising physician and a practice that best suits you and will allow you to be as successful as possible.

Most people will change careers or jobs at some point or another and as PAs, our flexibility as practitioners allows us to do so with relative ease. We are very fortunate to work in an industry and at a time where our services are needed. Transition can be difficult. Leaving a practice where you are comfortable, where you know the front office and back office system and the paperwork, for a new and completely different work environment is not always easy. However, if you put some time and thought into the decision, the transition can be much less stressful and you may be able to adapt easier and faster. I am extremely grateful for the opportunity I had to work in emergency medicine right out of school for the time that I did. The people with whom I worked taught me a great deal about medicine and what is means to be a PA. Those are things that I will remember and carry with me as long as I am PA. To those of you thinking about or getting ready to change specialties, good luck!

Continued from page 3

Switching Specialties: A Recipe for Changeby: Matthew Keane, MPAS, PA-C, Director-At-Large, Student Affairs Committee Chair

CURES: Those Attending CAPA’s Controlled Substances Education Course Consistently Note CURES As The Number One Greatest Resource Provided

The state’s database known as the Controlled

Substance Utilization Review and Evaluation System, CURES,

contains over 100 million entries of controlled substance drugs that were dispensed in California. The online PDMP system makes it much easier for authorized prescribers and pharmacists to quickly review controlled substance information via the automated Patient Activity Report (PAR) in an effort to identify and deter drug abuse and diversion through accurate and rapid tracking of Schedule II through IV controlled substances. In order to obtain access to the PDMP system Prescribers

and Pharmacists must first register with CURES by submitting an application form electronically at https://pmp.doj.ca.gov/pmpreg/. In addition, your registration must be followed up with a signed copy of your application and notarized copies of your validating documentation which includes: Drug Enforcement Administration Registration, State Medical License or State Pharmacy License, and a government issued identification. You can mail your application and notarized documents to:

Bureau of Narcotic Enforcement (BNE) Attn: PDMP Registration P.O. Box 160447 Sacramento, CA 95816

New CME Requirements for California PAs

• There will be a check-off box to attest to your compliance on the license renewal application.

• The PAC may choose to audit a random sample to document CME compliance.

• Evidence of Certification or CME must be retained for a minimum of four years.

• Misrepresentation of compliance may “constitute unprofessional conduct” and can result in enforcement action and/or ineligibility for license renewal.

Further information can be found on the PAC website at www.pac.ca.gov.

Did You Know?

Congresswoman-Elect, Karen Bass served on CAPA’s Board of Directors in 1982.  She was the Student Representative.

CAPA FACT

14 CAPA NEWS

An article in the July/August

edition of CAPA News discussed the formation of an advisory committee to

the Medical Board of California to address “non-physicians” performing cosmetic enhancements. As more physician assistants venture into the rapidly expanding field of cosmetic services, it behooves us to recognize the dependent nature of the physician/physician assistant relationship and to understand how current Physician Assistant Regulations apply to physician assistants who perform cosmetic procedures, such as cosmetic injections, laser therapy, and subcutaneous injections, which may include replacement hormones. Physician assistants who fail to comply with current regulations, whether through ignorance or arrogance, run the risk of facing a regulatory agency and potentially put their license and career in jeopardy.

I have been a practicing physician assistant since 1977 and have had the unique opportunity to serve as an expert reviewer of over 300 cases for the Medical Board of California regarding the standard of care provided by physician assistants.

A physician assistant who elects to provide cosmetic services is still a dependent practitioner who must function under the aegis of a physician. As a dependent practitioner, the physician assistant is required to have in place a Delegation of Services Agreement and practice protocols governing the practice of the physician assistant, which are consistent with the supervising physician’s specialty. Any minor surgical procedure must additionally be listed as authorized by the supervising physician and consistent with his or her specialty. A practice-specific formulary is also required if medications are transmitted by the physician assistant.

A physician assistant who provides cosmetic services without a Delegation of Services

Cosmetic Services Performed Through Medical Spas by Vito Almaraz, PA-C , CAPA Member

Agreement and practice protocols in place would be considered to be functioning autonomously, which would represent an extreme departure from the standard of care. This could have serious repercussions in the event a dissatisfied patient were to lodge a complaint with the Medical Board regarding the cosmetic services rendered by the physician assistant, even if such care was ultimately determined to be within acceptable medical practices. For example, a patient undergoing laser hair removal treatment might complain about suffering second or third degree burns. The untoward effects the patient experienced could be an uncommon but expected side effect and would not necessarily represent a departure from the standard of care. However, the failure to have a Delegation of Services Agreement and practice protocols in place would be an extreme departure from the standard of practice and a serious violation of current regulations.

Additionally, failure to comply with regulatory requirements could leave the supervising physician vulnerable to legal actions or sanctions by the Medical Board of California if he or she is ignorant of current regulations regarding the supervision of physician assistants. Experience suggests that most cosmetic procedures are performed by dermatology and plastic surgery groups. Physician assistants contemplating venturing into this field should consider a relationship with a dermatology or plastic surgery group. Physician assistants may also wish to consult with the Physician Assistant Committee and/or CAPA regarding current regulations.

I f you haven’t received email from CAPA lately, we may have an incorrect email address or your computer may be blocking an unknown sender. Please add the following to your address book to keep from blocking our impor-

tant emails: capa_action_network@capanet.org and webmaster@capanet.org. Please keep the CAPA office informed of your current email address by log-ging onto the CAPA website and updating your member profile by clicking on “Your Profile” in the top right hand corner.

Set Your Computer/SPAM Filter So You Can Receive E-Mails from CAPA

NOVEMBER/DECEMBER 2010 15

What’s a PA…So you think you know your profession? Part 2by Greg Mennie, PA-C, MSed, Director-At-Large

A s I wrote in the last CAPA newsletter, I have new found interest/fascination with

discovering more about the PA Profession (my profession), and the myriad of organizations that are part of our profession.

I’ve gathered more information from multiple sources (PA Historical Society, AAPA, CAPA, Wikipedia, and Google) and put together a few short quizzes to share with you over the next few editions of the CAPA news. Enjoy and don’t forget to dazzle your friends and colleagues with the incredible knowledge of YOUR profession.

1. Funding for the first PA class came from a grant authored by:

a. Dr. Herbert Saltsmanb. Dr. Eugene Steadc. Dr. Michael Alostesd. Dr. Ruben Marcento

2. The actual funds for the above grant came from:

a. The National Institute of Healthb. The National Nursing and

Midwifery Associationc. The United States Food and

Drug Administrationd. The National Heart Institute

3. How many students were enrolled in the first PA class?

a. 3b. 4c. 6d. 8

4. The first PA class trained at:

a. The National Institutes of Healthb. Duke University Medical Center

in Durham, NCc. Bethesda Naval Hospitald. Veterans Administration in

Quantico, Virginia

5. This professional often considered by some to mirror PA’s was started in China in 1968.

a. Barefoot Doctorb. Barefoot Nursec. Medicnuad. Health Advocate

6. National PA Day is celebrated on October 6th because:

a. It’s the day the first PA class started training

b. It’s the date of the grant submission for funding for the first PA class.

c. Out of 10 candidates for the first PA class 6 were chosen

d. It’s Dr. Steads birthday.

See answers to quiz below. 1965 New York City – Photo property of www.pahx.org

Back row, left to right: Bondy, Hempelmann, Hickam, Myers, Dammin, Michael, WarrenSeated: Romano, Stead, Beeson, Jereway, Sheldon

Answers to Quiz

1. The answer is a Dr. Herbert Saltsman

2. The answer is d The National Heart InstituteAcademic Committee chaired by Dr. Andrew Wallace approves Dr. Stead’s proposed PA curriculum and the National Heart Institute funds Dr. Herbert Saltsman’s grant to train hyperbaric chamber operators and physician assistants.

3. The answer is b 4

After funding was secured for Dr. Saltsman’s grant, the way was cleared for the first four physician assistant (PA) students, all ex-Navy hospital corpsmen.

4. The answer is b Duke University Medical Center in Durham, NCDr. Stead began to formulate his two-year curriculum to expand the prior education and experience of these corpsmen to become competent physician assistants. With the support of the Duke faculty and administration, he launched the first formal educational program for physician assistants at Duke University in 1965. For the next seven years, Duke University and later the University of Washington (Dr. Richard Smith’s MEDEX program) became focal points for the development of the physician assistant profession.

5. The answer is a Barefoot DoctorBarefoot Doctors were introduced into China after the Cultural Revolution to provide basic medical services to rural populations. 

6. The answer is d It’s Dr. Steads birthdayAs founder of the Physician Assistant Profession, Dr. Stead is recognized as one of the top educational innovators of the twenty-first century. Although not planned, it is only appropriate that National PA Day (now week) is celebrated each year on his birthday - October 6th.

16 CAPA NEWS

A s the Nominating Committee Chair, it is my job to actively find CAPA members to join

the “CAPA family” of leaders. It takes a lot of individuals to make the California Academy of Physician Assistants such a successful state chapter of the American Academy of Physician Assistants. We couldn’t do it without all the hard work of members who make up our Committee Chairs and Board of Directors. We are always looking for new volunteers and potential leaders to join us and to help us make PA practice in California even better.

So what does it take to become involved with CAPA? Most importantly, our number one goal is to help fulfill the CAPA mission:

The Mission of the California Academy of Physician Assistants is to represent and serve PAs statewide. As an advocate of its members for quality healthcare and for their valued, unique alliance with supervising physicians, CAPA will enhance, educate and empower physician assistants for the ultimate benefit of their patients.

First of all, and it may seem obvious but not always, you must be a dues-paying member, but by reading this article you most likely already are a member. Secondly, it

takes a willingness to lend a hand where a hand is needed. There are many different tasks needed to be completed throughout the year. We all come to the table with different talents, interests and strengths. Lastly, it takes someone who wants to make a difference in our still young profession by joining our CAPA family. Notice that I never said that you have to have any special training to be a leader, just a willingness to help out.

Being part of the CAPA family is no different than being part of any other family. We all have to work well and get along with others. We have to be able to listen to one another and learn from one another. On our board we talk about “Board Culture.” One statement that we have on our Board is: Listen in order to understand, not just to debate. We have to be able to understand different individual’s thoughts and points of view so that we can come to a consensus and make good decisions for our profession and fellow PAs.

CAPA has been going strong ever since its inception over 30 years ago. It has seen hundreds of individuals help to make CAPA one of the strongest state chapters and make it one of the best states in which to practice our profession. We are working hard every day to make sure we protect what we have and to make it even better, but we need help.

Several different opportunities exist to get involved. One can serve on a Committee or be a Committee Chair. The following committees can always use help: Nominating, Government Affairs, Political Action, Public Relations, Continuing Medical Education, Diversity, PA Program Relations, Professional Practice and Student Affairs. Each

Committee has different duties and levels of involvement. You can look up the specifics on the CAPA website for details and descriptions. Committee appointments are a one-year term. The President appoints the Chairs and the Chairs appoint Committee members.

Another opportunity to get involved is by running for an elected position on the Board of Directors. Board positions include: Secretary, Treasurer, Vice President, President-Elect, Student Representative and Director-At-Large (three positions available). These are also one year terms except for President-Elect which is a three-year term. Declarations for these positions must be made to the CAPA office by February 20, 2010.

Lastly, one can serve as a Delegate on the AAPA House of Delegates at the Annual AAPA Conference. Generally, California is apportioned eight Delegates to the House and this again is a one-year term with the term starting July 15.

As you can see, there are many opportunities to get involved and lend a hand for our profession. As the saying goes, “Many hands make light work.” We are looking for new leaders in California and if you think you have what it takes and a desire to get involved, feel free to inquire at the CAPA office or email me with any questions at president_elect@capanet.org. Also, we have board meetings every few months and would love for you to observe a meeting if you have an interest in becoming involved at any level. Come and see for yourself what goes on at these meetings and how decisions are made. So, join us and help us make our profession even better than it is today.

2010-2011 CAPA Leaders

We Want You!!!!by Eric Glassman, PA-C, President

Deadline for CAPA office to receive Candidate Date Form for those who do not wish to go through the Nom Com: February 16, 2011

Deadline for CAPA office to receive Candidate Data Form for those who do wish to be reviewed/endorsed by the Nom Com: March 6, 2011

NOVEMBER/DECEMBER 2010 17

Do you have an interest in helping to develop the educational programs for

CAPA’s CME Conferences?

We are looking for CAPA members who would like to help us identify gaps in medical knowledge of PAs working in various practices/specialties. Once we identify the needs of our potential audience, we will come up with lecture topics. We will then need to find exceptional speakers to address those topics. We are very discerning in our speaker selection which makes for an excellent program and ensures a quality conference for those who attend. This is no easy task, but with a Committee of PAs who work in various specialties/settings, it is manageable and we make it fun as well!

Most, if not all, of the CME Program Development Committee meetings will be via conference call at a time determined to be convenient for the majority of the participants. Most of the communication will be done through email. Your time commitment should be no more than an hour or two each week for a period of about six months. The CME Committee’s term is November 1 through October 31 each year. The CME Program Development Committee is a sub-committee of the CME Committee.

If you have an interest in helping to develop the Conference program, helping to find excellent speakers and at the same time becoming more involved with CAPA, we want to hear from you. No previous experience is required. If you are particularly adept at writing learning objectives or have experience with doing needs assessment, you are at the top of our wish list and we hope you contact us

or mail it to: CME Program Development Committee, 3100 W. Warner Avenue, Suite 3, Santa Ana, CA 92704. The selection process will be complete by mid February. If you have questions, please contact CME Chair, Cyndy Flores, PA-C via email at cynpac@aol.com. Thank you.

soon.

To apply to be on the CME Program Development Committee, please send us an email or letter describing why you think you would be a good fit for the Committee, what your particular interests are (if any), and any experience you have that would aid you in your assignments and what kind of practice you are in. There are several positions open on this Committee.

The deadline to apply is January 31, 2011. You may email your information to capa@capanet.org using the following subject line: CME Program Development Committee

Special Call for: CME Program Development Committee Members

Evaluation

Raquel Caldera, PA-C

Martha Cody, PA-C

I. Jean Davis, PhD, DC, PA

Cyndy Flores, PA-C

Michael Flores, CHES

Eric Glassman, PA-C

Edwina Hardieway, PA

Donald Jones, PA-C

Amber Klispie, PA-C

Dana Landavazo, PA-C

Tam Le, PA-C

Tina Lewis, MMSc, PA-C

Daniel Lowery, PA-C

Tony Luza, PA-C

Margaret Mandry, PA-C

Miguel Medina, PA-C

Sheri Oswald, PA-C

Marsha Teague Grinstead, PA-C

Thank You To The 2010 CME Program Development Committee Members

18 CAPA NEWS

I enjoyed the beautiful drive to work this early-May morning. Snow occurred again last night, so

the trees are lightly frosted and the highway is a little bit slick. I take my time so as not to become an accident statistic on my way to the rural health clinic where I’m employed as a physician assistant. The beautiful scenery does not completely distract me. I’m usually occupied thinking about the patients, the clinic and the needs of the community on my drives to and from my workplace in this economically impoverished part of the state. I enjoy a close relationship with my physician assistant co-worker at the clinic. We are frequently in discussion about how to improve the health of the patients, decrease their risk of disease and improve their chances of productive longevity. Tobacco use is a frequent focus of our discussions. More accurately, he and I frequently discuss how to decrease and eliminate the use of tobacco among our patients. The continuing use of tobacco products presents the greatest aggregate threat to the health and welfare of the members of our community.

I arrive at the clinic a little more than an hour ahead of the first patient’s appointment. I notice that the schedule is almost full, and expect that it will become busier with walk-in urgently needed visits after we open the doors. I use the time to complete tasks remaining from yesterday, and to organize everything for smooth patient flow today. The collective problem list is typical. We are seeing patients for respiratory, cardiovascular, mental health and musculoskeletal complaints. Mingled in with that will be whatever acute problems develop during the course of the day. It is a busy clinic, and

degenerative disc disease affecting both the cervical and lumbar portions of his spine, hypertension and elevated cholesterol. He and his wife have been moderate to heavy smokers since their early 20s. She is worried about him today because she says last weekend he started “talking nonsense and gibberish.” She said the symptoms lasted about two hours and then he was very sleepy. She is worried that he might’ve had a stroke. He is speaking clearly today and says he does not remember the episode that his wife is describing to me. There is a very strong odor of tobacco around both of these patients today. The patient says that he is “pretty scared” because other members of his family have informed him in detail about his recent aberrant behavior. During my examination of this patient, I notice that he has mild right-sided weakness in his hand and arm, a mild but distinct balance disturbance and a visual deficit in the right upper quadrant of his visual field apparently affecting the right eye only. Because several days have passed since the symptoms occurred, it is too late for acute stroke damage prevention measures. Instead, I schedule a CT scan of the brain as quickly as an appointment time is available at the hospital which is located one mountain pass away from our clinic. The CT scan results confirm everyone’s suspicions, the patient has had a recent stroke and there is evidence of a previous stroke as well. We initiate changes to his medication to help prevent any reoccurrence and I ask him again to quit smoking cigarettes. I have asked him to do this with nearly every visit he has made to the clinic. I have talked to the patient’s wife about the importance

no one working here is idle. I finish my preparations and move into my first appointment of the day, a blood pressure follow up on a patient who has been off of cigarettes for about three months. Her blood pressure has steadily decreased since she quit, and today we are able to diminish the dosage of blood pressure medication she has been using. She is really proud of herself and says that she has been able to increase her walking distance without becoming short of breath. I praise her for her efforts and encourage her not to touch tobacco in any form in order to stay completely free of the addiction. I schedule a blood pressure recheck visit for her in three weeks and we have a discussion about diet and exercise in order to help her avoid gaining weight. She departs happy with her achievement and the morning flows on in a fairly orderly fashion.

Between appointments, I notice that an urgent visit has been scheduled for a patient I have gotten to know well over the last four years. He is a male in his late 50s with a history of cardiovascular disease, chronic obstructive pulmonary disease and

Patient Education and the Importance of Health Insurance Coverage for Smoking Cessation by Denis Hentrich, PA-C, Mount Shasta, CA

Continued on page 38

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20 CAPA NEWS

A s I sat down to write this article, I received that little pop up on my computer screen that shows

I have a new email. This email was from the CAPA office sending me the final numbers from our 2010

Conference – all I can say is: “WOW.” We exceeded every expectation CAPA could have ever imagined and I think we exceeded yours! Though I suppose we really can’t take credit for the 80 degree weather in Palm Springs that week!

This year’s conference

was different from day one. The entire agenda was created by the Conference Planning Committee and they obviously hit a home run. This year’s lecture topics were extremely varied and appealed to a wide range of PAs, no matter your practice specialty. Then the schedule was tweaked to better meet the needs of our attendees and once you arrived you were treated to the incredible

new Renaissance Hotel. But despite all these changes, there was still that same old “you are one of the family” feeling while you were there. The CAPA Board of Directors, CME Committee, staff and volunteers made everyone feel right at home.

The agenda this year featured some of your favorite speakers like Dr. O’Carroll, Dr. Mimi Lu, Dr. Yoshida, Shelby Edwards, PA-C, John Bielinski, PA-C and Greg Mennie, PA-C along with some new sensations like Dr. Thomas Adamson and James Mathey, PA-C. We will be sure to invite these folks back for next year. Lectures included the “meat and potatoes” of medicine but we also had some really interesting new topics like “Cochlear Implants, Bariatric Surgery Patient Follow Up, and “Medical Errors: Thinking That’s Stinking.”

Almost every workshop was sold out this year, so obviously we are giving you the hands-on experiences you want and need. Our workshop instructors and attendees all reported back that the workshops were very educational, had plenty of hands-on time and everyone had some good laughs. So don’t wait next year, sign up early!

The Exhibit Hall was full no matter when I walked through it. In this world of no more pharmaceutical give-a-ways, I love that our attendees go to the Exhibit Hall to talk to our pharmaceutical exhibitors and supporters. And, let me tell you, our pharmaceutical partners love it even more. If it wasn’t for the attention you give to our exhibitors, frankly we wouldn’t have any. So keep up the good work.

But as wonderful as our exhibitors were, the Sharing Our Selves Posters

CAPA’s 2010 Annual CME Conference Sharing Our Selvesby Cyndy Flores, PA-C, CME Committee Chair

stole the show! How could anyone possibly go to the Exhibit Hall and not be touched by the stories that were told to us through these posters. Over 100 of you told us about yourselves, you shared your stories and you evoked smiles, laughter and tears. I was personally overwhelmed as I walked the avenue of posters and read each and every one. I felt so humbled to be among so many incredibly wonderful people. It also made me realize that it was not just these people who did the posters, but the thousands of other California PAs who are doing really great things, providing extraordinary services and are spouses, aunts/uncles, sisters/brothers and so very much more. A personal thank you for Sharing Yourself with us.

The CAPA Conference is well known nationally for our organization, smooth running on-site, great lectures and of course – our FUN! We brought back the PArty of the Year to the Palm Springs Convention Center foyer. It was an amazing transformation of this beautiful space to become the spot to be at on Friday night. The dance floor was packed as usual and our new DJ had everyone moving with music for all tastes. This year’s American PA Idol had some stiff competition. As the counter of the ballots (a job I take very seriously), I can tell you all performers received votes and it was a close race. But in the end, the incredible voice and stage performance of Stephanie Rolfo, PA-S came out on top and she now reigns as the 2010 CAPA American PA Idol.

Our PA MarketPlace continues to grow every year, and this year we moved it closer for your shopping convenience. And, from all the people I saw doing some serious

“…the CAPA office sending me

the final numbers from our

2010 Conference – all I can say

is: “WOW.” We exceeded every

expectation CAPA could have

ever imagined and I think we

exceeded yours! ”

An absolutely beautiful day to enjoy the Student Medical Challenge Bowl

NOVEMBER/DECEMBER 2010 21

CAPA’s 2010 Annual CME Conference Sharing Our Selvesby Cyndy Flores, PA-C, CME Committee Chair

shopping, you liked it too. Did you know that either the cost of the space rental or 20% of the proceeds from the PA MarketPlace goes to CAPA’s Political Action Committee? So by shopping, you are really helping to support the CAPA PAC. So, shop on my friends!

And, speaking of the CAPA PAC, the Jungle Wheel and the Silent Auction were big hits this year. We are going to have to give our wheel a vacation from all the hard work it did this year. The Silent Auction boasted many items you thought were well worth the bidding. I was around for the close of some of the items and saw the bidding was hot and heavy. You are some serious bidders – so please keep doing so and support the CAPA PAC!

As you know, this conference doesn’t happen overnight nor does it happen with just a few people. I am so proud to say that this is not the typical case of the few same old people doing the work for many. So many of you are involved in making the conference the success it is. You refer speakers to us, you helped plan the agenda and schedule, you moderate, you volunteer on-site, you write evaluations that we use to plan the next great conference and the list goes on and on. So many people help and many do so behind the scenes. To each and every one of you, a big thank you from CAPA and very personal thank you from me.

And, while we have so many volunteers to help the conference, we clearly couldn’t do one-millionth of the work our incredible CAPA staff does for us. Not only do they have to continue with the day-to-day operations of running one of the largest state chapters in the U.S., they also have to produce

this extraordinary conference for you. Gaye Breyman, CAE, CAPA COO, holds her staff’s feet to the fire when it comes to providing the best customer service and takes the success of this conference and all CAPA does personally and I think you can see the result of her commitment and dedication. Everything you see and feel at the conference is truly due to her brilliance and creativity and all the personal touches come from Gaye. I can’t imagine how boring our conference would be without all the little things she does for us. Jennifer Deane and Scott Watkins are those friendly and helpful voices you hear when you call the CAPA office and it is so great to have them on-site so you can meet them in person. I am sure none of us can know the amount of work and detail the CAPA staff does for us. This year we were fortunate to have Denise Werner join us as the administrative support for the conference. Denise has been involved with CAPA and the conference for many years as our graphic designer, but this year she took on the demands of administrative support in addition to making Gaye’s visions for the conference come to life. Denise worked with all the speakers this year and made each and every person feel welcome to CAPA. She also handled the mounds of paperwork that must be in place for this conference, and worked on many of the particulars that make this conference happen.

For many of us, the post conference time is especially difficult. Why you ask? Because we arrive days before the conference begins to start setting up and meet with the hotel and convention center staff to make sure they know what our expectations are of them for you, our attendees. Then you all start arriving and the energy and fun start to get fired up and then

we are off and running. Then for 4 ½ days we are going full speed, it’s crazy, chaotic and so very much fun. Then comes the tear down and you all start packing up and heading home and suddenly the hotel is quiet and it’s just us. We all become very close during this time; it’s kind of hard to explain unless you’ve lived this experience. But I am particularly thankful for the opportunity to have had this kind of experience, I am a richer person for it and for that I am grateful.

And then…it’s time to start planning for 2011! Yep, that’s right, no rest for the weary, even as I am finishing this article the ideas are forming and excitement begins to build again. So we’ll see you next year in Palm Springs for CAPA’s 35th Annual CME Conference (and PArty!)

“I was personally

overwhelmed as I walked

the avenue of posters and

read each and every one.

I felt so humbled to be

among so many incredibly

wonderful people. ”

Cyndy Flores, PA-C admires an SOS Poster.

22 CAPA NEWS

This year at the CAPA Conference we gathered in the beautiful, new Renaissance lobby for a photo op

before we all walked downtown to the CAPA Booth at the VillageFest on Palm Canyon Drive.

At the CAPA Booth we had paper pink ribbons so all who visited the booth could write the name of someone who is a breast cancer survivor or someone who lost their battle with breast cancer. We posted the ribbons on a wall at the booth. Donations were requested for each of the pink ribbons and all proceeds went to the Suzanne Jackson Breast Cancer Fund of the Desert Cancer Foundation. The Cancer Fund provides free mammograms to residents of Coachella Valley who are uninsured, cannot afford testing and who meet income requirements.

People enjoyed the short walk to the VillageFest, a fun, open market place where you can eat, drink, shop and run into your PA colleagues; a Thursday evening tradition for CAPA Conference goers. The VillageFest is visited by thousands each Thursday and we had many visitors come by the booth, donate money, write the name of a loved one and ask about the PA profession as well.

Thank you to all who shared in that wonderful evening.

We Were Tickled Pink With the Turn Out!

Sharing Our Selves

...---...www.nbcam.org

Awareness, Education and Empowerment

Sharon R

Grace F.

LW

CAPA Honors Harvey Lesser, PA

On Friday, October 8, 2010 at lunch at the CAPA Conference, Harvey

Lesser was presented with a plaque honoring him for his many years of service on the CME Committee. Harvey did it all: checked badges at the doors, handed out packets at the registration desk, took on

any task, large or small while at the CAPA Conference.

CAPA Past President, Miguel Medina presented Harvey with the plaque. Upon receiving the plaque, Harvey gave a heartfelt acceptance speech telling the hundreds of PAs in attendance of his love for CAPA and the

leaders who he has worked with over the years, most specifically Cyndy Flores, PA-C, CME Chair and Gaye Breyman, CAE, CAPA COO.

Thank you, Harvey, for all you have done for the PA profession in California.

NOVEMBER/DECEMBER 2010 23

I hope everyone who attended this year’s Annual CAPA Conference in Palm Springs had a wonderful and

memorable experience. This year’s conference landed right on PA Week as well as PA Day which is such a great reminder of who we are as a profession and where we come from. It’s also a great time to realize we all need to do our part to help promote our profession in any way we can. If you were unable to attend this year, I hope that next year, on September 23-26, you will join us in Palm Springs to enjoy all the festivities as well as the well-planned CME lectures.

This year at the conference, I had a unique opportunity to share a little bit about the profession on live FM radio. KNEWS 94.3 FM had received our press release about our upcoming conference in Palm Springs and requested we come down to the studio for a live radio interview. Beth Grivett PA-C (Legislative Affairs Coordinator and Director-At-Large) and I were interviewed on live radio for about 15 minutes on Thursday afternoon of the conference at the studio in downtown Palm Springs.

Going into this interview we really had no idea what was in store for us or what type of questions we would be asked during this interview. All we knew is that we had given the radio station a short bio about each of us and that they had the press release which told them a bit about what was going on at our 34th Annual Conference. We arrive to the radio station and are quickly greeted by

Lee Rayburn, talk show host of the Lee Rayburn Show. He’s very nice and polite, and obviously very easy to talk to. It’s quite a relaxed vibe in this radio studio with private, soundproof rooms where they conduct their shows. When Lee was ready for us, we headed into the newsroom and both Beth and I put on the big headphones and sat in front of one of those huge soft microphones. We still have no idea what he will be asking

in terms of questions.

When we finally go live after a commercial break, Lee first starts with asking us the difference between us and a physician.

Both Beth and I handled this question with no problem as we have answered this plenty of times in clinical practice. Lee said he regularly sees a PA in his primary care physician’s office and actually thought we were physicians and he calls his PA “doctor”. We explained to him the difference in our training as well as how we practice. Lee also asked how I function in an orthopedic surgery practice and he actually wanted me to take a look at his shoulder which has been hurting him lately. The questions continued about the conference itself and the CME lectures we would be attending. He also wanted to know what we did for fun at the conference and I think next year he wants to make a guest appearance at our American PA Idol competition at our Friday night dance.All in all it was a fun and unique

Talking “Physician Assistants” on KNEWS FM 94.3by Eric Glassman, PA-C, President

experience. Not every PA gets the opportunity to share about the PA profession on live radio. It’s my hope though that each day we are sharing and taking the time to explain what we do, how we are trained, and how important PAs are to the health care industry. We all need to be spokespeople for our profession and get the word out to as many people as possible. I’m not saying to stand on a street corner with a bullhorn. But rather, I think it’s important that when given the opportunity and an interested audience, we need to take the time and share what we do as a PA and how wonderful our profession is.

“When we finally go live after

a commercial break, Lee first

starts with asking us the

difference between us and a

physician.”

CAPA FACTDid You Know?

We have not raised CAPA membership dues since 2006.

24 CAPA NEWS

Application has been made to the American Academy of Physician Assistants (AAPA) for 6 hours of Category I CME credit. Approval is pending.

Controlled Substances Courseon Sunday

Saturday, February 26, 20118:45 am - 5:00 pm

Register online at www.capanet.org

Sponsored by theCalifornia Academy of Physician Assistants

Name _______________________________________________________

PA-C PA PA-S NP MD/DO Other __________________

PA License # __________________________________________________

Address ___________________________City _______________________

State _______________________________ Zip Code_________________

Phone (____) __________________ Fax (____) ______________________

Work Address _________________________________________________

City ________________________________________________________

State _______________________________ Zip Code_________________

Phone (____) __________________ Fax (____) ______________________

CAPA Member - $100 Non-Member - $190 PA Student - $50 Late Registration Fee after February 1, 2011 - add $20 Bring a Guest to Lunch - $25 (must be over 18)

Name(s)_________________________________________________

Vegetarian Meal Required Total Amount $ _____________

Signature ________________________________ Exp. Date ___________

In accordance with the Americans with Disabilities Act, please check here if you have any special needs. You will be contacted by CAPA.

Mail Registration Form and make checks payable to:

CAPACalifornia Academy of Physician Assistants

3100 W. Warner Ave., Suite 3 • Santa Ana, CA 92704-5331Phone: (714) 427-0321 • Fax: (714) 427-0324 • Toll Free Fax: (800) 480-2272

or Register online at: http://www.capanet.org

Registration Form 8:00 a.m. – 8:45 a.m. Registration

8:00 a.m. – 8:45 a.m. Continental Breakfast and Exhibits

8:45 a.m. – 10:00 a.m. Strategies for Improving Adherence and Outcomes for Patients with Type 2 Diabetes

Susan Cornell, Pharm.D., CDE, FAPhA, FAADE

10:00 a.m. – 11:15 a.m. Spine Pathology: The Latest in Conservative and Surgical Management

Kevin Robertson, PA-C

11:15 a.m. – 12:00 p.m. Break and Exhibits

12:00 p.m. – 1:15 p.m. Cardiac Murmurs - Whispers of the Heart Jennifer Carlquist, PA-C

1:15 p.m. – 1:25 p.m. President’s Address Eric Glassman, PA-C; CAPA President

1:30 p.m. – 2:30 p.m. Lunch (Non-CME Program) Atrial Fibrillation – Focus on Guidelines for

Therapeutic Intervention Andrea L. Cooper, Pharm.D., MPH, BCPS

2:30 p.m. – 3:45 p.m. How Common Problems Present in Darker Skin

John V. Notabartolo, MPAS, PA-C

3:45 p.m. – 4:45 p.m. Mastering the Protocols for Optimization of Hormone Replacement Therapy

Neil Rouzier, MD

4:45 p.m. – 5:00 p.m. Prize Drawing and Closing

6 Hours Category ICME Credit Applied For

Application has been made to the American Academy of Physician Assistants (AAPA) for 6 hours of Category I CME credit. Approval is pending.

CAPA at NapaJoin us in Napa. We have developed an excellent educational program set in the beautiful, lush green Napa Valley and offer it to you at a very reasonable price. CAPA is coming to Napa and you won’t want to miss it!

One-Day Conferencein Napa at the Napa Valley

6 Hours of Cat. I CME

Program

NOVEMBER/DECEMBER 2010 25

Controlled Substances Education CourseA Course Which Upon Successful Completion Will Allow You To Write For

Controlled Substances Without Patient Specific Approval*

*California Code of Regulations Sections: 1399.541(h), 1399.610 and 1399.612. A PA may administer, provide, or issue a drug order for Schedule II through V controlled substances without patient specific approval if the PA completes specified educational requirements and if his/her Supervising Physician delegates the authority to them.

Sunday, February 27, 2011Napa Valley Marriott

3425 Solano AveNapa, CA 94558

Saturday, March 29, 2011Western University of Health Sciences

Lecture Hall 1309 E Second St

Pomona, CA 91766

Saturday, April 23, 2011Samuel Merritt University

Fontaine Auditorium, Health Education Center

450 30th StOakland, CA 94609

Comments From Previous Courses

Newport Beach—November 1, 2009“Both speakers were excellent. Mr. Adler especially was clear and concise and provided numerous practical tools and advice for handling complex situations involving patients that truly need opioids and tips for identifying diversion attempts.”

La Jolla—March 6, 2010“This course was very interesting and helpful. Well worth my time (aside from CME’s and the certificate). The slides printed in the handouts were a very useful reference.”

“Thank you, the course answered many questions for me today and reassured me about my approach to dispensing controlled substances. I can’t wait to sign up to use the CURES system, we will be on our way to hopefully identifying problem patients and getting them help.”

Sacramento—July 24, 2010“Sensational! PA/Physician driven education is paramount in the PA profession. Thank you!”

“I learned some new things and reviewed others. Great course! Thanks!”

Palm Springs—October 6, 2010“Enjoyable yet informative presentations from Dr. Lowe and Jeremy Adler, PA-C. Both instructors made the topics discussed interesting and applicable. Thank you!”

“Excellent course, I learned a lot. I will use this information next week when I return to work. Very helpful. Thank you.”

Los Angeles (USC)—January 16, 2010“Enjoyed both lectures; very good personal experiences injected into each lecture. Both lecturers complimented each other. Catering was a good choice.”

“Going home and back to work with some very helpful tools! Thank you both!”

“The course was informative and helpful. I learned new things I was not aware of in the use of prescribing controlled substances. Thank you!”

RegisterToday

6 Hours

Cat. ICME

Courses will be canceled if minimum number of registrants is not met.

26 CAPA NEWS

SOS Poster Project

Thank you to all who submitted a poster for the SOS Poster Project. Over the past several

years at the CAPA Conference we have presented you with several projects:

Where you submitted photos of your SP (team) and you

Where you wrote about a PA who impacted your life

Where you brought a poster about you – to share something about you

When we propose these projects, we feel like they are great ideas, of course. However, like every great idea, they remain just that until

the magic of action is added. You have proven, yet again, that when the hearts and minds of hundreds of California PAs are ignited, ideas turn into art, entertainment and inspiration! It is a huge part of what makes the CAPA Conference so special.

You make magic at the CAPA Conference. Each year, project or not, you bring something special and unique to the conference and it changes the dynamic, the look and feel of the Conference. Thank you!

This year’s project took a lot more of your time and meant creating a wonderful representation of something about you, your work, your passion, your hobbies, your family, your life! The posters were varied in the way they were produced; so creative and different. You did a great job and I loved hearing that even though it was work, it was a labor of love. The act of pulling everything together became a wonderful time of reflection for people. They got to look back and feel the pride associated with each piece of the poster. Families got involved and learned some things they hadn’t known before. Co-workers helped and in the process they learned more about their PA colleague as well. It was a shared project. And, it was a huge success.

Many people took their poster home at the end of the conference. They became treasured pieces full of memories and pride. Others left

theirs and we have them here at the CAPA office. We will be using the posters as seeds of inspiration for future articles about PAs. The SOS Poster Project itself is press worthy and we will be doing several press releases about it.

At the conference we had two SOS Ribbon Stations with tons of felt-tip markers, puffy paints and glitter pens. We provided blank badge ribbons along with stickers, glue, charms, etc. Again, you all took that idea and ran with it. Such fun at the tables watching people get to know each other and share stories of what their ribbon creation meant. It turned out to be quite a good networking tool throughout the conference and we have decided to bring the Ribbon Stations back next year.

All of the posters that were directly related to a 503 (c) 3 charitable organization were entered into a drawing for a $500 contribution in their name. We are pleased to announce that Thanksgiving Studios will soon be receiving that $500 donation in Tung Cheung, PA-C’s name.

What Makes The CAPA Conference So Special?

by Gaye Breyman, CAE, Chief Operating Officer

Good ideas are common - what’s uncommon are people who’ll work hard enough to bring them about.

Ashleigh Ellwood Brilliant

Teaming With Pride

YOU Do!!

Sharing Our Selves

S S...---...

NOVEMBER/DECEMBER 2010 27

SOS Poster Project

Cyndy Flores, PA-C

Submitted by: Cyndy Flores, PA-C Director of PA/NP Operations, Chair CAPA CME CommitteePictured: Elaine Nelson, MD “Best Supervising Physician!”

What We Do In Life Echoes in Eternity

Submitted by: Bob Bessler, PACwww.em-pac.com (Emergency Medicine PAs of California)

USC PAs Volunteer

Submitted by: USC PA Students

CAPA’s 2010 SOS Poster Project

When the hearts and minds of hundreds of California PAs are ignited, ideas turn into art, entertainment and inspiration!

28 CAPA NEWS

SOS Poster Project

Peaceworks Medical – Cambodia

Submitted by: J. Deasey, PA-C, MPH, L. Geisler, PA-C, F. Segal-Gidan, PA-C, PhDPictured: Pam Burwell, PA-C Founder & Director, Peacework Medical ProjectJan/Feb 2009 & 2010www.peaceworkmedical.com

“The Painted Turtle” - My 29th Year at Hemophilia Camp

Submitted by: Bob Miller, PA-C Past President, Treasurer, Professional Practice Committee Chair – CAPAChildren’s Hospital L.A.www.thepaintedturtle.org/

Service Learning in Central America

Submitted by: Stephen J. Neal, Physician Assistant Student, USC

The Sonoma Jr. Dragons Youth Jr. Midget Cheer Squad

Submitted by: Kimberlee Walsh, PA-C Sonoma, CAPictured: Clinton Lane, MD

Loma Linda University PA Missions

Submitted by: Loma Linda University PAs

USC PA-S Honduras

Submitted by: USC Global Brigadors – Claudia Solis, Janice Matias, Julie Vuong, Ernesto Ortiz Jr., Carrie Kowalskihttp://globalbrigades.org/

NOVEMBER/DECEMBER 2010 29

SOS Poster Project

Sharing Our Selves at CAPA 2010

Submitted by: Sun Safety and Literacy UC Davis FNP –PA Program, Sacramento, Class of 2010 & 2011 and UC Davis FNP/PA Program, UC Davis School of MedicinePictured: Graduating class of 2010, Suzie Choi PA-S, Maniev Thip MSN-S

Hunro Public Library & Learning Center

Phaao Village, Kampong Cham Province, CambodiaSubmitted by: Sokan L. Hunro, PA-C, MPH

Lestonnac Free Clinic

Submitted by: Joan Stoykovich, PA-C, FNP and Tommy Salazar, PA-Cwww.lestonnacfreeclinic.org

Kaiser Permanente – Helping Others

Submitted by: Stephanie Ngo

Student-Run Health Clinic

Submitted by: Touro University, California

A Season of Change – LEAVES Infinite Possibilities….

Golden Valley Health CentersSubmitted by: Jay Williamson, PA-C – Ripon, CA

30 CAPA NEWS

SOS Poster Project

PAs Volunteering in the Medical Aid Stations for Marathons & Triathlons

Submitted by: Cherri Penne-Myers, PA-CPictured: Dr. Skain, Cherrie Penne-Myers, PA-C, Maria Caserio, PA-C, Sally Tilsen, PA-C, John Western, PA-C

When Alone…Get Involved

Submitted by: Bernadine Sonnier – Society of Physician Assistants in Otorhinolaryngology – Head and Neck Surgery – www.entpa.org Pictured: Marcie Mofid, Jose C. Mercado SPAO President, Marie T. Gilbert, SPAO Director at Large

Breast Reduction Class

Submitted by: Cynthia L. Carson, PA-C, Plastic and Reconstructive Surgery, Kaiser Permanente, San Diego

Male Breast Cancer on the Rise

Submitted by: John W. Nick Foundation, Inc.www.Malebreastcancer.org

Sharing Our Selves

Submitted by: Eric V. Glassman, PA-C

Sharing CA ENT PAs

Submitted by: Bernadine Sonnier, PA-C, LAC + USC Healthcare Network, Los Angeles

NOVEMBER/DECEMBER 2010 31

SOS Poster Project

Sharing Our Selves

Submitted by: Western University Department of Physician Assistant

Thanksgiving Studio, Children of China Medical Mission 2008

Submitted by: Tung Ping Cheung, PA-C and Larry Rosen, PA-C

US Army – Prior Medical Experience

Submitted by: Antonia Luza, PA-C, 91-C Clinical Specialist, Combat Medic 1/27th Infantry “Wolfhounds”, 25th DivisionPictured: Specialist Five Antonio Luza, Private First Class Daniel Reed and Private First Class Donald L. O’Quinn.

Homeboy Industries

Submitted by: Greg Mennie, PA-C, MSedwww.homeboy-industries.org

Vietnam to Physician Assistant Pioneer

Submitted by: Joseph Tate, PA-C

Physician Assistant Certified

Submitted by: Krista Budreau, PA-C, San Jose

32 CAPA NEWS

SOS Poster Project

SOS

Submitted by: unknown

Newport Dermatology & Laser Association

Submitted by: Melissa M. Gilbert, MSPAS, PA-CPictured: Dr. Aszterbaumwww.drdoregilbert.com

A PA in the UK

Submitted by: Sharon Girard, PA-C

Tegucigalpa, Honduras Medical Brigade

Submitted by: Cherri Penne-Myers, PA-C

PA - SOS, Palm Springs

Submitted by: Chris Clark, PA-C

Medicine In Africa

Submitted by: Greg Mennie, PA-C, MSed

NOVEMBER/DECEMBER 2010 33

SOS Poster Project

Siloé Community Clinic

Submitted by: Sarah Mayer, MPA, PA-Cwww.siloeclinic.org

Students International Medical Mission - Shiroles, Costa Rica

Submitted by: Adan Marks, MPA, PA-C

CAPA PRESIDENT – 1988

Submitted by: Robert E. Sachs, PA-C, Chairman Physician Assistant Committee, State of California

The Sonoma Jr. Dragons Youth Jr. Midget Cheer Squad

Submitted by: Kimberlee Walsh, PA-C Sonoma, CA Pictured: Clinton Lane, MD,

Sharing Our Selves

Submitted by: Steve Klompus, PA

Sharing Our Selves with Reading for the Blind and Dyslexic

Submitted by: Tim Wood, Paige McNamara, Nancy Nielsen-Brown, Monica Adams, Greta Vines-Douglas, Tina Boykin-Mowry of Western University of Health Sciences.

SOS Poster Project

34 CAPA NEWS

SOS Poster Project

SOS Cal. State Fullerton

Submitted by: unknown

Hobbies and Interests

Submitted by: Beth Bratt, PA-CRegional Medical Center of San Jose

PA-C 28 Years

Submitted by: Nancy Kluth-Safinick, PA Pepperdine University

Advanced Surgical Associates

Submitted by: Rick O’Bringer, PA-C

Jenn Baltazar, PA-S CAPA Student Representative 2010-2011

Submitted by: Jenn B., Western University of Health Sciences PA-S 2011

So You Want To Be A Physician Assistant, Your Guide to a New Career

Submitted by: Beth Grivett, PA-Cwww.physician assistantbooks.com

NOVEMBER/DECEMBER 2010 35

SOS Poster ProjectSOS Poster Project

Touro University, California

Submitted by: Class of 2012

Balance of Life

Submitted by: Richard Onysko, PA-C, USC Class of 1984Pictured: K.H. Vogelbach, MD

Kanti Children’s Hospital

Submitted by: Julie Jung, PA-C, San Jose

I Like All Things Silly

Submitted by: Trang Luong, PA-C

DB – Debbie Brown

Submitted by: Debbie Brown, PA-C, FNP

PAs Sharing Our Selves

Submitted by: Tiffany Purvis, PA-CPictured: Wilson Lem, MD, Mark Notash, MD

36 CAPA NEWS

SOS Poster Project

Physician Assistant & My Everyday Roles

Submitted by: Sonia Nodal, PA-C

I Need A Job!

Submitted by: Mary Johnson, PA-C

I My Family

Submitted by: Ryan Keefe, PA-C

El Camino Hospital and Tri-Valley Animal Rescue

Submitted by: Michael Park, PA-C, Lead Physician Assistant, California Emergency Physicians

Global Brigades, Samuel Merritt University

Submitted by: Michael De Rosa, MPH, PhD, PA-C

SOS

Submitted by: unknown

NOVEMBER/DECEMBER 2010 37

SOS Poster Project

Pump It Up – Team Cynthia

Submitted by: Beth Grivett, PA-C, Greater Newport Physicians and JDRF Juvenile Diabetes Research Foundation

Dynamite Job!

Submitted by: Rosie Holiwell, PA-C 2000 Western University

Alternative Pathways – The Transition From Medical Practice to Industry

Submitted by: Michelle Lim Serrao, PA-C, DEXA Tech, MERCK

Gold Country – Medical History Museum

Submitted by: Rod Moser, PA, Ph.D.www.goldcountrymedicalmuseum.com

Healing Art of Medicine

Submitted by: Diane Botticelli, MA, PA, Conscious Health Consultants

Faces of University Access Healthcare

Submitted by: Jane Shiota, PA and Thomas Colivas, PA

38 CAPA NEWS

Patient Education and the Importance of Health Insurance Coverage for Smoking Cessation

Continued from page 18

of joining in this quit smoking effort, in order to preserve and improve the health picture for both she and her husband. They have always said that they are trying to cut down. I explained that cutting down rarely works. I tell them my own story of the difficulties of tobacco cessation from when I ultimately was able to quit 19 years ago. They have asked me at various times to prescribe smoking cessation medications such as chewing gum, patches, or pharmaceutical medications designed to reduce the craving for tobacco. In each case, coverage was not available, or the quantities of the medication were so limited that the efforts were ineffective. I explained to the patient about the role of cigarettes in creating the circumstances that permit strokes to take place. I tell him again today about the absolute importance of quitting smoking now. He says again that he will try, and I write a prescription for nicotine patches to help him withdraw from the habit. He says he isn’t sure he can get the money for the patches, though I do point out that he is finding money for the cigarettes. He explains that having the money all one time to buy the quantity of patches required to successfully withdraw is a distinct challenge with his family’s current economic state.

I will do all that I can to assist his efforts. I know firsthand the incredible hold that tobacco use can have on a person. I made at least a dozen efforts to try to quit smoking, some of these lasted as few as two days, and others lasted two to three months. Ultimately, I was able to give it up completely. I am fully sympathetic to the efforts of anyone who is trying to discontinue an association with this dangerous drug. Please allow me to use the example of our stroke victim patient to illustrate the pervasive and deadly nature of tobacco addiction, and to underscore why it is vitally important to good medical economics to make tobacco cessation materials available to every patient who wants to try to quit using tobacco.

Continued on page 46

Vickie Cranford-Lonquich Then and Now

Submitted by: Vickie Cranford-Lonquich, PA-C

Sharing of Yourself

Submitted by: Jennifer Carlquist, PA-C American Heart Association, ACLS Instructor

San Joaquin Valley College

Submitted by: SJVC Students

SOS Poster Project

NOVEMBER/DECEMBER 2010 39

OK. An odd article title from the

Past President of CAPA, right? Let me explain…

On Friday, October 8, 2010, a team of CAPA representatives visited Vista Del Monte Elementary School in Palm Springs during the 34th Annual

CAPA Conference. This is the 4th year CAPA has sponsored a Health Literacy Program. The program is designed to stimulate elementary school children to read and ask questions about health related topics. The CAPA team was led by Past President, Tom Gaughan, PA-C and included Steve Klompus, PA, Chair of the Physician Assistant Committee, Joy Dugan, PA-S, Student Ambassador and member of the 2012 Touro University PA Program and me, the official photographer.

“Grossology” (2002)Written by: Sylvia BranzeiIllustrated by: Jack Keely

“Who Wants To Read About Snot?” by Joy Dugan, PA-S, Touro University, 2010 Annual Conference Student Ambassador

E ach year during the an-nual CAPA Palm Springs Conference, PAs visit Vista

Del Monte Elementary School in Palm Springs, in an effort to promote health literacy and the PA profession. While serving as a Student Ambassador, I had the opportunity to read to 3rd, 4th and 5th graders about snot, flatulence, diarrhea and other bodily functions from “Grossol-ogy” by Sylvia Branzei. When I asked, “Who wants to read about snot?” You can imagine, I instantly had the attention of the entire class. Alongside PAs Tom Gaughan, Steve Klompus, and Migel Medina, we created a safe environment for children to ask questions about the human body ranging from how the heart works to disease prevention. We also covered timely topics like the importance of hand-washing during the flu season. In an effort to increase health literacy, every student received a book donated by CAPA regarding the human body. I enjoyed this read-ing program and look forward to participating in it again next year when I attend the CAPA Palm Springs Conference.

Farts and Diarrheaby Miguel Medina, PA-C, Committee on Diversity Chair

We arrived at the school at 9 a.m. and visited 3rd, 4th and 5th grade classes. We spent 30 minutes with each class. We distributed books and asked for volunteers to read out loud. The students were very excited and were very attentive. The subjects read varied from the circulation system, the skin, the heart and the intestines. Our discussion also included topics on disease prevention and good hygiene.

We brought along our stethoscopes and showed the children how to check their pulses and listen to their hearts. One of the highlights of our visit was to see the excitement and smiles that appeared on their faces when they were able feel their pulse and hear their heart.

We also took the opportunity to read to them and we ask what subject they were interested in learning about. Farts and diarrhea were the subjects that got their attention. Joy Dugan, PA-S read from a book titled Grossology and proceeded to describe in great detail how we produce farts and what causes diarrhea. Some of the students volunteered to make fart noises and when Joy asked what food produces farts the unanimous answer was beans.

This is the second time I had the opportunity to participate in this program and I thoroughly enjoyed the experience. I hope the pictures can do justice to the experience we all had. It was a blast (no pun intended.)

CAPA Health Literacy Campaign during the annual conference in Palm Springs

40 CAPA NEWS

PAC is Backby Cherri Penne-Myers, PA-C, MSCS, Political Action Committee Chair and Secretary

I Want PAs to Be Heard – To Create A Roar Heard Throughout the Jungle (Please photocopy this form and mail with donation.)

Name ___________________________________________________________________________________________

Address: _______________________________City __________________________State______ Zip ______________

Phone _______________________________ Email ______________________________________________________

Amount of cash/check/credit card donation: $ ______________

If donation is $100 or more please list employer _________________________________________________________________________________________

Please make checks payable to CAPA PAC. You may also pay by credit card. All contributions are voluntary. PAC ID # 981553

Exp. Date _____________________

Signature ______________________________________________________________________________________________________________________

Cheetah Up to $50 Leopard $51 to $99 Jaguar $100 to $149 Bengal Tiger $150 to $199 King/Queen

of the Jungle $200 or more

W e are all now back and settled into our normal routine after attending the Annual

CAPA Conference. I certainly hope that everyone had a wonderful time meeting new colleagues, getting re-acquainted with old colleagues, hopefully meeting numerous new PA students and giving them helpful advice, or you may have been greeted by the many Student Ambassadors.

This year I was not able to attend the Annual Conference, but I had awesome assistants that kept everyone well informed about the PAC. Plus, you may have spun the wheel, purchased a fan, met Bryce Docherty at the PAC table or won an item from the Silent Auction.

My thanks to all of you who donated to the PAC this year at the conference. We certainly appreciate your support and any contribution you may have given.

I would like to extend a huge thank you to Vickie Cranford-Lonquich, PA-C who stepped in to oversee all the duties of the PAC at conference this year. WOW, what a fabulous job, Vickie!! She also had an assistant this year, Paige Fitzgerald-Smith, who was a tremendous helper. Thank you to all the Student Ambassadors who sat at the PAC table or assisted with the PAC booth in the Exhibit Hall. I can’t forget my wonderful CAPA Board colleagues who took time out of their hectic schedule to volunteer some time with PAC at the conference. Thank you Bob Miller, Beth Grivett, Miguel Medina, Greg Mennie and Matt Keane!! And a special thank you to Bryce Docherty for also spending time at the PAC table.

There were also many donors who gave to our Silent Auction. Thank you’s to: John Western, PA-C, Linden Soukesian of Covidien Pharmaceuticals, Dr. Daniel Amen, Lorraine Halverson, Miguel Medina, PA-C and Nancy Nielsen-Brown, PA-C who are

repeat donors for several years. Your continued support to the PAC is very much appreciated.

I would also like to extend thank you’s to: Le Derma Dermatology, California Dermatology, Dr. Calvert and Jennifer Baltazar, PA-S and Eric Glassman, PA-C for their donations to the silent auction.

I hope that many of you took the time and stopped by the many booths at the PA MarketPlace. Each of the MarketPlace participants have given a donation to the PAC also. Thank you to A Pair of Genes, LLC, Moonrise Jewelry, Art by Oahn, Cookie Lee Jewelry, EMMI, Isagenix, Just For You Purses, Live Smart 360, Photography by George Wright, PA-C, Scentsy and Touch of Elegance. We hope to see you again next year!

And thanks to Jennifer Deane at the CAPA office who is totally AWESOME with support not only for me, but all of CAPA Board members. Finally, last but not least, Gaye Breyman who is this amazing, talented and creative woman. As you know we gave her a special tribute during the conference this year. We love you, Gaye!!

Next stop for the CAPA PAC will be in February at CAPA at NAPA.

Vickie Cranford Lonquich, PA-C (in the middle) with PAC Booth volunteers.

NOVEMBER/DECEMBER 2010 41

Thank You to Our 2010 CAPA Conference PA MarketPlace Vendors

Kyla Hendricks, PA-CCookie Lee Jewelrykhendrickspa@hotmail.com

Oanh and Alex Heckman, PA-CArtotmooi@gmail.com

Tina Lewis, PAA Pair of Genes, LLCinfo@apairofgenes.com

Mimi Hughes, PAIsagenixMimi.m.hughes@gmail.com

George Wright, PA-CPhotographyGhwright2000@yahoo.com

Alma MaciasTouch of Elegance Jewelry(760) 412-9385

Kathy EarleJust For You PursesJustforyou.kathy@hotmail.com

Monica Regina Guillemin, PA-CLive Smart 360monica@my360life.org

Maria Maldonado, PA-C and Esmeralda EndejeEMMImexxichina@yahoo.com

Suzanne Rohde-MoeMoonrise JewelryOne.particular_harbor@yahoo.com

Jandie WeberScentsyYankeebabie224@yahoo.com

PAM A R K E T P L A C E

Congratulations to CAPA’s 2010 American PA Idol, Stephanie Rolfo, PA-S. The audience cheered as she belted out: Natural Woman. Stephanie’s classmates from SJVC joined her on stage as she receives the PA Idol plaque.

2010 American PA Idol

Steph on CAPA You Tube CAPA Connection – CAPA’s New Channel

http://www.youtube.com/user/CAPACON2010?feature=mhum

Videos from the 2010 CAPA Conference in Palm Springs

Be sure to SUBSCRIBE so you will be notified of new videos when they are posted

JustAdded

Scan QR Code Link above for CAPA You Tube Site

Phone App Required

Students Students Students Students Students Students

42 CAPA NEWS

The Advanced Practice Council at Santa Clara Valley Medical Center in San Jose, California (which includes

physician assistants, nurse practitioners, certified registered nurse anesthetists, and clinical nurse specialists), has recently organized monthly “Nursing Grand Rounds.” Robert Chapra, PA-C, spoke at this month’s meeting about his career as a physician assistant at Santa Clara Valley Medical Center and the preparation

and education required to pursue a career as a PA.  There were PAs, RNs, LVNs, physicians, and administration representatives in the audience.  In addition, during National PA Week, patients and staff in the hospital and Out-Patient Clinics were greeted by these great posters which highlighted the contributions we make as physician assistants in the medical community.

The RCRMC/RCC PA Program is now offering a 6-month fellowship

program for graduate physician assistants who have an interest in working in mental health. The program is being sponsored in partnership with the Riverside County Department of Mental Health and is designed to address the critical shortage of mental health care providers in California. The project is funded by the State of California Department of Mental Health. The fellowship will provide advanced training and experience in mental health to include training and experience in crisis/emergency, inpatient, outpatient and consultation services. The curriculum emphasizes the diagnosis of mental health conditions of pediatric, adult and elderly patients with a focus on the principles of the Mental Health Service Act. Participants will be assigned to work at the Department of Mental Health

facilities throughout Riverside County and will serve as a member of the treatment team along with psychiatrists, family medicine residents, peer support specialist, parent partners and other behavioral professionals. At the completion of the program, the graduate will be qualified and competent to work in an array of mental health settings. The program will pay each participant $3500 a month while training. 

Requirements for the program are as follows:

PA Week at Santa Clara Valley Medical Centerby Linda O’Keefe, PA-C, CAPA Member

Robert Chapra, PA-C

New Post Graduate Program

• Graduate from an accredited physician assistant program

• Must have license to practice as a physician assistant in the State of California

• Complete the required application packet

This is a wonderful opportunity for PAs in California to move into a specialty area that is opening up to PAs. Any one interested in this fellowship program should e-mail me at delores.middleton@rcc.edu and I will forward you the application packet.

Congratulations!

CAPA Congratulates the following California programs who won HRSA grants under the Expansion of Physician Assistant Training program. These grants will provide

scholarship support to increase class size for students interested in primary care in underserved areas. Congratulations!

Riverside Community College University of Southern California

Leland Stanford University Samuel Merritt University

Students Students Students Students Students Students

NOVEMBER/DECEMBER 2010 43

Thank You Student Ambassadors

Jessica Adamich .................TouroJennifer Baltazar ................WesternEric Chow ..........................Samuel Merritt Casey Crocker ....................Western Joy Dugan .........................TouroAnanda Fidani ....................USCStacy Frazer ......................UC DavisPasha Fruman ....................RCCMaria Fuchs .......................TouroDalan Garcia ......................WesternChris Garibay .....................RCCDaniel Hicks .......................RCCJennifer Ngo ......................WesternBeverly Redsar ..................WesternSarah Sharp .......................Samuel MerrittKimberly Warburton ...........Touro

The Ruth Webb Minority Scholarshipby Miguel Medina, PA-C, Committee on Diversity Chair

• The Ray Dale Memorial Scholarship $1000 Scholarship Ray Dale served as Executive Officer of the Physician Assistant Committee from 1980-2000, and was instrumental in the development and growth of CAPA as an organization representing our profession. Working with the Department of Consumer Affairs, he would give CAPA good counsel and support regarding legislative issues, and would help by acting as our “lobbyist” and “attorney” when CAPA could not afford one. He contributed his time and his efforts to the growth of the PA profession and protection of its consumers.

• The Community Outreach Scholarship$1000 Scholarship This scholarship will be awarded to a student who is currently in good academic standing and has demonstrated community outreach and other philanthropic activities as a student.

Student Members of CAPA currently enrolled in primary care PA Programs located in the state of California are eligible to apply for CAPA scholarships.

The deadline to apply for the three $1,000 CAPA Scholarships is December 31, 2010. Please visit the CAPA website for an application and for eligibility requirements.

I want to remind students of the Ruth Web Scholarship that is available through CAPA.

Ruth Webb served as program director for the Charles R. Drew University PA Program for several years, and was actively involved with numerous local, state, and national professional organizations. She was not one to sit back and let others do the work. She took a very active role doing committee work. She served as Vice Chair of the Board on Medical Quality Assurance, member of the Physician Assistant Examining Committee, member of the California Council of PA and NP programs, and founding member of the LA County Joint Practice Advisory Council on NPs and PAs. Known for “keeping it real,” she would do whatever it took to help students achieve the goal of becoming a PA-C.

Attention: PA Program Directors, Class Presidents, Student Society Leaders, Faculty and Students

L et CAPA know what you are doing by submitting an article and include a photo if possible.

Or, you may simply send a photo with a descriptive caption. We want to let our readers know the wonderful things that are happening at our PA programs. We will print submissions on a space available basis. Send your article/photos, etc. to capa@capanet.org. Thank you!!

Students Students Students Students Students Students

44 CAPA NEWS

M y name is Jenn Baltazar, your CAPA Student Representative for the

2010-2011 term and a 2nd year PA-S at Western University of Health Sciences in Pomona, CA.

The inspiration for my article this month is to share reflections into the lives of a new, 1st year PA student and 2nd year student. So whether you are a PA student, a hopeful PA student, or a practicing PA, I hope these words strike a chord with you because as everyone knows…PA school is an all-consuming endeavor. This profession changes you in so many ways. There are not many other career paths which challenge a person in ways they never thought possible. Below are journal entries from August-September from a 1st year PA student named Raelyn and from me as we discovered the anticipation, changes, balancing act, and art of medicine that come with the territory of being a PA-S.

AnticipationRaelyn, 1st Year PA-S: It’s Sunday, I’ve been in PA school for 2 weeks. This is the first I’ve been able to find the time to see my boyfriend and family even though they only live 45 minutes away.

Tuesday we have our first Adult Med Exam (one of 10 classes we are juggling). It is said to be a heavy hitter and does not go so well for most. Thursday we have our second pharmacology quiz, and Friday a quiz in pediatrics. Even though my stress level is okay now, my nervousness has started to increase for the coming weeks ahead.

Jenn, 2nd Year PA-S: It’s the last day of August and my goal to get organized, and review my notes in the last month of break didn’t happen. I did however get very good at keeping the stress of starting rotations out of my head until now. I woke up today and it hit me. No more multiple choice test “case patients,” sitting in class next to familiar faces, and goodbye to teacher’s office hours. Hello real patients, with real medical problems, SOAP noting till my

hand cramps up, and unknown work schedule every 30 days with a new preceptor.

It’s hard to imagine that I actually know enough about medicine to do anything right. I remember feeling this helpless before PA school started last year. Both then and now I have channeled all that worry into cleaning my house like the Tasmanian devil, stocking the fridge with perfect, good healthy snacks, and sleeping away each night like it’s my job. None of which will help me build a differential diagnosis for a patient’s chief complaint. Here goes nothing.

Change: We’re not in Kansas anymoreRaelyn ,1st Year PA-S: This week was challenging and the long weekend will be great to catch up! We had a week of tests and quizzes, got our first Adult Medicine test back, and were told by our Professor that it was our easiest test all year. Wow. Most of us put so much time into studying for it and still didn’t score that great. Oh well, on to a weekend’s to-do list with 4 class assignments, CPR certification, and prep, 2 weeks filled with 7 tests and 2 quizzes.

Jenn, 2nd Year PA-S: Day one of rotations proved to be much less intimidating than I thought! I shadowed my precepting doctor, performed a few histories and physicals solo, used electronic medical recording, and molded a wrist cast for a 100 y/o female. All and all, I couldn’t have asked for a better first day. Here’s what some of

Days of Our Livesby Jenn Baltazar, PA-S, Student Representative

Jenn Baltazar 2nd Year PA student ACLS training

Raelyn Ritchie, White Coat Ceremony

Students Students Students Students Students Students

NOVEMBER/DECEMBER 2010 45

my fellow WesternU students had to say on Facebook about day one:

• Got lost, almost lost my rotation, got told who’s boss, almost cried, saw patients by myself, almost fainted...low and behold I SURVIVED

• I assisted with the removal of a gallbladder today

• I didn’t faint in surgery AND my patients didn’t die!

• Got to cardiovert a patient and almost pressed the wrong button.

• I thought dermatology would be easy, boy was I wrong

Balancing ActRaelyn 1st Year PA-S: Things have been going okay so far. I do nothing but study and on the weekends see family and friends for a few hours. Their support has been great and I couldn’t do it without them. Besides that, I sit at my computer keeping up with the ever-changing calendar and course load. I’ve found that preparing for the next day, printing out, organizing etc., can take a lot of time. Jenn 2nd Year PA-S: I am officially done with my first full 7 days of rotations and am wondering how on earth students keep the balance with rotations and school. Writing a master’s thesis, studying for 2 exams, reviewing for clinical gaps in knowledge, and oh yeah, family and friends! Don’t get me wrong, rotations are great. I find myself smiling at the most peculiar things, like seeing erythema and exudates instead of just reading about

them. Listening to a pneumonia patient’s lungs to hearing wheezing and crackles or performing a positive Rovsing and rebound sign excites me. I doubt that the staff I work with actually get excited by moments like these. But as a PA student, it is exactly these moments that prove all your hard work and studying has actually manifested itself into applicable knowledge.

Art of MedicineRaelyn, 1st Year PA-S: The true “Art of Medicine” is being able to apply what you have learned in the classroom and on rotations in order to earn your patients’ trust and make them comfortable. We are practicing this in the classroom, but no one can prepare you for the stories your patient will tell you and the shocking things you’ll see. That only comes with experience.

Right now we are performing proctored physical examinations on fellow classmates. Even this is nerve racking. We are also practicing procedures in clinical skills. Last week each student gave their partner three different injections. That was it! We’re now supposed to know how to give injections? Well, yes! I volunteered at a Flu Vaccine Clinic last week and guess what? I was fine!

I look forward to rotations next year and seeing what is out there. I do fear not knowing the differential diagnosis, or knowing how to do a procedure, but I also know that I’m being taught by the best and that I need to have confidence in myself. To me the “art of medicine” starts

in the classroom, and it’s a wild ride!

Jenn, 2nd Year PA-S: If I had a nickel for all the times I heard our first-year professors say, “There is an art of medicine that can’t be taught in the books,” I would have at least half of my student loans paid off by now! We read the books, take the tests, and listen to lectures about how to practice medicine. Yet, 25 days into my first rotation knowing the “art” of medicine is just as important. Years of science courses, my first year of PA school under my belt, and it occurs to me that I know so little. Every time I enter a room to examine a patient I have made a differential in my head, but who’s to say any of that will play out the way I am expecting it to? For instance, in school we are taught that strep throat presents with beefy red tonsils or strawberry tongue. But of the six cases I saw this week…only one fit that description, yet textbook descriptions make it seem so clear cut, easy and concise! At the end of the day, I just have to feel so grateful for the Professors, Doctors, Nurses, PA-S, and MAs who are willing to let me ask the questions, ultimately leading to quality health care based on medical knowledge, your personality, and the age old “art” of medicine.

Lauren Hutchison CPR class WesternU PA-S 1st Year Student

46 CAPA NEWS

Nearly everyone is familiar with the negative effect of smoking on the lungs. Most of us are at this point convinced that smoking tobacco causes or promotes lung cancer and emphysema. Because this patient has a diagnosis of chronic obstructive pulmonary disease, we can see that he has not escaped this particular deleterious effect of prolonged tobacco use. He has also been diagnosed with cardiovascular disease. This is a circumstance that has been contributed to by tobacco use as well. The constant influx of nicotine causes constriction of the arteries which raises blood pressure, promotes wear and tear on the heart and begins to limit the ability of the vasculature to adapt to changing demands of exercise. This is collectively referred to as atherosclerosis or hardening of the arteries. He also is being treated for chronic pain resulting from degenerative disc disease. There is strong evidence that interruption in the delivery of adequate blood flow to the already relatively oxygen-poor areas of the vertebral disks promotes the breakdown and decay of these tissues. The microvasculature of the body is universally negatively affected by the influx of nicotine. This drug causes the vasculature to clamp down and limit blood and oxygen delivery to these tissues. Through this mechanism, every tissue in the body including the skin is negatively affected by the habitual use of tobacco products. He is also being treated for high blood pressure and high cholesterol. Physical exercise is the least expensive treatment to assist with the correction of these issues. As the patient becomes less capable of exercise due to lung obstruction

Patient Education and the Importance of Health Insurance Coverage for Smoking Cessation Continued from page 38

and circulatory disease, these other causes of mortality stake their claim on the lives of the tobacco addicted patient.

Conversely, if the tobacco habit can be removed earlier in the patient’s life, the need for medical care to treat a host of debilitating and expensive medical conditions is substantially reduced. The list of ailments associated with tobacco is long, and reading the list is a discouraging exercise unless you are thinking in terms of how easily these conditions can be

avoided or minimized simply by eliminating the use of tobacco. The focus of this discussion has been centered on smoking tobacco. The elimination of tobacco in the form of oral or inhaled versions is also vitally important. There is a separate and equally disturbing list of serious ailments that accompany the use of snuff and chewing

tobacco. In the area that my clinic serves, this is a common form of addiction to tobacco.

I work through the rest of my day. I silently bless our medical assistants and nurses for asking every patient with every visit, “Do you smoke or otherwise use tobacco products?” This addiction remains the largest life and death medical issue that we face on a daily basis. The manufacturers of tobacco products maintain enormous advertising budgets to persuade people to stay with the habit. It only makes sense to me that our health care industry respond with funds designated to help people break the deadly chains of addiction.

As I head home at the end of a long day, I am not really discouraged; our clinic has a particular focus on addiction issues, tobacco included. We have helped many people to overcome their addictions and assisted them to achieve an improved state of health. We are always looking for assistance in our quest to improve outcomes for the patients. In this writer’s opinion, it is money very well spent to provide tobacco cessation materials and pharmaceuticals as a core insurance benefit to all patients who request them. In an era of tight medical economics is not just the right thing to do, it is the smart thing to do. 

“I silently bless our medical

assistants and nurses for

asking every patient with

every visit, ‘Do you smoke

or otherwise use tobacco

products?’”

NOVEMBER/DECEMBER 2010 47

Welcome New MembersJuly 15, 2010 through November 11, 2010

Lisa Abresch, PA-CLauren Adams, PA-CLauren Adler, PA-SNicole AgostinoValerie Aguilar, PA-SPamela Ahmed, PA-CAshley Aldridge, PA-CNabilah Ali, PA-SKrista Alldritt, PA-SArtur Ambartsumyan, PA-SHolly Ariss, PA-SHeather Atamian, PA-CDennis Balough, PA-SJoseph Baltrushes, Jr., PA-CPaul Barnes, PA-C, MPAS, MPHErika Barnes, PA-CJoseph Bartle, PA-CMichelle Bauer, PA-SCecelia Beckwith, ARNPDawn Bernard, PA-CAlice Berta, PA-SHope Beverly, PA-CJasmine Bhasin, PA-SDesiree Bonomo, PA-CDiane Botticelli, PABraden Bowles, PA-SRegina Boyle, JDStacia Brandenburg, PA-SNancy Bravo, PA-SSarah Broome, PA-SLaurel Brown, PA-CViktor Buzin, PA-SBreanna Caro, PA-CMelissa Casas Martin Ceballos, PA-STricia Chiaramonte, PA-SLacee Childers, PA-CIan Childs, PA-CCoury Clemens, PA-SNicholas Collins, PA-SNancy Cooper, PA-CChristopher Davis, PA-SDaniel DavisNicholas de La Motte Hurst, PA-SAllison De Young, PA-SMason Devon, PA-SNatalie Dorsey, PA-SKristen Dufrene, PA-SMary Duong, PA-CJoAnn EimanElena Eisenman, PA-SDina Elkady, PA-SRonald Ellison, PACindy Elsayed, PA-CKimberly Ernest, PA-SJames Eshom, MDLacie Esser, PA-SCharie Evans, PA-SPatricia Farnam, PA-CPamela Farrer, PA-CLexy Farzami, PA-SJill Fattor, PA-SAllyse Fidler, PA-SDavid Flores, PA-SSophia Fong, PA-SMegan FordAudrey Francis, PA-SStefanie Fregeolle, PA-CLucas French, PA-SLisa Gail, PA-SAndrea Gamez, PA-SJessica Garner, PA-SErin Gleckman, PA-SAbigail Goetz, PA-SDana Goldenberg, PA-SEric Gonzalez, PA-C

Alicia Gordon, PA-SAshley Gregory, PA-CRigoberto Gutierrez, PA-SChristina Guzman, PA-SGary Hamilton, PAAshley Handlery, PA-SAndrew Harmon, PA-SKenneth Harrison, PA-CMichelle Harsono, PA-SJoshua Hedberg, PA-SDaniel Heffelfinger, PA-CDouglas Hilton, PA-CPatrick Hopkins, PA-SHeather Hosack, PA-SHaley Hubbard, PA-SLauren Hutchison, PA-SKatherine Ishihara, PA-CTitus Jackson, PA-SDustin Jacot, PA-SCrystal Jeffers, PA-SNikki Jenkins, PA-CNina Joe, PA-CNicholas Johantgen, PA-SMark Kane, PA-SManpreet Kaur, PA-SKarin Kessey, PA-SChristopher Key, PA-SShagufta Khaw, PA-SBarbara Kinkle, PA-SAutumn Konz, PA-SMichelle Lagua, PA-SKen Lam, DC, LAc, PA-SGregory,Lancaster,PA-SJason,Langlois,PA-SHoonjung LeeJennifer Lewis, PA-CKrista Limburg, PA-SAndrew Lobe, PA-CGina Lopez, PALauren Low, PA-SMusarrat Malik, PA-SShannon Malouf, PA-SGregory Marony, PA-SJorge Mata-Vargas, PA-SPauline Matar, PA-SDaniel McConnell, PA-SJeremy Meis, PA-SAnn Mendenhall, EMT-1Natalia Michan, PA-SJoy Miller, PA-CCalvin Miller, PA-CEvan Miller, PA-SChina Milligan, PA-SJamie Min De Angela Minter, PA-SKatie Mintz, PA-SMary Irene Miranda, PA-SJesus Molina, PA-CJennifer Moller, PA-SErin Montgomery, MA, CPT-1Brian MontgomeryLeah Morris, PA-SHeather Morse, PA-SYanina Moya, PA-CMartina Murialdo, PA-CMohammad Naghibi, PA-CErin Nash-Fairfax, PA-SDareen NassmanJessica Nelson, PA-CZabiullah Nessary, PA-CMartin Neubert, PA-CRachel Newgard, PA-SKim Ngo, PA-CTuyet-Khanh Nguyen, PA-CVan Nguyen, PA-CTony Nguyen, PA-S

Thu Nguyen, PA-SLissette Novar, PA-CKim Oelschlager, PA-SMelinda Oliver, PA-S, RNDiklah Orevi, PA-SMark Oribello, PA-CSandra Ovadia, PA-CMark Owens, PA-CLucy Paredes, PA-SJacqueline Parker, PA-CReema Patel, PA-CAshley Patteson, PA-SKatherine Pavlik, PA-SElizabeth Pecoy, PA-CWilliam Peterson, PA-CMinh Pham, PA-SAlexander Phan, PA-SStacey Phelps, PA-CSondra Piazza, PA-SJennafer Piccolo, PA-SJames Pierog, MDChristy Pifer, CCRPKiara Puccino, PA-SJennie QuachKailen QuirosMohammad Raheen, PA-CSamuel Ramirez, PA-SAmber RangelDawn Resney-Deems, PA-CKelly Rhodus, PA-CCorine Riedell, PA-SShelley Riegert, PA-SCari Rodgers, PA-CAngelica Ross, PA-CJennifer Roth, PA-STrent Russell, PA-SDelaram Saatchi, PA-SPaul SchoernerTanya Schrobilgen, PA-SSaruol Seng, PA-CReena Shah, PA-SNicole Sherfield, PA-SMegan Shirley, PA-SWilliam Sullivan, PA-SHung-Wen Sun, MMS, PA-CTom Sverchek, PA-SKristin Sylvan, PA-CRoland Szemerei, PA-SJulia Tehrani, PA-CChristopher Thompson, PA-SErin Thurman-Fabbricatore, PA-CElizabeth Tomatsu, PA-SAmber Torres, PA-SChristopher Tran, PA-CEvans Tran, PA-SKatelynn Upham, PA-SJames Van Der Heyden, PA-SShannan Van Houten, PA-SShawn VanGronigen, PA-CMaricela Villalta, PA-CLinda Villarreal, PA-SDaniel Villegas, PA-SJessica Walters, PA-SMegan Ward, PA-SRobin Wempe, PA-CAmanda Whitaker, PA-SRyan Wilson, PA-SH. Alexandra Winship, PA-SJessica Wirth, PA-SChing Wong, BSSydney Wood, PA-SChristina Wu, PA-COlivia Xiajun Wu, PA-SStephen YuenErin Zee, PA-SSamantha Zubiena, MA

1. Redding Area PA/NP AllianceSummer Ross, PA-C; (530) 275-5747summerross@hughes.net

2. Physician Assistant Society of Sacramento (PASS)Carlos De Villa, PA-C, PASS President; (916) 973-6185, pasocietyofsac@yahoo.comAtul Sharma, PA-C, MMS, MPH, CHES; (916) 397-6035, pasocietyofsac@yahoo.com

3. Contra Costa Clinicians AssociationBrian Costello, PA-C; (707) 651-2705, brianc510@comcast.net

4. San Francisco Bay Area Physician Assistants (SFBAPA)www.sfbapa.com, PO Box 14096, San Francisco, CA 94114-0096Martin Kramer, PA-C; (415) 433-5359, Fax: (415) 397-6805, mkramersf@hotmail.com

5. Bay Area Mid-Level PractitionersRose Abendroth, PA-C; (650) 697-3583, Fax: (650) 692-6251, rosepard@aol.comMatt Dillon, PA-C; (650) 591-6601, mattdillon42@hotmail.com

6. Bay Area Non-DocsLinda O’Keeffe, PA-C; (650) 366-2050, lindapac@aol.com

7. Northcoast Association of Advanced Practice CliniciansJohn Coleman, PA-C; (707) 845-6008, streetdrag49@sbcglobal.net

8. Stanislaus County NP/PA NetworkBrian Cormier, PA-C; (209) 605-4966, briancor@verizon.net, www.nppanetwork.org

9. Stockton MidlevelsEmma Calvert, PA-C; stocktonmidlevels@gmail.com

10. Journal Club for PAs and NPs (Fresno area)Cristina Lopez, PA-C; (559) 875-4060; Fax: (559) 875-3434, clopez875@aol.com; 2134 10th St, Sanger, CA 93657

11. Tulare/Kings NP/PA AssociationSteve Henry, PA-C; Pager: (559) 749-4348, msh649@sbcglobal.net

12. Central Coast Nurse Practitioners & Physician AssistantsKris Dillworth, NP; ccnppa@yahoo.com

13. So Cal PAsLinda Aghakhanian, PA-C; want2heal@hotmail.com

14. Orange CountyHung Nguyen, PA-C; (714) 846-8178; nhy52@yahoo.com

15. San Gabriel Valley Local GroupM. Rachel DuBria, PA-C; (818) 744-6159, racheldca@aol.com

16. San Fernando/Santa Clarita Valley GroupJonah Tan, MPT, PA-C; (818) 634-0007, jotptpa@yahoo.com

17. Coachella Valley Physician Assistant GroupMatthew Keane, MS, PA-C; mkeanepas@gmail.com

18. San Diego AreaJeremy Adler, MS, PA-C; (619) 829-1430, jadler@simplyweb.net

Local Groups

NEW

NEW

California Academy of Physician Assistants3100 W. Warner Avenue, Suite 3Santa Ana, CA 92704-5331

Address Service Requested

PRSRT STDUS POSTAGE

PAIDSANTA ANA, CAPERMIT NO 949

Sunday, February 27, 2011Napa Valley Marriott3425 Solano Ave Napa, CA 94558(707) 253-8600

Saturday, March 19, 2011Western University of Health Sciences

Health Education Center, Lecture Hall 1

521 E 2nd St/College PlazaPomona, CA 91766

Saturday, April 23, 2011Samuel Merritt University

Fontaine Auditorium, Health Education Center

450 30th St Oakland, CA 94609

6 Hours

Cat. I

CME

Controlled Substances Education Course for PAs

One-Day Conferencein Napa at the Napa Valley

6 Hours of Cat. I CME

Saturday, February 26, 20118:45 am - 5:00 pm

Register online at www.capanet.org

CAPA at Napa

Sponsored by theCalifornia Academy of Physician Assistants