AM Rounds

Beyond the pages of Academic Medicine, journal of the AAMC

PA Programs: Using Military Medics to Address a Critical Need in our Civilian Health Care System

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By: Bruce A. Cairns, MD and Anita M. Navarro, M.Ed

The AAMC and many other organizations recognize that there is an alarming health care provider shortage in our nation.  In “The Military Veteran to Physician Assistant Pathway: Building the Primary Care Workforce” by Brock and colleagues, the authors report that physician assistants (PAs), particularly those with military backgrounds, are poised to significantly contribute to the U.S. health care workforce, yet, many qualified medics with substantial training and experience disappear from the healthcare workforce following their military service. Losing this highly trained cohort as a health care resource would truly be unfortunate, as retraining these mature, experienced providers for work in the civilian health care setting could substantially address the physician workforce gap as well as provide tailored care to those with military affiliations.

Service members and veterans of our nation’s armed forces are often cared for in their local community by providers unfamiliar with the military, its branches, traditions, missions, and cultures. In these encounters patients generally are not asked about their military background. However, as with other aspects of patient diversity, military experience is an important element of a person’s identity that impacts the patient-provider dynamic. Patient-provider concordance, where patients feel most comfortable with a provider similar to their race and gender, is a principal that should intuitively apply to those who have served in the military.

Since 2011, the Association of American Medical Colleges (AAMC) has partnered with the White House in the Joining Forces initiative and member medical schools have committed to mobilize their integrated missions in education, research, and clinical care to train our nation’s physicians to meet the health care needs of the military and their families. As part of the Joining Forces initiative, the AAMC conducted a survey in 2012 of over 100 academic medical schools and generated a report titled: “Serving Those Who Serve America.” This report found that while there are a number of veteran initiatives in academic medical centers across the country, there are still major gaps in military cultural competence, clinical care and education in our civilian health care system.

One strategy to address the multiple issues identified in the report is to develop specific training programs that target service members who would then be integrated into the civilian academic health care system. PAs from the military are well-positioned to fill a void, particularly in primary care, for all patients, but especially for patients who have served in the military.  Patients would see someone who is just like they are and may feel more comfortable discussing TBI, PTSD, military sexual trauma, and other health and wellness issues related to their service.  An example is at the UNC-Chapel Hill School of Medicine which is creating a novel Physician Assistants program that specifically targets Special Forces (SF) medics and others with similar training and experience. This PA program was developed in direct response to a survey of current and former SF medics that revealed their interest in serving in the civilian health care field, particularly as PAs. The PA Program at UNC Chapel Hill, scheduled to open in 2015, while laudable, is small (approximately 15 students a year) and clearly is not enough.

As noted by Brock and colleagues, over 50,000 service members with health care training have separated from the military from 2006-2010. Additional and larger academic initiatives and PA programs will be needed to fully address the need to take full advantage of the opportunity these service members represent. Furthermore, these programs will need to be supported and there will be a major role for various organizations in coordinating this effort. We applaud the work of Brock and colleagues and thank them for bringing these issues to our attention. It is clear that the academic medical community needs to support our nation’s veterans and their families. Not only will these PA programs address a critical need in our civilian health care system, it is the least we can do for those who have sacrificed so much.

Bruce A. Cairns, MD is the John Stackhouse Distinguished Professor of Surgery and Director of the North Carolina Jaycee Burn Center at the UNC School of Medicine. Dr. Cairns is a veteran having served as a general surgeon in the US Navy on Guam and at the Camp Lejeune Naval Hospital. Dr. Cairns is Special Advisor to the UNC-Chapel Hill Physician Assistants Program and is the AAMC Joining Forces representative at UNC.

Anita M. Navarro, M.Ed., is one of the AAMC staff members supporting the Joining Forces initiative.  Prior to joining the AAMC three years ago, she worked at a medical school for 11 years.  She is a former Army wife, whose husband was deployed in Operation Desert Storm, 1990-1991.

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