PAs are Often at the Heart of Rural Healthcare

Last Tuesday, I met with the sheriff’s department to discuss treatment protocols for heroin addicts (a growing problem in rural areas).  Wednesday I worked an extended day and treated over 20 patients including a retired diabetic farmer. Thursday I visited a nursing home to see three patients I follow monthly.

That’s just a small flavor of the life of a healthcare provider in a rural area. There are far too many needs, far too few physicians, and a growing urgency to find solutions. 

It’s not easy to do, however, with clinics closing, newly insured patients under the Affordable Care Act, and productivity-based payments that require providers to see an increasing patient load. Many of you feel this same pressure in your practices.

As a certified PA, I think my profession can and should be part of the solution.

Certified PAs are educated in the medical model and undergo a rigorous certification process. We are equipped with broad-based medical knowledge and skills and always work in collaboration with (though not necessarily on-site with) physicians. We are cost-effective providers, handle our own patient panels, and are available for extended hours and services.

As a PA at Family Health, a Federally Qualified Health Center located in Greenville, Ohio, I see firsthand how we can help solve the challenges of rural healthcare. The town has a population density of a scant 89 people per square mile, compared to Dayton, where the population density is over 2,500 inhabitants per square mile. Horse and buggies are a common sight.

I came to Family Health 23 years ago after graduating from PA school. We are the only primary-care group practice in the county, with just 21 providers to care for a population of over 53,000. Family Health has 40,000 patients, and we have multiple locations to accommodate them.

PAs meet the needs of rural patients in the following ways.

Expanding Access: Family Health is at capacity with a waiting list. We make visiting a healthcare provider convenient by offering normal business hours as well as evening and Saturday hours to keep up with our current patient roster. If your practice needs to expand patient access, certified PAs may be the answer. PAs can be educated and available to practice more quickly than a physician, as the average PA program is about 27 months post baccalaureate.

Creativity: Because we are in a rural area, I have to be more creative about my resources. If a patient has no insurance or financial means, I still try to find a way to care for him. I know that if I refer a patient to a specialist an hour a way, I may also have to help solve the patient’s transportation issue. Certified PAs in rural areas are an important source of referrals to specialists, but before we refer them we exhaust every avenue within our means.

Flexibility: Often, new primary-care physicians are seeking a Monday to Friday, 9 to 5 workweek and don’t want to take on additional duties outside the office. My experience has been that PAs recognize such a lifestyle isn’t always possible in rural health settings. We seek to collaborate with busy physicians to lessen the load, often handling the extended day and Saturday appointments as well as off-site care at nursing homes. Working in family practice, there is nothing I won’t do. I treat 22 patients to 27 patients a day, work one evening a week, do nursing home visits every week, and am now working with two physicians and the sheriff’s office to pilot the Vivitrol care protocols for heroin addicts.

Connecting with patients: While there is considerable discussion about telemedicine, face-to-face communication remains critical to patient engagement, education, and outcomes. PAs are the face of medicine to many people in rural communities. Being a PA that patients call by my first name facilitates a different connection than addressing a provider as “doctor.” My patients freely tell me what’s bothering them, and we frequently share a hug to say hello or goodbye.

Patient Engagement and Delivery of Care: Lately I’ve noticed a disturbing trend: more patients who are complacent about their health and don’t see themselves getting better. Because of this, it is sometimes necessary to spend more time with them to ask additional questions. I always close an appointment by asking if there’s anything else of concern, and it’s surprising how many people hold back until that moment. These extra minutes may be the most important time I have to make a difference in their lives.

Rural healthcare will remain a challenge for physicians, hospitals, and states working to ensure optimal care to their entire population. PAs deliver cost-effective quality care to practices in rural areas that are striving to more effectively treat today’s more complex patients.

Stephanie House, PA-C, is a physician assistant certified by the National Commission on Certification of Physician Assistants.