MILITARY MEDICINE, 179, 12:1444, 2014
Full Circle: A New Classroom Site to Facilitate the Veteran to Physician Assistant Pathway Keren H. Wick, PhD*; Vanessa Bester, MPAS, P A -C f; Drew A. Garcia, MPAS, P A -C f; Henry Stoll, P A -C f
ABSTRACT Introduction: Former military medics and corpsmen face challenges entering a civilian health care system that underutilizes their training and experience. The MEDEX Northwest physician assistant (PA) program launched a new classroom site in Tacoma, Washington, near local military bases, to ease entry into the PA profession for those in the local military and civilian communities. Methods: To fill the new classroom, the program conducted outreach to prospective applicants at community colleges, on-base transition and education centers, and education and career events near local installations. Results: Half of the first Tacoma class members are military veterans, half are female, 71% are from disadvantaged backgrounds, and the average age is 33. The Tacoma class demographics are equivalent to the overall 2013 MEDEX entering class with the exception of a higher veteran population (p < 0.001) and a higher rate of educational or economic disadvantage (p = 0.001). Discussion: The MEDEX PA program has met its mission with the new Tacoma site in terms of access for former military, disadvantaged, and local enrollees. Offering a pathway to the PA profession for those with prior military medical experience recognizes the training and skills attained while in uniform and allows entry into a meaningful civilian career.
INTRODUCTION The physician assistant (PA) profession was created in the 1960s through matriculating former medics and corpsmen to training programs designed to build on their military medical training and experience.1 One of these early programs, MEDEX Northwest— the PA program at the University of W ashington— focused on filling gaps in primary care access, particularly in the rural northwest, where physician shortages were acutely felt. The program founder saw that service members with valuable field experience gained in the Vietnam conflict were being discharged into a civilian environment that used only a fraction of their medical skills. The program addressed both of these challenges at the same time, with the first 5 classes made up entirely of fonner medics and corpsmen.2 The proportion of PAs with a military background has diminished since those early years, to the point where only 8% of 2007 (the most recent year for which data are avail able)3 entering students nationwide were veterans, and only 16% of PA programs actively recruited applicants who were current or former members of the military.4 Once again, the country is welcoming large numbers of military medical personnel home from international conflicts, and many of them are finding it challenging to translate their skills and experience into civilian positions. As with the early days of the profession, the nation is also facing a clinician shortage, which is anticipated to deepen as health care reform *MEDEX Northwest Physician Assistant Program, University of Washington School of Medicine, 4311 11th Avenue NE, Suite 200, Seattle, WA 98105. tMEDEX Northwest Physician Assistant Program, University of Washington, 1900 Commerce Street, Harmon Building 305, Tacoma, WA 98402. doi: 10.7205/MILMED-D-14-00117
1444
is implemented.5" 8 In 2011, the White House launched an initiative to facilitate the career path from medic or corpsman to PA.9 This led to the Joining Forces initiative, which is a series of programs to promote appropriate employment and educational opportunities for all service members and their families.10 The Health Resources and Services Administration responded by adding extra review points to the existing pri mary care training grant program for proposals that included veterans activities.11' 12 MEDEX— a program with existing classroom locations in Seattle and Spokane Washington and Anchorage, Alaska— received one of these grants in 2012 and applied the funding to start-up activities for a new classroom located in Tacoma, Washington (Grant number D57HP24691). The new didactic (classroom) site at the University of Washington Tacoma (UWT) campus is approximately 13 miles from Joint Base Lewis-McChord (Army and Air Force), and also serves individuals coming from Naval installations in neighboring counties. This article will focus on describing the methods and preliminary outcomes of this new PA education site that seeks to facilitate the pathway for military medical personnel to move up the civilian health care career ladder into the PA profession.
METHODS The MEDEX program began the process of developing a new site by obtaining support from the leadership at the local university campus. UWT leadership shares the MEDEX mis sion to reach the nearby military community as well as indi viduals in the local area who may have had limited access to educational opportunities. Additional conversations with the nursing faculty (the only other health professions pro gram on campus) ensured a spirit of collaboration and coop eration. These meetings with colleagues on the new campus
MILITARY MEDICINE, Vol. 179, December 2014
Full Circle: Veteran to Physician Assistant established a solid working relationship that fostered effective planning and implementation to obtain appropriate classroom facilities and access to campus services. The implementation stage began with reassignment of a senior faculty member who would become the local site coor dinator. This site leader strengthened ties with on-campus leadership and potential colleagues. He played a key role in the recruitment committee to identify additional faculty for the new site. With the support of UWT leadership, the program was successful in negotiating a dedicated classroom on the local campus. This space had been designed with potential clinical skills training in mind, and included space for physical exam ination instruction as well as interview and exam rooms along one side. The start-up grant included funds for class room and office supplies, which facilitated the process of equipping the new site before the first day of class. Outreach activities began as the new application cycle opened in early 2012 for applications to enter PA education in 2013. These efforts were necessarily general to MEDEX rather than specific to Tacoma as the accreditation approval for the new site was still pending. The program runs a series of information sessions during the admissions cycle. These standardized presentations provide details on program his tory, mission, admissions process, admissions data, and steps to build a competitive application. Formal information ses sions take place throughout the 5-state northwest service region. The program added supplemental sessions in the Tacoma area during the 2012 admissions cycle on or near the adjacent military installations (Army, Air Force, Navy). The program participated in military-sponsored education and career fairs, which allowed MEDEX to add a Coast Guard contact. The program gave promotional handouts to the on-base education and transition offices so counselors could provide details on PA education to appropriate poten tial candidates. MEDEX also offered informal information booths at nearby military medical facilities. Fostering contacts in the local community as well as offer ing information sessions in the military and civilian commu nities resulted in several opportunities to publicize the MEDEX program and the PA profession in general. During the year before enrolling the first class, the program partici pated in 4 formal or informal information sessions or booths on military bases, 6 formal information sessions near military installations, 8 military-sponsored networking events, 2 onpost education and career fairs, and 4 other meetings with military educators or contractors. The program estimates that it made approximately 325 contacts with prospective appli cants and approximately 20 contacts with military transition or education personnel. Education and transition counselors either took handouts to distribute or relayed information about the program verbally to an unknown number of addi tional contacts. Program faculty noted a high proportion of prospective applicants who were planning 1 to 3 years ahead for application to PA education.
MILITARY MEDICINE, Vol. 179, December 2014
The Tacoma site received accreditation approval in Octo ber 2012 and opened in September 2013 as an undergraduate option. In the program’s experience, requiring a bachelor’s degree before PA education poses challenges to those cur rently serving in the military.1’ Deployments disrupt the course calendar, and even online courses can become difficult during deployments. For those at home, frequent reassign ments to new posts can mean collecting a range of courses at a variety of colleges around the country. On-campus resi dency requirements for a traditional undergraduate program can put off degree completion for years. The Servicemembers Opportunity Colleges program14 and colleges or universities that compile credits from disparate institutions into a bacca laureate degree both offer options to address this challenge, yet the need for undergraduate opportunities remains. MEDEX considered this as well as demographics around the Tacoma area that indicate below-average bachelor’s degree attainment in the general population.15 The program, there fore, sought to keep PA education accessible through offering a bachelor’s option for PA school completion at the Tacoma campus. As the profession nears 2021, when all PA programs must be at a master’s level, MEDEX will make the transition to remain in compliance. The program is developing a bridge program involving local community colleges as well as UWT that is intended to keep the door open to these otherwise qualified applicants. The program committed itself to have at least one prior service member on the faculty at this site. Part of the MEDEX program’s success in educating military veterans comes from hiring PA faculty who have served in uniform. This faculty presence contributes to appropriate guidance as students make the transition from uniformed service to a civilian educational setting. Of the 3 initial faculty members at the Tacoma site, one is a veteran, one has practiced in military medicine as a civilian, and the third is the son and brother of career military officers. A fourth PA faculty mem ber will join the team in time for the start of the second MEDEX Tacoma class. He is a veteran who has spent his entire PA career in military medicine. Demographics of the overall MEDEX program (across its didactic sites in Seattle, Spokane, and Tacoma, Washington; and Anchorage, Alaska) see minor variation from year to year. A comparison between the new Tacoma class and the rest of MEDEX 2013 enrollees determined whether Tacoma students displayed any key differences from other MEDEX students. %2 tests were applied to dichotomous variables and a t test compared average ages between groups using SPSS version 19. The University of Washington’s Institutional Review Board (IRB) determined that this report does not require IRB review (communication on October 24, 2013). RESULTS
MEDEX held interviews in January 2013 at the new didactic location (UWT). Of the 88 qualified applicants who indicated
1445
Full Circle: Veteran to Physician Assistant
.
TABLE 1
Demographics of Tacoma Class 1
Characteristic
TABLE III.
Number (%)"
Sex Male Female Race/Ethnicity White African American/Black Hispanic/Latino Asian Age (Average Age 33.3) 25-29 30-39 40-50'’ Educational Attainment No Degree (Some College) Associate Degree Bachelor’s Degree International Medical Graduate Military Background Army Navy No Military Background Disadvantaged Background Economic Disadvantage (Only) Educational Disadvantage (Only) Both Educational and Economic Disadvantage Not Disadvantaged Urban Background Urban (>50,000) Non-Urban"
Characteristic
14 (50%) 14 (50%) 22 (79%) 1 (4%) 3(11%) 2 (7%) 8 (29%) 15 (54%) 5 (18%)
10 (40%) 8 (32%) 18 (72%) 14(56%) 33.2 9 (36%)
Tacoma Class 2 is accepted but has not yet begun coursework. More detailed data reporting and cross-site comparisons will begin after the class composi tion is finalized.
8 (29%) 15 (54%) 3(11%) 2 (7%) 12 (43%) 2 (7%) 14 (50%) 9 (32%) 5 (18%) 6(21%) 8 (29%) 20 (71%) 8 (29%)
an interest in Tacoma, the program interviewed 36 and selected 26 for the first Tacoma class. Other students accepted to the program in another location subsequently transferred for a total of 28 students in the first Tacoma class. Table I describes the demographic composition of the class, which began its PA education in the 2013-2014 academic year. In addition to the 14 military veterans shown in the table, 6 students are military spouses (some fall into both categories). Half the class is female and 4 of the veterans are
female. The average age is 33. Twenty, or 71.4% of the Tacoma class self-declared either educational or economic disadvantage (or both) when provided federal definitions of these categories. When compared with the rest of the 2013 entering MEDEX class (in other didactic locations), the Tacoma class was no different in terms of ethnicity, sex, and age (Table II). The Tacoma class was more likely to have a military background ( p < 0.001) and to come from a disadvantaged background ( p = 0.001). MEDEX cur rently offers both a master’s-level and an undergraduate option. When disadvantaged status was compared with other undergraduate students only, Tacoma students remained significantly more likely to have a disadvantaged background ( p = 0.04). Tacoma Class 2 is now accepted to enter the MEDEX program in the 2014—2015 academic year. Preliminary demo graphic data describing this class are shown in Table III. Initial results indicate that the accepted class will be 40% female, 32% minority, 56% from disadvantaged back grounds, and 36% current or former military. These figures will be adjusted as students who are accepted declare their intent to enroll in the 2014 entering Tacoma class or to attend school elsewhere. In qualitative terms, the faculty has assessed the Tacoma class as a positive, collaborative, team-oriented group. The
Comparison of Tacoma Demographics with Other MEDEX Students Entering in 2013
Characteristic Sex Female Race/Ethnicity Racial/Ethnic Minority Average Age" Veteran Military Service Disadvantaged Economic or Educational Disadvantage (or Both)'’
Tacoma Class 1 (n [%])
MEDEX Non-Tacoma
(n [%])
p-Value
14 (50.0%)
51 (49.0%)
1.00
6(21.4%) 33.3 (SD 6.3)
21 (20.2%) 32.6 (SD 6.8)
1.00 0.64
14 (50.0%)
12(11.5%)
Full Circle: A New Classroom Site to Facilitate the Veteran to Physician Assistant Pathway Keren H. Wick, PhD*; Vanessa Bester, MPAS, P A -C f; Drew A. Garcia, MPAS, P A -C f; Henry Stoll, P A -C f
ABSTRACT Introduction: Former military medics and corpsmen face challenges entering a civilian health care system that underutilizes their training and experience. The MEDEX Northwest physician assistant (PA) program launched a new classroom site in Tacoma, Washington, near local military bases, to ease entry into the PA profession for those in the local military and civilian communities. Methods: To fill the new classroom, the program conducted outreach to prospective applicants at community colleges, on-base transition and education centers, and education and career events near local installations. Results: Half of the first Tacoma class members are military veterans, half are female, 71% are from disadvantaged backgrounds, and the average age is 33. The Tacoma class demographics are equivalent to the overall 2013 MEDEX entering class with the exception of a higher veteran population (p < 0.001) and a higher rate of educational or economic disadvantage (p = 0.001). Discussion: The MEDEX PA program has met its mission with the new Tacoma site in terms of access for former military, disadvantaged, and local enrollees. Offering a pathway to the PA profession for those with prior military medical experience recognizes the training and skills attained while in uniform and allows entry into a meaningful civilian career.
INTRODUCTION The physician assistant (PA) profession was created in the 1960s through matriculating former medics and corpsmen to training programs designed to build on their military medical training and experience.1 One of these early programs, MEDEX Northwest— the PA program at the University of W ashington— focused on filling gaps in primary care access, particularly in the rural northwest, where physician shortages were acutely felt. The program founder saw that service members with valuable field experience gained in the Vietnam conflict were being discharged into a civilian environment that used only a fraction of their medical skills. The program addressed both of these challenges at the same time, with the first 5 classes made up entirely of fonner medics and corpsmen.2 The proportion of PAs with a military background has diminished since those early years, to the point where only 8% of 2007 (the most recent year for which data are avail able)3 entering students nationwide were veterans, and only 16% of PA programs actively recruited applicants who were current or former members of the military.4 Once again, the country is welcoming large numbers of military medical personnel home from international conflicts, and many of them are finding it challenging to translate their skills and experience into civilian positions. As with the early days of the profession, the nation is also facing a clinician shortage, which is anticipated to deepen as health care reform *MEDEX Northwest Physician Assistant Program, University of Washington School of Medicine, 4311 11th Avenue NE, Suite 200, Seattle, WA 98105. tMEDEX Northwest Physician Assistant Program, University of Washington, 1900 Commerce Street, Harmon Building 305, Tacoma, WA 98402. doi: 10.7205/MILMED-D-14-00117
1444
is implemented.5" 8 In 2011, the White House launched an initiative to facilitate the career path from medic or corpsman to PA.9 This led to the Joining Forces initiative, which is a series of programs to promote appropriate employment and educational opportunities for all service members and their families.10 The Health Resources and Services Administration responded by adding extra review points to the existing pri mary care training grant program for proposals that included veterans activities.11' 12 MEDEX— a program with existing classroom locations in Seattle and Spokane Washington and Anchorage, Alaska— received one of these grants in 2012 and applied the funding to start-up activities for a new classroom located in Tacoma, Washington (Grant number D57HP24691). The new didactic (classroom) site at the University of Washington Tacoma (UWT) campus is approximately 13 miles from Joint Base Lewis-McChord (Army and Air Force), and also serves individuals coming from Naval installations in neighboring counties. This article will focus on describing the methods and preliminary outcomes of this new PA education site that seeks to facilitate the pathway for military medical personnel to move up the civilian health care career ladder into the PA profession.
METHODS The MEDEX program began the process of developing a new site by obtaining support from the leadership at the local university campus. UWT leadership shares the MEDEX mis sion to reach the nearby military community as well as indi viduals in the local area who may have had limited access to educational opportunities. Additional conversations with the nursing faculty (the only other health professions pro gram on campus) ensured a spirit of collaboration and coop eration. These meetings with colleagues on the new campus
MILITARY MEDICINE, Vol. 179, December 2014
Full Circle: Veteran to Physician Assistant established a solid working relationship that fostered effective planning and implementation to obtain appropriate classroom facilities and access to campus services. The implementation stage began with reassignment of a senior faculty member who would become the local site coor dinator. This site leader strengthened ties with on-campus leadership and potential colleagues. He played a key role in the recruitment committee to identify additional faculty for the new site. With the support of UWT leadership, the program was successful in negotiating a dedicated classroom on the local campus. This space had been designed with potential clinical skills training in mind, and included space for physical exam ination instruction as well as interview and exam rooms along one side. The start-up grant included funds for class room and office supplies, which facilitated the process of equipping the new site before the first day of class. Outreach activities began as the new application cycle opened in early 2012 for applications to enter PA education in 2013. These efforts were necessarily general to MEDEX rather than specific to Tacoma as the accreditation approval for the new site was still pending. The program runs a series of information sessions during the admissions cycle. These standardized presentations provide details on program his tory, mission, admissions process, admissions data, and steps to build a competitive application. Formal information ses sions take place throughout the 5-state northwest service region. The program added supplemental sessions in the Tacoma area during the 2012 admissions cycle on or near the adjacent military installations (Army, Air Force, Navy). The program participated in military-sponsored education and career fairs, which allowed MEDEX to add a Coast Guard contact. The program gave promotional handouts to the on-base education and transition offices so counselors could provide details on PA education to appropriate poten tial candidates. MEDEX also offered informal information booths at nearby military medical facilities. Fostering contacts in the local community as well as offer ing information sessions in the military and civilian commu nities resulted in several opportunities to publicize the MEDEX program and the PA profession in general. During the year before enrolling the first class, the program partici pated in 4 formal or informal information sessions or booths on military bases, 6 formal information sessions near military installations, 8 military-sponsored networking events, 2 onpost education and career fairs, and 4 other meetings with military educators or contractors. The program estimates that it made approximately 325 contacts with prospective appli cants and approximately 20 contacts with military transition or education personnel. Education and transition counselors either took handouts to distribute or relayed information about the program verbally to an unknown number of addi tional contacts. Program faculty noted a high proportion of prospective applicants who were planning 1 to 3 years ahead for application to PA education.
MILITARY MEDICINE, Vol. 179, December 2014
The Tacoma site received accreditation approval in Octo ber 2012 and opened in September 2013 as an undergraduate option. In the program’s experience, requiring a bachelor’s degree before PA education poses challenges to those cur rently serving in the military.1’ Deployments disrupt the course calendar, and even online courses can become difficult during deployments. For those at home, frequent reassign ments to new posts can mean collecting a range of courses at a variety of colleges around the country. On-campus resi dency requirements for a traditional undergraduate program can put off degree completion for years. The Servicemembers Opportunity Colleges program14 and colleges or universities that compile credits from disparate institutions into a bacca laureate degree both offer options to address this challenge, yet the need for undergraduate opportunities remains. MEDEX considered this as well as demographics around the Tacoma area that indicate below-average bachelor’s degree attainment in the general population.15 The program, there fore, sought to keep PA education accessible through offering a bachelor’s option for PA school completion at the Tacoma campus. As the profession nears 2021, when all PA programs must be at a master’s level, MEDEX will make the transition to remain in compliance. The program is developing a bridge program involving local community colleges as well as UWT that is intended to keep the door open to these otherwise qualified applicants. The program committed itself to have at least one prior service member on the faculty at this site. Part of the MEDEX program’s success in educating military veterans comes from hiring PA faculty who have served in uniform. This faculty presence contributes to appropriate guidance as students make the transition from uniformed service to a civilian educational setting. Of the 3 initial faculty members at the Tacoma site, one is a veteran, one has practiced in military medicine as a civilian, and the third is the son and brother of career military officers. A fourth PA faculty mem ber will join the team in time for the start of the second MEDEX Tacoma class. He is a veteran who has spent his entire PA career in military medicine. Demographics of the overall MEDEX program (across its didactic sites in Seattle, Spokane, and Tacoma, Washington; and Anchorage, Alaska) see minor variation from year to year. A comparison between the new Tacoma class and the rest of MEDEX 2013 enrollees determined whether Tacoma students displayed any key differences from other MEDEX students. %2 tests were applied to dichotomous variables and a t test compared average ages between groups using SPSS version 19. The University of Washington’s Institutional Review Board (IRB) determined that this report does not require IRB review (communication on October 24, 2013). RESULTS
MEDEX held interviews in January 2013 at the new didactic location (UWT). Of the 88 qualified applicants who indicated
1445
Full Circle: Veteran to Physician Assistant
.
TABLE 1
Demographics of Tacoma Class 1
Characteristic
TABLE III.
Number (%)"
Sex Male Female Race/Ethnicity White African American/Black Hispanic/Latino Asian Age (Average Age 33.3) 25-29 30-39 40-50'’ Educational Attainment No Degree (Some College) Associate Degree Bachelor’s Degree International Medical Graduate Military Background Army Navy No Military Background Disadvantaged Background Economic Disadvantage (Only) Educational Disadvantage (Only) Both Educational and Economic Disadvantage Not Disadvantaged Urban Background Urban (>50,000) Non-Urban"
Characteristic
14 (50%) 14 (50%) 22 (79%) 1 (4%) 3(11%) 2 (7%) 8 (29%) 15 (54%) 5 (18%)
10 (40%) 8 (32%) 18 (72%) 14(56%) 33.2 9 (36%)
Tacoma Class 2 is accepted but has not yet begun coursework. More detailed data reporting and cross-site comparisons will begin after the class composi tion is finalized.
8 (29%) 15 (54%) 3(11%) 2 (7%) 12 (43%) 2 (7%) 14 (50%) 9 (32%) 5 (18%) 6(21%) 8 (29%) 20 (71%) 8 (29%)
an interest in Tacoma, the program interviewed 36 and selected 26 for the first Tacoma class. Other students accepted to the program in another location subsequently transferred for a total of 28 students in the first Tacoma class. Table I describes the demographic composition of the class, which began its PA education in the 2013-2014 academic year. In addition to the 14 military veterans shown in the table, 6 students are military spouses (some fall into both categories). Half the class is female and 4 of the veterans are
female. The average age is 33. Twenty, or 71.4% of the Tacoma class self-declared either educational or economic disadvantage (or both) when provided federal definitions of these categories. When compared with the rest of the 2013 entering MEDEX class (in other didactic locations), the Tacoma class was no different in terms of ethnicity, sex, and age (Table II). The Tacoma class was more likely to have a military background ( p < 0.001) and to come from a disadvantaged background ( p = 0.001). MEDEX cur rently offers both a master’s-level and an undergraduate option. When disadvantaged status was compared with other undergraduate students only, Tacoma students remained significantly more likely to have a disadvantaged background ( p = 0.04). Tacoma Class 2 is now accepted to enter the MEDEX program in the 2014—2015 academic year. Preliminary demo graphic data describing this class are shown in Table III. Initial results indicate that the accepted class will be 40% female, 32% minority, 56% from disadvantaged back grounds, and 36% current or former military. These figures will be adjusted as students who are accepted declare their intent to enroll in the 2014 entering Tacoma class or to attend school elsewhere. In qualitative terms, the faculty has assessed the Tacoma class as a positive, collaborative, team-oriented group. The
Comparison of Tacoma Demographics with Other MEDEX Students Entering in 2013
Characteristic Sex Female Race/Ethnicity Racial/Ethnic Minority Average Age" Veteran Military Service Disadvantaged Economic or Educational Disadvantage (or Both)'’
Tacoma Class 1 (n [%])
MEDEX Non-Tacoma
(n [%])
p-Value
14 (50.0%)
51 (49.0%)
1.00
6(21.4%) 33.3 (SD 6.3)
21 (20.2%) 32.6 (SD 6.8)
1.00 0.64
14 (50.0%)
12(11.5%)
