DEAPA News Archive
- PA DAY AT THE LEGISLATURE Posted: 03-19-2013
- DEAPA 23rd Annual Winter CME Conference Posted: 02-06-2013
- What if Everyone had Health Care in Maine? Posted: 11-15-2012
- Innovative Solutions for Building Recovery w/ Alternatives to Psychotropic Meds Posted: 07-12-2012
- DEAPA Membership Dues 2012-2013 Posted: 07-03-2012
- DEAPA WELCOMES A NEW PA Program to New England!!! Posted: 05-18-2012
- STUDENTS....Apply for a scholarship!!! Posted: 02-23-2012
- Annual Nominations polls are OPEN Posted: 02-23-2012
- Become a DEAPA member! Posted: 02-21-2012
- AAPA Physician Assistants Census Posted: 01-09-2012
- Maine CDC Pertussis Survey Posted: 12-08-2011
- Congratulations to Kenneth Nadeau, PA-C! Posted: 11-01-2011
- Physician Assistant’s Response to Domestic Violence Posted: 09-30-2011
- Theater as a Catalyst for Community Conversations Posted: 09-30-2011
- Where will you be in 2029? Study Babies will be voting! Posted: 09-30-2011
- MICIS is a Resource For Independent Information on Prescription Drugs Posted: 09-30-2011
- Working Group on Opioid Overuse and Abuse Posted: 08-12-2011
- One Member Speaks—What Are Your Thoughts? Posted: 08-12-2011
- Splinters From The Board Posted: 08-02-2011
- Dialog on Health Care Policy Posted: 08-02-2011
- UNE PA PROGRAM GRADUATES ITS 16TH CLASS by Emily Kumagae, PA-C Posted: 07-01-2011
- MANAGING OPIATE ABUSE AND DEPENDENCE - PREVENTION IS KEY! by Bob Klotz, PA-C Posted: 07-01-2011
- DEAPA JOINS MMA & MOA AT PHYSICIAN'S DAY AT THE MAINE LEGISLATURE Posted: 06-10-2011
- DEAPA PRESIDENT, PRESIDENT-ELECT MEET WITH GOVERNOR PAUL LEPAGE, COMMISSIONER MAYHEW Posted: 05-20-2011
- CONGRATULATIONS TO DEAPA's 2011 ANNUAL AWARD RECIPIENTS! Posted: 04-09-2011
- BOARD OF LICENSURE IN MEDICINE PA ADVISORY COMMITTEE UPDATE Posted: 03-18-2011
- OSTEOPATHIC OUTLOOK Posted: 03-18-2011
- DEAPA Representatives Attend CORE / Meet With Senator Snowe Posted: 03-09-2011
- Physician Assistant Practice Ownership Posted: 03-09-2011
- PAs Encouraged to Utilize Maine Prescription Monitoring Program Posted: 10-22-2010
- Volunteerism Posted: 10-22-2010
- Splinters From The Board Posted: 10-09-2010
- Splinters From The Board Posted: 07-10-2010
- Splinters From The Board Posted: 04-10-2010
- Spotlight on Laura Corbett, PA-C—Haitian Experience “His Hands for Haiti” Posted: 04-01-2010
- Splinters From The Board Posted: 01-10-2010
Archived News Articles:
PA DAY AT THE LEGISLATURE
Mar 19, 2013- PAs and Physicians will participate alongside each other at Physicians/PA Day at the Legislature,State House, Hall of Flags, Second Floor
March 19th, 2013
8:00 am to 4:00 pm
Engage with your legislators and participate in the legislative process. Speak up on issues of significance to physicians and PAs, such as: implementation of the Affordable Care Act (ACA) and health care reform; scope of practice for non-physician practitioners; state budget priorities including MaineCare funding; public health promotion efforts; and more.
We strongly urge you to attend and invite your colleagues.
Our State House visits make a very positive impression on legislators.
The day will begin with a continental breakfast at MMA headquarters at 7:30am. Then at 8am there will be a 1 hour briefing on DEAPA legislation & talking points for the day's events. At 9am we will travel to the statehouse where we will have the opportunity to meet with legislators and staff throughout the day. A complete agenda and packets will be provided for all PAs.
Contact Maureen Elwell:
(207) 622-3374 ext. 219
Maine Medical Association
DEAPA 23rd Annual Winter CME Conference
Feb 06, 2013- Date(s): February 06, 2013 to February 09, 2013
Location: Sunday River Resort, Grand Summit Hotel, Bethel, Maine
Contact: Diane McMahon Phone: 207-622-3374 x216 email: email@example.com
Event Details: Session Topics Include:
*Overdoses & PMP Database
*Complementary Medicine after Breast Cancer Treatment
*Affordable Care Act
***2 hours of CME Requirements for Maine PAs with Schedule II prescribing privilege
The Grand Summit Resort Hotel combines the best of two worlds. It offers all the amenities you would expect from a full service hotel, like two restaurants, a heated outdoor pool with hot tub, fitness and health center with sauna, free wi-fi, public computer, gift shop and game room. Accommodations range from standard hotel rooms to one-bedroom suites with kitchenettes. Additional services and amenities include valet parking, day care, ski check, spa and concierge.
For more information and to be added to the mailing list, contact Diane McMahon, DEAPA Staff Liaison at 207-622-3374 ext. 216 or firstname.lastname@example.org
Additional hotel information can be found at www.sundayriver.com/lodging/LodgingDescriptions/GrandSummitHotel.html
What if Everyone had Health Care in Maine?
Nov 15, 2012- A Moderated Public Discussion: What If Everyone Had Health Care in Maine?
Date/time: November 15, 2012 6:30 PM
Location: Think Tank, 533 Congress Street, Portland ME
Contact: Beth Franklin 650-3177 or email@example.com
The public is cordially invited to a moderated discussion of our current health care system in
Maine – the problems, the progress, and how to make it really work for everyone – on Thursday,
November 15th, at 6:30 pm, at the Think Tank at 533 Congress Street in Portland. The evening
will include a condensed, 27-minute version of the film, The Healthcare Movie, narrated by
Kiefer Sutherland, highlighting the differences between the health care systems in Canada and
the United States.
Some of the points of discussion will include:
• Over 48 million Americans are uninsured
• Over 133,000 Mainers are uninsured
• Over 45,000 Americans die each year because of a lack of health insurance
• The US spends more on health care than any other country in the world
• The US ranks 36th in life expectancy
Additionally, two recently released reports, one by the Institute of Medicine and one by
Consumers for Affordable Health Care conclude that health care spending continues to be
wasteful nationally, and insurance costs continue to escalate here in Maine.
The moderator for the evening will be Dr. Philip Caper from Portland, a physician and former
lecturer at the Kennedy School of Government at Harvard, and one of the founders of Maine All
Care. Following the screening, Beth Franklin, a community leader and a health reform advocate,
will join Dr.Caper to answer questions as part of the Q&A session.
This event is sponsored by Maine AllCare, an all-volunteer, non-partisan, non-profit
organization, whose goal is to promote quality, affordable, equitable and universal health care for
Maine people through research, education and advocacy. Maine AllCare is Maine state chapter
of Physicians for a National Health Program (PNHP).
Please come and join the discussion and learn what you can do to help.
Contributions to Maine AllCare are tax-deductible under section 510(c)(3). of the IRS code.
For additional info please contact: Beth Franklin 650-3177
There is no excuse for letting our friends and neighbors die for lack of health care.
Innovative Solutions for Building Recovery w/ Alternatives to Psychotropic Meds
Jul 12, 2012- September 20-21, 2012
This cutting edge conference hosted by Co-Occurring Collaborative Serving Maine (CCSME) includes nationally and internationally recognized keynote speakers, breakout sessions, an expert panel discussion, and opportunities for networking in beautiful New England fall foliage. With a focus on effective, empirically demonstrated non-medical solutions for behavioral conditions, this conference brings together the foremost experts in the field to present the evidence about the true effectiveness of psychotropic medication and to introduce viable alternatives to medication and guidelines to raise the bar of care equal to the available science. Presenters include Robert Whitaker, James Greenblatt, MD, Joanna Moncrieff, MD, Barry Duncan, PsyD, David Oaks, David Cohen, PhD and others. CME have been applied for.
DEAPA Membership Dues 2012-2013
Jul 03, 2012- There are still members who need to renew their memberships. Go back to the DEAPA home page, you will see the on-line link to renew your membership.
DEAPA WELCOMES A NEW PA Program to New England!!!
May 18, 2012- The Tufts University School of Medicine’s Physician Assistant is currently accepting applications for its inaugural class. Pending ARC-PA provisional accreditation (Program is scheduled for accreditation review at the September 2012 ARC-PA commissioners meeting), the University intends to seat it first class of thirty students in January 2013. Tufts PA Program Brochure
STUDENTS....Apply for a scholarship!!!
Feb 23, 2012- If you know students who are Maine residents with a desire to practice in our state after graduation who might be interested in applying for the Susan Vincent Memorial Scholarship, please encourage them to do so. All application must be received into Karen Snell by June 1, 2012
The application form is on the home page
Annual Nominations polls are OPEN
Feb 23, 2012- The Awards Committee of DEAPA have announced the request for nominations for each of our four annual awards.Voting is made easy to do online, by clicking on the link below. If you prefer to print out a nomination forma; visit the Home page of this website and follow the instructions to print out the form. All nomination forms need to be returned to Karen Snell by April 2, 2012
Become a DEAPA member!
Feb 21, 2012- The Board of Directors is composed of elected DEAPA members who meet on a quarterly basis for board meetings and periodic conference calls. We are looking to fill the position of DEAPA Vice-President, Secretary and Treasurer. For further information regarding the roles and responsibilities of these two positions you can view them in the DEAPA Policy Manual online at:
deapa.com to the membership tab and to the policy manual link.
AAPA Physician Assistants Census
Jan 09, 2012- AAPA Physician Assistant Census
Take the census – win an iPAD!
Please support your profession by taking AAPA’s Census online at www.aapa.org/census and get entered to win an Apple® iPAD and many other prizes!
Maine CDC Pertussis Survey
Dec 08, 2011- Pertussis continues to increase in Maine and in many regions of the United States. The majority of reported pertussis infections have occurred in Penobscot County, but sporadic infections have occurred throughout the state.
In order to learn more about pertussis diagnosis and testing practices, Maine CDC is currently conducting a pertussis provider survey. So far, our response rate has been less than 10%, so your participation is greatly needed and appreciated. Your answers will remain anonymous and it should only take you 3-5 minutes to complete. Results of the survey will be shared with you and used by Maine CDC to reduce barriers to optimal pertussis diagnosis and management. Following completion of the survey you will have a chance to win a one year subscription to one of the following professional journals of your choice: New England Journal of Medicine, Pediatrics, Clinical Infectious Diseases, Archives of Pediatric & Adolescent Medicine or Public Health Reports. There will be 14 winners. The survey link will be open until December 9th.
Please click the link below to take the survey.
Congratulations to Kenneth Nadeau, PA-C!
Nov 01, 2011- Congratulations to Kenneth
Nadeau, PA-C on his Clinical Excellence
Award from Maine Primary
Care Association. Kenneth is a PA
of 32 years and was recently promoted
to Associate Medical Director
at Penobscot Community Health
Center's Helen Hunt Health Center
in Old Town. Kenneth was awarded
the Physician Assistant Excellence
Award during the Maine Primary
Care Association's October
Annual Meeting at the Harborside
Hotel in Bar Harbor.
Physician Assistant’s Response to Domestic Violence
Sep 30, 2011- Domestic violence constitutes a major health care problem with potentially disabling or lethal outcomes. The direct and indirect costs are staggering, estimated at in excess of 6 billion dollars annually in ER visits, clinic visits, mental health treatment, and time lost from work. Screening and identification is oftentimes challenging in the face of the dynamics of abusive relationships. Universal screening should be standard practice in all healthcare facilities and health care providers must be trained in screening, identification, documentation and appropriate referrals.
The Maine Coalition to End Domestic Violence reported in July, 2011 that of the 26 homicides in Maine so far this year, 11 (42.3%) are classified as “domestic homicides”. According to the U.S. Department of Justice, between 1976 and 2005, 11% of all homicides were related to domestic violence. These data raise questions about steps that can be taken to help reverse this alarming trend.
There is no specific demographic profile of a victim of domestic abuse. This crime transcends all socio-economical tiers, all racial and ethnic groups, educational levels, ages, genders, and sexual and religious orientations. Most victims, however, are women 16-24 years of age. Domestic violence is a pattern of coercive behavior that is used by a person against family or household members or current or former dating partners to gain and maintain power and control in a relationship through the use of intimidating, threatening, harmful, or harassing behavior. Abuse is purposeful and deliberate. Through threat of physical, emotional, financial or sexual abuse, victims are often isolated from the resources available to help them.
Domestic violence is a public health problem that can significantly and negatively impact our patients’ health outcomes. Domestic violence can manifest itself in many ways, and victims of domestic abuse are at an increased risk of heart disease, stroke and chronic pain. Abused women and girls are at significantly higher risk for unintended pregnancy and sexually transmitted infections, including HIV and poor pregnancy outcomes. Children who witness family violence are more likely to experience depression, substance abuse, obesity and asthma. Pre-existing health conditions can also be exacerbated by chronic abuse.
In the medical field, there is a unique opportunity for early identification and intervention of abuse. Identification of domestic abuse through routine screening of all female patients is a Standard of Care recommended by organizations including:
The American Medical Association (AMA)
Joint Commission in Accreditation of Healthcare Organizations (JCAHO)
The American Academy of Physician Assistants (AAPA)
The American College of Obstetricians and Gynecologists (ACOG)
The Centers for Disease Control ( CDC)
The Nursing Network
The Institute of Medicine
Routine screening, in addition to indicator-based screening, can increase the identification of domestic abuse, provide opportunities for patient disclosure, lead to a reduction in mortality, save the healthcare system million of dollars, and it can help physician assistants provide vital options to patients. Face-to-face screening by skilled healthcare workers has been shown to significantly increase the identification of domestic violence (McFarlane et al, 1991). This important provider-patient interaction validates the patient’s situation, communicates to her (or him) that the healthcare provider is willing to listen, that abuse is an issue to be taken seriously and that help can be provided in a safe way.
Physicians for Social Responsibility (PSR) has done some initial investigation regarding which routine screening questions are most likely elicit a positive response. Through surveying practicing health care providers throughout the country and narrowing down their preferred screening questions to the top 3 questions through consumer focus groups, PSR has determined that an indirect approach builds more trust in the patient-provider relationship and demonstrates the most compassion, while being applicable to many different patient populations: “Who do you live with? Does he (she) treat you kindly? Does he hurt you in any way (either physically or emotionally)?” This 3-part question can lead to follow-up questions if the provider detects any hesitation or other cues to move forward. The questioning can be about any current or former relationships and can include questions about stalking or other predatory, intimidating or controlling behavior.
Many patients have already left an abusive situation and might be in hiding. Patients may disclose abuse but can not safely leave the situation at the time of the disclosure. We need to be sensitive and supportive of these patients. It is crucial that practices be prepared for the possibility that a perpetrator accompanies a patient to her appointment (as they often do as part of the control dynamic). It is essential to have mechanisms in place to allow the patient to be questioned alone. Many offices now have a policy in place that the first few minutes of all visits are with the patient and provider alone. Another time to interview the patient alone might be while escorting to a restroom or lab for specimens or blood work. It is important to be creative and proactive, but in any case never to bring up the issue when anyone else is present. It may be that the medical office is the only safe place from which a patient can talk to a local helpline, so providing this opportunity can be vital.
PSR has been providing medical personnel in Maine with the appropriate education and practical tools to help prevent domestic abuse since 1996. Using the medical RADAR tool, medical facilities have learned to Routinely screen all patients; Ask direct, non-judgmental questions, always alone; Document responses and findings accurately and verbatum; Assess immediate patient safety; and Refer the patient to the appropriate resource. This program is distributed and taught by PSR-trained clinicians and local violence prevention educators, in partnership with the Maine Coalition to End Domestic Violence, Maine Coalition Against Sexual Assault, Violence Intervention Partnership, and MMC. Physicians for Social Responsibility offers the Domestic Violence Response Initiative (DVRI) to medical practices and clinics, at grand rounds, and at conferences as a way to train health care providers and staff in the effective and efficient response to abuse in their practices. The DVRI training reviews the basics of domestic violence, the health risks associated with abuse, clinical “red flags” and the RADAR process. This interactive training can be accomplished in any office setting, tailored to fit the specific needs of the practice (elder abuse, pregnancy, minority health, etc). The presentation takes approximately one hour and CME credits are available. Local and statewide resource materials, RADAR cards, materials for the office to display, screening questions and diagnostic guidelines are provided as part of this free of charge program.
PSR/ Maine welcomes members from the entire spectrum of healthcare. For more information about joining PSR/Maine please contact our office at 207.869.1014. Contact PSR’s Domestic Violence Program Director, Janey Morse at 603-828-6272 or firstname.lastname@example.org to schedule a training at your facility or to find out more about volunteering as a trainer in your area.
Theater as a Catalyst for Community Conversations
Sep 30, 2011- The Maine Humanities Council’s Literature & Medicine Program is providing health care professionals in Maine with a rare opportunity to see two performances by Outside the Wire. http://www.outsidethewirellc.com/about.html), an innovative, nationally acclaimed reader’s theater troupe that that uses ancient Greek drama to spark community dialogue about pressing public health issues. The performances, “End of Life” and “Theater of War,” promise to be riveting, and will, we hope, be the start for further conversations about issues related to end of life and to the effects of combat on soldiers.
Why use ancient Greek plays? In ancient Greece theater was employed as a tool to engage audiences in dynamic, thoughtful dialogue about difficult issues; there are few issues more difficult to discuss than those related to the re-integration of warriors into society, and to the end of life. In both performances, a cast of professional actors brings the characters and issues to life, delivering a powerful performance that engages audiences on a deep level, eliciting heart-felt conversation in the town-hall style discussion that follows the performance. This moderated discussion is led off by a panel of Mainers representative of those engaged in issues related to the readings- including family members and health care professionals- who share their reactions to the performance. The moderator then opens up the discussion to the audience.
“Theater of War” will be performed at the University of Southern Maine on October 19th. It
presents a reading of scenes from Sophocles’ Ajax and Philoctetes, timeless ancient plays that read like a textbook description of wounded warriors struggling under the weight of psychological and physical injuries to maintain their dignity, identity, and honor. This is followed by a town-hall style discussion of the issues raised by the play. Director Bryan Doerries created the performance in the hope that it would help to de-stigmatize psychological injury among soldiers and veterans, and open a safe space for dialogue about the challenges faced by service members, veterans, and their caregivers and families. “Theater of War” was performed at MHC’s recent conference on humanities and trauma held last November. As one participant put it, “Theater of War shook me to my core, and the response of the panel members was raw and incredibly effective.”
In addition to the health care professionals at our conference (many from Veterans Administration Medical Centers), the performance has reached military sites throughout the United States and Europe under a contract from the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) in 2009-2010.
“End of Life” will be performed twice- at Maine Medical Center in Portland on October 18th, and at the Gracie Theater at Husson University in Bangor on October 20th. “End of Life” also presents classical Greek drama read in reader’s theater style, performed by professional actors. Most of us, whether a professional health care provider or not, will be called upon to care for another who is approaching death, and we can hope that we will, in turn, be cared for in the same way. “End of Life” helps audience members begin – or continue - the difficult discussions about death that are hard for all of us, and it will also promote exploration of the ethics of treating patients facing painful, prolonged deaths.
“End of Life” has been used as a teaching tool by Harvard Medical School and the University of Virginia School of Medicine to prepare medical students to face the challenges of attending to the needs of terminally ill and chronically suffering patients and their families. The production draws on key scenes from two classical plays that reach directly to the heart of issues involved in the end of life: loss, pain, anger, fear, isolation, love and compassion. The scenes present emotionally charged, ethically complex situations involving suffering patients and conflicted caregivers, providing an ancient perspective on contemporary medical issues.
The performances are made possible by support from The Sewall Foundation, the Hospice Fund of the Maine Community Foundation, Maine Medical Center, the University of Maine at Augusta, The Ethics Committee of Eastern Maine Medical Center, Husson University, Eastern Maine Charities, and the Maine Humanities Council.
We encourage you to attend one or more of these performances. Please contact Annie Medeiros (email@example.com ) if you would like to receive more information about the performances when the final details are finalized.
Maine Humanities Council is a private nonprofit organization, Maine’s affiliate of the National Endowment for the Humanities. It promotes strong communities and informed citizens by providing Mainers with opportunities to explore the power and pleasure of ideas. For more information about the Council and its award-winning Literature & Medicine program, visit: www.mainehumanities.org
Where will you be in 2029? Study Babies will be voting!
Sep 30, 2011- In 2029, the babies born and enrolled into the National Children's Study (NCS) through the Maine Study Center will celebrate their 18th birthday. Most of them will be healthy, but some may struggle with health issues like asthma, attention disorders, or obesity.
Why do children carry such burdens, and how can we help them? "When I talk with parents, they want to know how to keep their kids healthy," says Laura Blaisdell, MD, MPH, FAAP, a pediatrician and investigator in the study. "The NCS will help us understand children's health by observing children over many years, expanding vital, evidence-based knowledge to improve the health of our nation."
The National Children's Study, funded by the National Institutes of Health, is the largest study of its kind ever to be conducted in the United States. It's designed to expand our knowledge of children's health and development here and across the country for generations to come.
The Maine Study Center began recruiting families from selected areas of Cumberland County in December, as part of a pilot study. Every home in eligible neighborhoods is visited to ensure the study represents the diversity of Cumberland County families. The Study team has visited more than 16,000* homes and recruited almost 200* women and families who are pregnant or likely to become pregnant soon. Recruitment for the Study will continue over the next 4 years. To date, families in the Study have delivered almost 100* babies. Eventually 100,000 children across the US (including an expected 1,100 from Maine) will be followed from before birth until age 21.
For more information, contact Jessica Begley, Hospital Liaison, at 207-662-4069 or firstname.lastname@example.org.
*NCS Rounding rules apply.
MICIS is a Resource For Independent Information on Prescription Drugs
Sep 30, 2011- The Maine Independent Clinical Information Service (MICIS) is an academic detailing program run by the Maine Medical Association that provides a valuable free service available to all prescribers in Maine. It offers up-to-date, evidence-based information on prescription drugs brought to you by a non-commercial source in the convenience of your own practice setting.
MICIS was launched in 2009 and since then has reached over 750 prescribers in Maine who have received academic detailing on one or more of the four topics offered to date: diabetes, anti-platelets, hypertension, and atrial fibrillation. Prescribers rate the program, and the quality of information it provides, highly. Three-quarters of participants indicate that they plan to make changes to their prescribing practices based on the evidence presented by MICIS.
Newest module: Chronic pain
This fall, by popular demand, the program will offer an academic detailing module on the outpatient management of chronic pain. More than 100 million people in the United States have chronic pain and many don’t receive the treatment they need. While under-treatment is more common among the elderly, many younger patients may be receiving pain medication in a manner not supported by the evidence.
Prescribers report many barriers to the effective management of pain including fear of side effects such as addiction or dependence. The MICIS chronic pain module offers providers key informing for addressing those barriers and others in order to optimize the treatment of chronic pain for patients in their practice.
This module includes the following important topics among others:
Management of chronic non-cancer nocioceptive pain: acetaminophen, NSAIDS, opiates and opiate-like agents
Management of chronic non-cancer neuropathic pain: anticonvulsants and antidepressants
Comparative safety, efficacy and costs of pain medications
Attenuating the risks of adverse events from pain medications including guidelines for reducing the risk of opiate addiction and misuse
Also available: Atrial fibrillation
Earlier this year, the program launched an academic detailing module on atrial fibrillation. Atrial fibrillation (AF) is the most common arrhythmia, affecting nearly 2.5 million Americans. Because its prevalence rises rapidly over 60 years of age, this number is likely to increase significantly as the population ages. Regardless of underlying causes, or if no cause be found, the patient should be evaluated for rate or rhythm control. Rate control appears to cause fewer adverse drug effects and hospitalizations than rhythm control.
AF is a major cause of stroke, but treatment can reduce that risk by two-thirds. Most AF patients will require long-term anticoagulant or anti-platelet medication to reduce their risk of stroke however, there is ample evidence that anticoagulation is vastly under-utilized in patients with AF, particularly the elderly. This appears to result from an incorrect assumption that the risks of bleeding from these regimens are greater than the risk of stroke, which is generally not the case.
This module covers the following important information for the care of patients with AF:
Treatment targets: Control the rate, or control the rhythm?
Beta blockers, calcium channel blockers, digoxin and antiarrhythmics
Using the CHADS2 scoring system and the HAS-BLED risk index to guide thromboprophylactic therapy
Aspirin, clopidogrel, warfarin and dabigatran
Contact MICIS for a visit
A visit from one of the program’s academic detailers can be arranged upon request for a one-or-one session or for a group session within a practice setting, including hospital grand rounds. To request an educational session at no cost to your practice, please contact the Maine Medical Association at 207.622.3374 or email@example.com. Please also visit the Maine Medical Association’s website to learn more about the program, and watch out for upcoming topics to be made available such as atypical anti-psychotics: www.mainemed.com/academic/index.php.
Working Group on Opioid Overuse and Abuse
Aug 12, 2011- On Friday (August 5), the State Substance Abuse Services Commission convened a legislatively-mandated work group to review and make recommendations for improvements in how physicians and other prescribers treat chronic, non-cancer pain without causing addiction or diversion. The group's recommendations will be reported to the Health and Human Services Committee by December 1, 2011. These recommendations and any subsequent enactment of them by the legislature could have a very profound impact on medical practice.
The work group is the result of the HHS Committee deliberation and action on L.D. 1501, An Act to Reduce Opioid Overprescription, Overuse and Abuse, which was introduced by Portland representative Jon Hinck. As originally drafted, the legislation would have imposed the same requirements as recently established in the state of Washington, including: mandatory CME, mandatory referrals and mandatory use of the Prescription Monitoring Program for physicians and other prescribers who treat chronic pain with controlled substances. Ultimately, the legislation was amended to simply require the existing Substance Abuse Services Commission to convene a working group of interested parties to review existing practices and make recommendations for improvements.
Specifically, the working group is to:
- Review current efforts in the State aimed at preventing addiction and diversion.
- Examine similar efforts in other states, including Washington State, which earlier this year implemented comprehensive legislation on this subject.
- Consider additional tools that could lead to decreased abuse while not unduly restricting access to adequate pain control.
- Consider enhancements to the current Controlled Substances Prescription Monitoring Program.
The Friday morning meeting was the first of the group and virtually all the discussion involved the process of how the work of the group will get done and who should be around the table. The group agreed to meet every two weeks for two to three hours until the report is finalized for the legislature. The next three meetings will be held on August 19, September 9, and September 23rd, all beginning at 9:00am at the offices of the Office of Substance Abuse in Augusta. All the meetings are open to the public.
(Reprinted with permission by the Maine Medical Association)
DEAPA was represented by Ken Tolman, PA-C of Greenville. Ken has agreed to represent DEAPA on this work group; however, due to the time commitment, the DEAPA Government Affairs Committee is open to having more than one representative at the meetings if there are other PAs interested in being involved with the work group. Please contact DEAPA President and Government Affairs Committee Chair, Erika Pierce at firstname.lastname@example.org with questions or interests in joining the work group.
One Member Speaks—What Are Your Thoughts?
Aug 12, 2011- DEAPA has received the following letter from member David Hamel, PA-C, who works in emergency and occupational medicine/urgent care in southern Maine. Dave also has a commercial pilot's license and works part time as a flight instructor at Southern Maine Aviation. He owned and operated Northstar Aerial Photography for a number of years. He says, “Flying has been a good counterbalance to medicine for me. I love the precise nature of it: You know immediately whether the landing was good or bad. In medicine there is more uncertainty and sometimes the outcomes are not so clear.”
DEAPA’s Government Affairs Committee (GAC) welcomes Dave, as he brings clear opinions to several issues of great importance to the profession. DEAPA members know that the GAC is currently monitoring proposed changes to the Chapter 2 Rules of the BOLIM governing PA Practice. DEAPA President Erika Pierce is also working with the Board of Osteopathic Licensure on a possible proposal for PAs working with DOs, enabling Schedule II prescribing authority. DEAPA leadership needs to know members’ opinions. Dave has helped the debate by drafting a clear document, outlining possible approaches to the issues before us. We’d like to hear your comments on Dave’s opinions. Thanks to Dave, and (in advance) to all of you for sending in comments.
First of all, THANK YOU for the work you do for Maine PAs.
I think a number of changes are long overdue for the PA profession in Maine including:
- We need to change our name to Physician Associate to more closely represent how we actually practice medicine.
- We should change the regulatory language from "Supervising Physician" to Sponsoring Physician.
- PAs should be ENCOURAGED to start, own, and operate primary care practices...especially in underserved areas.
- We should have Schedule 2 privileges for all PAs instated IMMEDIATELY, without any extra paperwork required.
- Stop requiring the redundant reporting of our CME on our license renewal applications if we are NCCPA certified.
- We need MORE autonomy in our practice regulations, especially in primary care settings.
Let me give you an example of why I think the system is broken:
I've been a PA for 25 years, most of it spent working in primary care settings. I was recently asking one of my ED physician supervisors to sign a Schedule 2 prescription… Sitting across the room was a new graduate NP, just out of school, who overheard this and chimed in: "Us NPs can prescribe Schedule 2!!!" Imagine me tracking down the busy ED doc in order to ask "Mother, may I prescribe this Tylox" for the patient with a fracture, while this fresh-faced kid with 3 months experience is sitting there chuckling at us.
The NPs have done a great job of increasing demand for their services, by making themselves less cumbersome to employ. They have advocated for their profession tirelessly and promoted themselves vigorously. Meanwhile, the burgeoning NP educational industry is cranking out new grads to fill the slots.
Why hire a PA when you can get an NP to do the same thing and not have to worry about "supervising" them? That is the current reality here in Maine and numerous other states that no longer require MDs to supervise NPs. I actually admire what the NPs have done for their profession.
Maine used to be a good state for PAs to practice in. It was the first state to allow PAs to prescribe. What happened?
Why as a profession are we going backwards in the state of Maine?
Why can we STILL not prescribe Schedule 2 medications?
Why are we PAs singled-out to have to participate in the PMP? Are PAs suddenly not to be trusted?
Why this increase in the level of required formal supervision?
The PA profession expanded significantly over the years into the specialties because we were seen as money-makers for physician entrepreneurs. The surgical subspecialties, in particular, make a lot of money off of their PAs. I am sure many specialty PAs still think life is rosy and the future bright.
As a result, I think the profession has neglected its primary care roots. This is unfortunate because primary care is the "face" of the profession.
Now, the demise of the private physician practice is upon us, and the trend is towards consolidation and ownership of practices by hospitals and other large corporations. Physicians are becoming employees. The financial benefits to them of supervising a PA may no longer outweigh the perceived risks and additional workload of doing so. It is much easier for a healthcare organization to hire an NP who the physicians can ignore, than to hire a PA who must then be attached to some supervising doctors. And all this in a time when there is a worsening shortage of primary care providers.
PAs were DESIGNED TO BE PRIMARY CARE PROVIDERS.
We are not the problem...We are part of the solution. Primary care has the potential for the highest number of patient encounters with PAs. It is where the public is most likely to see what we can do. We should be vigorously promoting PAs as the answer to the worsening lack of access to primary care. Yet here in Maine (and increasingly elsewhere) we risk being shut out of the primary care workforce by employers who would much rather hire an autonomous, independent, low-maintenance NP.
Its time for the profession to stand up for itself, speak out, evolve and change with the times. Or risk becoming irrelevant.
I am interested in helping out on the legislative affairs committee. Give me a call if you want a "radical" to throw his hat into the ring.
Splinters From The Board
Aug 02, 2011- The following issues, which may be of interest to the general membership of DEAPA, were discussed at the July 16, 2011 meeting of the Board of Directors. Contact information for all Board members is available on the website at www.deapa.com.
• Gregg Christensen was presented with a clock and plaque at the July Board of Directors meeting, thanking him for his service and serving as president of DEAPA.
• DEAPA is in need of leadership and committee members for the CME committee. Two leaders are stepping down after this year, and DEAPA is actively trying to recruit new members.
• The Board voted to move the general membership meeting from the April Board Meeting to Thursday evening, Feb. 2nd, during the annual CME conference. The awards ceremony will remain a separate event, at the March or April board meeting.
• “DEAPA Dollars” reward program will soon be implemented. Members will receive “points” for referring members to DEAPA and can apply them to the CME conference or to renewing their membership.
• The Deputy Chief Medical Examiner expressed interest in recruiting PAs for death scene investigation. He would like to see if there is sufficient interest, and start a pilot training program to see if this is a feasible way to utilize PAs and fill a void for this need in Maine. Interested PAs should contact DEAPA VP Emily Kumagae (email@example.com).
• The Maine Medical Association (MMA) offered a $50 discount for PAs to attend MMA’s Annual Session in Bar Harbor in September. It can be applied to the full conference or a daily rate.
Dialog on Health Care Policy
Aug 02, 2011- DEAPA leaders have asked for your opinions, and one member responded by suggesting, a few weeks ago, that we distribute an article about a government study intended to find out if the nation's primary care providers were able to serve everyone, including patients insured by Medicaid. Opinion was divided, with some seeing the study as government intruding on providers' privacy, in addition to being unethical as the study design required researchers to essentially lie, posing as patients, and not identifying themselves as researchers. Others saw the study as a reasonable effort to discover whether or not there is adequate access to care for those who are publicly insured. Study results could potentially be used, for example, to determine whether or not funding of PA programs which train PAs to serve in primary care is a good use of our scarce rsources. Ultimately, the study was cancelled--its architects had failed to achieve, or even consider, the cooperation of the primary care community.
DEAPA encourages its members to familiarize themselves with important issues related to health care policy, and to pass their opinions along to be shared, if so desired. If you would like to write for DEAPA's e-news blasts or newsletter, please contact newsletter editor, Noel Genova at firstname.lastname@example.org.
One example of this support of study, sharing, and dialog is the Health Policy Study Group, started by MOA and MMA at Physician's Day at the Legislature earlier this spring. DEAPA is participating, led by Board member Kirsten Thomsen. Initially, participants are reading The Healing of America by TR Reid, as background for discussion about the direction participants think that health care reform should head. Any interested DEAPA member should contact Kirsten for details, at email@example.com.
We look forward to hearing from you!
UNE PA PROGRAM GRADUATES ITS 16TH CLASS by Emily Kumagae, PA-C
Jul 01, 2011- The University of New England Physician Assistant program recently honored its 16th graduating class. On Friday, May 20th, 47 classmates that comprise of Class of 2011 joined together in celebration. The Graduate PA Hooding Ceremony marked the completion of a required course of study. Students who enter the two-year program at UNE are already experienced health care providers who want to expand their skills. The class of 2011 came from careers in personal and athletic training, nursing, physical therapy, emergency services, research, and many other medical fields. All have at least one bachelor’s degree and many hold masters and doctorate degrees. Brian Fortie was recognized with the Outstanding Student Award for his academic accomplishments in the PA program. Emily Kumagae was honored to be nominated by the PA faculty for the prestigious Faculty Cup Award.
Of the graduating class, 20 new PAs plan on practicing in Maine and an additional 15 plan on staying in the greater New England area. DEAPA student directors Emily Kumagae and Angela Chase are amongst those who will be joining practices locally. Emily has accepted a position in spinal surgery at Falmouth Orthopaedic Center and Angela with the hospitalist group at St. Joseph Hospital. Their de-cision to become PAs has been most strongly influenced by experiences working with people who selflessly contribute their time and talents to the greater good of humanity. PAs take an oath, among other pledges, to hold the health, safety, welfare and dignity of all human beings as their primary responsibility and to work with other health care members to provide compassionate and effective care of patients. Thankful for the significant contributions of both past and present leadership, both Emily and Angela look forward to serving as advocates for PAs both in Maine and nationally.
Three new UNE graduates are recipients of the National Health Service Corps Scholarship. Upon graduation, NHSC Scholars are committed to serve two years at an approved site in a high-need Health Professional Shortage Area. Anthony Martin will be working in Northern Arizona, on the Hopi Reservation while Kellie Goudreau has accepted a position in New Mexico. Christine Strong is excited to be traveling to practice in the unincorporated U.S. territory of Guam, located in the western Pacific Ocean.
MANAGING OPIATE ABUSE AND DEPENDENCE - PREVENTION IS KEY! by Bob Klotz, PA-C
Jul 01, 2011- DEAPA News welcomes clinical articles of relevance to Maine PAs. Most of us realize that opioid dependence and addiction are serious issues in Maine. DEAPA member Bob Klotz has worked at Mercy’s Addiction Medicine Program, The Recovery Center, since 2006. For further information, he can be contacted through The Recovery Center at 207-857-8181, or at firstname.lastname@example.org. In addition, MMA and Maine’s Office of Substance Abuse (OSA) have resources for clinicians needing assistance for patients struggling with chronic pain (the MMA program) or with substance abuse (OSA). For further information on these programs, contact either newsletter editor Noel Genova at email@example.com, or Gordon Smith at firstname.lastname@example.org. Excellent resources are also available from the American Society of Addiction Medicine (ASAM), www.asam.org.
Bob graduated from George Washington University in 1980 and the Postgraduate Program for PA's at Maine Medical Center in 1983. Bob has extensive experience as a health educator with a special interest in complementary medicine (including training in osteopathic manipulative therapies and certification as a massage therapist). He has worked in family, occupational and emergency medicine along with a number of other specialties including proctology—truly a generalist PA who has been able to contribute in multiple settings.
Up-to-date statistics regarding opiate abuse and dependence are elusive, but here’s a notable one:
“Diversion through family and friends is now the greatest source of illicit opioids, and the majority of these opioids are obtained from 1 physician, not from ‘doctor shopping.’ “ 1,2
What to do with that individual abusing and/or dependent on opiates? Again, this is a complex issue, often best attended to with the variety of resources available. Some of the key tools are those required of any skilled practitioner: patience, compassion, organization and discipline, boundary and limit setting…including knowing one’s own limits. Comprehensive, coordinated care—often via a team approach—are also critical. Initially, this may include inpatient management of acute withdrawal from opiates.
The judicious and appropriate use of medications can be a key component in managing such abuse and dependence.
There are a number of medications generally used acutely in managing the transition from opiate dependence and addiction – including a host of “prn” medications to attend to the various symptoms associated with withdrawal, including clonidine, muscle relaxants, analgesics, and gastrointestinal medications.
Additional medications in the opiate antagonist or agonist groups may or may not be used for the short or longer term; consider:
Methadone has proven effective but possesses challenges – including a potentially narrow window of safety. It should be noted that Maine PAs are not authorized to prescribe methadone, and no prescriber is authorized to prescribe methadone for addiction outside of federally-licensed methadone clinics.
Naltrexone (Revia® orally, Vivitrol® injection monthly) is an opiate (and alcohol) antagonist but its use must be approached with caution, especially given its risk of inducing significant opiate withdrawal
Suboxone® includes buprenorphine (a partial opiate agonist) and naloxone (Narcan®; an opiate antagonist included to reduce the potential for injection) and is available as a 2 or 8 mg sublingual preparation. Lacking the risk-to-pregnancy naloxone ingredient, Subutex® can be part of an effort to attend to the 5-10,000 opioid dependent mothers yearly in this country. (Over 400 infants were born addicted to opioids in Maine last year.) Other formulations of buprenorphine exist including the transdermal product Butrans®. These products have been shown to be an effective adjunct to a comprehensive, long-term opioid maintenance process – as well as having benefits for the management of moderate-to-severe chronic pain. Maine PAs may prescribe buprenorphine for chronic pain, but great care must be taken not to prescribe it for opioid addiction, which is a violation of federal law.
At this point, there are significant limits on the prescribing of Suboxone® and Subutex® including special prescriber training required, a limit of 100 patients per prescriber – and physician-only prescribing of this Class III drug. Its use has proven most effective in the context of a larger communication and educational process including contractual agreements, random drug testing, and an expectation of ongoing interventions (including outpatient programs and counseling, 12-Step participation, and continued medical management).
Currently, there are political/professional activities to amend the Drug Addiction Treatment Act (DATA 2000) to allow PA’s to prescribe such medications; see AAPA related materials.3 All practitioners are encouraged to communicate with their fellow providers, their professional organizations, and their political representatives to expand the prescribing of these important medicinal interventions.
In closing, reinforcing the challenge we are confronting, consider: “Americans constitute 4.6% of the world’s population, but consume approximately 80% of the world’s opioid supply…Americans consume 99% of the world’s supply of hydrocodone…Americans consume roughly two-thirds of the world’s illegal drugs.” 1
Remember to be cautious with use of opioid medication. Each of us is part of the solution to the enormous problem of opioid addiction in Maine.
1 Opiod Abuse;http://emedicine.medscape.com/article/287790
2 Substance Abuse and Mental Health Services Administration. (2006). Results from the 2005 National Survey on Drug Use and Health: National Findings. (Of- fice of Applied Studies, NSDUH Series H-30, DHHS Publication No. SMA 06- 4194). Rockville, MD. www.oas.samhsa.
DEAPA JOINS MMA & MOA AT PHYSICIAN'S DAY AT THE MAINE LEGISLATURE
Jun 10, 2011- At the invitation of MMA, 4 DEAPA leaders staffed an informational table in the Hall of Flags at the Maine Legislature on Thursday, May 26, 2011. DEAPA President Gregg Christensen, Secretary Noel Genova, and BOD members Shawn McGlew and Kirsten Thomsen greeted many visitors to the table, primarily legislators and physicians, answering questions, sharing experiences and issues in our various clinical settings, and enjoying the hospitality of our state.
While hobnobbing, we enjoyed addresses by MMA and MOA leaders, as well as several Legislators. Gordon Smith and others, including newly-appointed Maine CDC Director, Dr. Sheila Pinette (a PA before she became a DO) briefed the 30+ MDs, DOs, and PAs on the current legislative session. Participants indicated an interest in being available to Legislators to shed light on the serious issues present in our current health care delivery system. A similar offer was made earlier this month to Governor Paul LePage and Commissioner Mary Mayhew by Gregg Christensen and DEAPA President-Elect Erika Pierce, on behalf of DEAPA. Director Pinette stated very clearly that Commissioner Mayhew is open to any and all ideas on how to improve access to care and the health of Mainers.
The important issues discussed at this session included medical marijuana, Certificate of Need (CON) process, and proposed changes to current laws allowing treatment of minors without parental consent in certain situations, such as for substance abuse.
A group of us attended part of a Senate session, and were recognized by the Senate President, and applauded by the Senators. It may sound corny, but it was very nice. Noel was able to meet with her State Senator, Justin
Alfond (D-Portland), the Senate minority leader, along with Gordon Smith, EVP of MMA. Senator Alfond admitted little familiarity with PAs, and we were able to describe the PA role to him. As with other leaders in the state, we offered ongoing assistance in information gathering on health care issues to Senator Alfond. (Noel skipped the photo op.) DEAPA President Gregg Christensen met with House Speaker Nutting, along with Andy MacLean, Deputy
Director of MMA. No photo op, but a report from Gregg about that meeting will be presented in the June DEAPA News.
Our goal in attending Physician’s Day was to begin to build relationships with our state Legislators. In the process, we had fun. We were invited to a tea at the Blaine House, with a
lecture by State historian Earle Shuttlesworth on the history of the Blaine House. (I confess, I thought it would be dull.) Not only was the lecture interesting, but the refreshments were yummy, the Blaine House and its gardens lovely, and we had further chances to converse with physicians on areas of mutual interest in a casual and relaxing setting.
We’ll have more on our experiences at Physician’s Day at the Legislature in the DEAPA News newsletter this month.
DEAPA PRESIDENT, PRESIDENT-ELECT MEET WITH GOVERNOR PAUL LEPAGE, COMMISSIONER MAYHEW
May 20, 2011- Gregg Christensen, DEAPA President, and Erika Pierce, DEAPA President-Elect met with Governor LePage and DHS Commissioner, Mary Mayhew on Monday May 16th to discuss PA issues in the State of Maine. Both Governor LePage and Ms. Mayhew are very aware of the vital role our profession serves for the citizens of Maine. Governor LePage’s PCP is a Physician Assistant (and DEAPA member) of whom he spoke very highly. We discussed the upcoming Chapter 2 rule changes, and they expressed support for DEAPA’s position on those changes. The
Governor feels that PAs will be integral in improving the access to Primary Care in the state. Erika provided them with materials and fact sheets which she had gathered from the AAPA. “We answered all their questions and we were very successful in opening a direct dialog with the Governor and the DHS Commissioner, offering them DEAPA as an informational resource as healthcare issues arise in the future”, stated Gregg Christensen.
CONGRATULATIONS TO DEAPA's 2011 ANNUAL AWARD RECIPIENTS!
Apr 09, 2011- Saturday, April 9th, DEAPA recognized 5 outstanding health care professionals at its Annual Membership & Award Meeting.
2011 Robert J. Lapham Outstanding Service Award presented to:
Cheryl DeGrandpre, PA-C and
Ann Norsworthy, PA-C
2011 Rural Physician Assistant of the Year awarded to:
Laura Corbett, PA-C
2011 Outstanding Health Care Professional awarded to:
Lori Eckerstorfer, PA-C
2011 Physician of the Year awarded to:
Mark Silver, MD
BOARD OF LICENSURE IN MEDICINE PA ADVISORY COMMITTEE UPDATE
Mar 18, 2011- One of the challenges facing the PA Advisory Committee (PAAC) of the Board of Licensure in Medicine (BOLIM) is how to define minimum supervision. What is supervision? When is supervision adequate and when is it inadequate? Part of the difficulties in regulating the PA Profession and in defining minimum supervision is that supervision is unique within every physician/PA team.
Members of the PAAC argue that it is difficult to discipline if minimum standards are undefined. In the process of trying to define minimum supervision we have heard many items discussed. Currently, the PAAC defines minimum supervision as twice yearly face to face meetings, with mandated items to be discussed within that meeting. DEAPA has some concerns about the rigidity within this definition of minimum supervision.
DEAPA supports leaving the definition of minimum supervision to the discretion of the physician/PA team. However, it has become clear that we must define minimum supervision.
I would ask every DEAPA member to tell us what minimum supervision is to you, in your practice, with your primary supervising physician. DEAPA is working hard to come up with solutions that help the PAAC of the BOLIM define minimum supervision and give them the needed muscle to discipline when necessary, but leave flexibility within the physician/PA team to allow for the innumerable nuances within these teams.
Please tell us more about what minimum supervision is to you. This allows the DEAPA Legislative Committee to have your input into their suggestions to the PAAC.
Next PA Advisory Committee Meeting: June 7th
Next Board of Licensure in Medicine Meeting: April 12th
Please respond to Barb Farrell: email@example.com
Mar 18, 2011- On March 10th Erika Pierce was joined by Angela Westhoff, Executive Director of the Maine Osteopathic Association and Gordon Smith, Executive Vice President of the Maine Medical Association at the Board of Osteopathic Licensure in Medicine Meeting.
Angela presented a letter from the current MOA president Joel Kase DO, MPH in support of Maine PAs licensed under the Osteopathic Board having access to Schedule II prescribing privileges. The letter supports PAs being considered on a case by case basis for schedule II prescribing privileges when supervised by a DO and an appropriate plan of supervision is in place.
Gordon Smith spoke in support of the measure as it is currently in place under the Board of Licensure in Medicine.
After hearing from all of us, the Board voted in favor of having DEAPA President Elect Erika Pierce PA-C work with a couple board members to develop the steps by which one would apply to the Osteopathic Board for schedule II privileges. Gary Palman DO and Marty McIntyre, public member of the Osteopathic Board of Licensure are the two Osteopathic Board members who Erika will be working with on this.
DEAPA appreciates your input on this matter.
What steps should be in place whereby a PA can request Schedule II privileges from the Osteopathic Board?
Any questions or concerns may be directed to DEAPA President Elect Erika Pierce at firstname.lastname@example.org
Next Osteopathic Board Meeting: April 14th
DEAPA Representatives Attend CORE / Meet With Senator Snowe
Mar 09, 2011- On February 17th I had the amazing opportunity to join over 250 PAs from across the country, including Maine PAs Erika Pierce and Paul Spencer, to deliver to Members of Congress a powerful, unified message about the PA profession.
The following three legislative issues were selected for discussion, and recommendations were presented in face-to-face meetings with Members of Congress and staff.
1. Currently, PAs are not allowed to provide hospice care to their patients, forcing families to seek alternative health care professionals to manage hospice care services. The recommendation was made to amend the Social Security Act to permit PAs to provide hospice care to their patients who elect Medicare’s hospice benefit.
2. The HITECH Act Limits the availability of Medicaid EHR incentive payments to “PA-led” rural health clinics and federally qualified health centers (FQHCs). An incorrect assumption was made when the Act was introduced that an incentive payment to PAs would be covered under payment to physicians. The recommendation was made to amend the Health Information Technology for Economic and Clinical Health (HITECH) Act to extend EHR Medicaid incentive payments to all PAs whose practice volume includes at least 30% Medicaid recipients.
3. DATA 2000 specifically requires that prescribers of buprenorphine be a physician and bars delegation of such prescriptive duties to PAs. This severely limits critically needed addiction treatment access. The recommendation was made to amend the Drug Addiction and Treatment Act of 2000 to allow PAs who complete certification training to obtain a DEA waiver to prescribe and dispense buprenorphine for opioid addiction.
Republican Senator Olympia Snowe met personally with us to discuss these issues. She said that she is grateful for the services PAs provide in Maine, especially in underserved communities, and supports legislation to further PA practice. She showed special interest in allowing PAs to provide hospice care services and is considering sponsoring a bill to amend the Social Security Act.
Members of Congress look to PAs to provide them with perspective and information on health care decisions affecting their communities. It is absolutely critical that PAs make their voices heard. I would encourage all PAs to visit their Member’s district office during Congressional recess periods to demonstrate the personal role PAs have in their communities. Get the latest federal and state advocacy news and tools through the AAPA’s Legislative Action Center. Together we can achieve the profession's legislative priorities!
Submitted by Emily Kumagae, PA-S2
Physician Assistant Practice Ownership
Mar 09, 2011- The DownEast Association of Physician Assistants is aware of excellent, well run, PA owned practices in the state. Over the years, Physician Assistant owned practices have served thousands of patients. Recently PA owned practices have become the center of the proposed changes to Chapter 2.
Under the Board of Licensure in Medicine (BOLIM), Chapter 2 contains the rules that govern current PA practice with a Medical Doctor (MD) in the state. The Physician Assistant Advisory Committee (PAAC) to the BOLIM was asked to review the chapter 2 rules and propose changes including limiting PA ownership of practices. The reasoning behind the concern over PA practice ownership is based on the perception that PA owned practices produce more numerous and significant complaints than from non-PA owned practices. However, when reviewing the public data on disciplined providers, it is not clear what percentage of PAs disciplined were actual practice owners. Several serious disciplinary actions against PAs did not involve PAs who owned their practices. Interested readers are invited to review disciplinary actions on the Board's website at www.docboard.org/me/discipline/dw_actions.html.
The Rules for Maine’s Osteopathic Physician Assistants
Several years ago the Maine Osteopathic Board of Licensure adopted a policy limiting PA practice ownership to 49%. This rule has been in place for several years, limiting the ability for PAs who are supervised by Osteopathic Physicians to own practices. Based on the request of BOLIM the PAAC has reviewed the Osteopathic Board’s rules on PA practice ownership and considered recommending a rule that mirrors the current Osteopathic rule.
The Potential Impact:
Although there are only a few PA owned practices in the state, if such a rule were put in place, those PA owned practices, as they currently stand, would have to restructure themselves or close, thereby impacting the community served by the practice. The real question is: Does closing or limiting PA owned practices increase public safety in the communities served by PA owned practices? If so, the BOLIM must limit PA practice ownership. At this time, DEAPA is not aware of any evidence to suggest that restriction of PA owned Practices increases public safety. This limitation will decrease access to care for patients who are currently served by a PA owned practice and prohibit any future PA owned practices from entering communities that may be served by such a clinic, at a time when access to care is limited for some populations.
An Ethical Dilemma?
There is concern that PA employment of the supervising physician renders it impossible for the physician to be impartial in their supervisory duties, suggesting that the relationship between a PA practice owner and the employed physician is unethical and should not be allowed.
In the recent March 1st PA Advisory Committee meeting the concern focused not on the PA employing the physician, or PA clinic ownership itself, but rather the need for transparency around the employment arrangement. There was consensus that all PA owned practices should disclose on Form C that the supervising physician is employed by the PA, as well as several ideas as to what else could be required disclosures. DEAPA leaders present at the meeting were encouraged that significant work is going into creating a licensing process that allows safe, competent, well-supervised PA owned practices which offer increased access to care in their communities.
A National Perspective:
The American Academy of Physician Assistants (AAPA) is very clear that the clinical relationship between a PA and their supervising physician is unrelated to employment arrangements. The supervising physician is always the clinical leader of the physician/PA team. The role of the supervising physician is defined in chapter 2 and that role remains the same whether the physician employs the PA, the PA employs the physician, or both the physician and the PA are employees (or co-owners) of the same practice.
What About Other States?
There are many examples of PA owned practices throughout the country. Many individual states have laws that clearly allow PAs to own practices. However, the majority of states do not define who can own a corporation. Silence on the issue leaves the issue up for interpretation, but according to the AAPA many of these “Silent States” have examples of PA owned practices within them. There are only three states with clear rules that prohibit PA practice ownership: Arkansas, Illinois, and Louisiana. There are four states beside Maine that allow PAs to own a practice, but restrict PAs to owning a minority share of the practice: California, Colorado, Kansas and Oregon. Sixteen states clearly allow PAs to own a practice, and do not restrict the percentage of shares that may be owned by PAs. Despite the differences at the state level, the Centers for Medicare & Medicaid Services (CMS) allow Physician Assistants to own ninety-nine percent of a practice. From a national perspective, limiting PA owned practices would leave Maine PAs in the minority when it comes to allowing PA practice ownership.
What Do The Physicians Think?
DEAPA asked the Maine Medical Association for their position on this issue. We are expecting a formal stance from them on the issue by mid-March. Gordon Smith, Esq. and Executive Vice President of the Maine Medical Association gave an informal opinion supporting PA practice ownership.
DEAPA supports PA practice ownership.
What Can You Do?
DEAPA is interested in your opinion, and want your input on this issue. What aspects of the employment and supervisory arrangements between a supervising physician and employing PA should be required by the BOLIM?
A few suggestions:
Express your opinion to DEAPA so we can better represent our membership.
Contact the PA Advisory Committee of the BOLIM directly to express your opinion. PAAC Committee Chair: Erich Fogg PA-C
Get your supervising physician involved by asking their opinion and encourage them to contact the MMA on the issue.
Join the DEAPA Legislative Committee.
Attend the upcoming June 7th, PA Advisory Committee Meeting in person.
DEAPA Welcomes your input!
Contact us at: email@example.com or firstname.lastname@example.org
PAs Encouraged to Utilize Maine Prescription Monitoring Program
Oct 22, 2010- (by Erika Snowman Pierce, PA-C)
The prescription monitoring program (PMP) was initiated in the State of Maine in 2003. Since its start, prescribers have been actively encouraged to participate in the program with hopes that it would lead to decreased rates of diversion of prescription drugs. Diversion of prescription medications is a difficult measure to trend, but in its 7 year history the PMP boasts a reduction in the number of physicians and pharmacies utilized by drug seekers. In other words, the program reduced the behavior of “doctor shopping” within the State of Maine. Despite reductions in “doctor shopping” we are seeing concerning increases in the death rate from narcotics such as methadone. Our current state law requires all Schedule II, III, and IV medications dispensed within Maine to be reported to the PMP. The information is added to the PMP database weekly and is available to registered prescribers via a log-in process on the PMP website at www.maine.gov/pmp. Anyone accessing data via PMP should do so only if a documented provider/patient relationship exists with the person whose data you are seeking. Those who are not yet enrolled in PMP will have an additional step to registering as of 10/1/2010 that includes a signed and notarized affidavit that may be found at the PMP website. This additional step is due to requirements for grant funding allocated to PMP.
Benefits of PMP:
PMPs have many potential benefits. According to the National Alliance for Model State Drug Laws(NAMSDL), PMPs’ purpose is to support legitimate medical use of controlled substances. The programs should also assist in identifying and deterring drug abuse and diversion, and assist in prevention and treatment of addiction to prescription medications. The PMP may also be used to help inform the public of drug use and abuse trends and to educate individuals about use, abuse, diversion, and addiction to prescription medications. Further information about these issues within the State of Maine is available via the Maine Drug Enforcement Agency website at www. maine.gov/dps/mdea.
Proposed Requirement for Use by PAs:
Requiring all Physician Assistants to register with the PMP has been proposed as part of rule changes which are still in draft stages within the PA Advisory Committee of the Board of Licensure in Medicine (BOLIM). Along with registering with the PMP, it has also been proposed that PAs working with allopathic physicians be required to review their prescribing history via a printout from the PMP bi-annually with their Primary Supervising Physician (PSP). At this time the BOLIM recommends this review be done routinely as part of the supervisory plan. DEAPA is following this issue closely, and welcomes comments from members. There will be a period for public comment during the rule making process on the above proposal. We will notify all DEAPA members of the comment period, and of a public hearing if one is held. A formal public hearing will be held if the Board determines one would be desirable or if five members of the public request a hearing in writing.
In addition to Maine, there are many other states with prescription monitoring programs (PMPs). According to the NAMSDL, there are 33 states with operational PMPs. In addition, there are 6 states that have enacted laws to create a PMP, and 2 states with legislation pending. Washington State is the only state with a previously enacted and operational PMP whose program operations are currently suspended. Only three states currently impose a burden on practitioners to access PMP information. Utah requires all prescribers to register for the PMP and all prescribers must pass the PMP tutorial. Delaware requires all prescribers to obtain a report from the PMP prior to prescribing schedule II-V medications. In 2005 the State of Nevada enacted a law requiring prescribers to obtain a PMP report prior to prescribing schedule II-IV medications. Despite 5 years’ experience with the requirement, the State of Nevada has not seen a decrease in the diversion of prescription medications. In fact, Nevada’s PMP boasts reductions in “doctor shopping”, and reductions in numbers of dosages of prescriptions received by drug seekers just as the Maine PMP. However, according to the United States Drug Enforcement Agency the death rate in Nevada due to diverted pharmaceuticals increased from 107 in 2006 to 169 in 2008.
Many PAs Utilize the PMP:
The State of Maine Office of Substance Abuse publishes a report card on their website which shows the type, and the percentage of clinicians that are registered with PMP. PAs lead the way with 52% registering for PMP under the current volunteer guidelines. Following close behind are the DO’s with 47%. The report card does not break out the PAs by licensing board: Board of Licensure in Medicine vs Osteopathic Board of Licensure.
Upcoming Relevant Rules and Legislation:
In addition to proposed rules being drafted by the BOLIM, there will also be regulatory hearings regarding the PMP in early November. Noel Genova, of the DEAPA Board and Gordon Smith of the Maine Medical Associations both serve on the PMP Advisory Committee. DEAPA has been invited to be present at the regulatory hearing regarding the PMP. Reports about the hearings, and any potential impact to PAs in Maine, will be made to the DEAPA membership.
Again, the DEAPA Board of Directors encourages member input on any issue regarding utilization of the PMP, either voluntary or mandatory. Comments will be reflected in any public comments made by Board members representing DEAPA.
National Alliance for Model State Drug Laws, “Components of a Strong Prescription Monitoring Statute/Program”, November 2004. www.namsdl.org
National Alliance for Model State Drug Laws, “Status of Prescription Drug Monitoring Programs”, June 2010 www.namsdl.org
Maine Office of Substance Abuse Website: www.maine.gov/pmp
Personal communication, Sarah Kesley, Atty for National Alliance for Model State Drug Laws, September, 2010
Personal Communication, Daniel Eccher, Maine Office of Substance Abuse, Prescription Monitoring Program Manager, September, 2010
State of Nevada Prescription Controlled Substance Abuse Prevention Task Force 1997-2003, www.dhp.state.va.us/dhp_programs/pmp/docs/REPORT OF THE PMP.pdf
United States Drug Enforcement Agency, State Fact Sheet, Nevada, www.justice.gov/dea/pubs/state_factsheets/nevada.html
Oct 22, 2010- (by Laura Corbett, PA-C)
Yes, it is a word that's so powerful. There is an amazing quote from famous medical missionary, theologian, musician, and philosopher, Albert Schwietzer. " I don't know what your destiny will be, but one thing I know: the only ones among you who will be really happy are those who will have sought and found how to serve."
Over the past four years I've read this quote over and over and wondered, “Where do I serve?” I've traveled to Haiti since 2007 and will enjoy my eighth trip at the end of this month, doing medical mission work. But when asked to share a few things about reaching out in volunteer work as a PA, I considered that most of us don't have to travel to a foreign country to do volunteer work but have a very rich field here in our own back yards.
Maine is a wonderful state, and like so many others, hosts those who have little or none—those who come to seek employment opportunities from other countries; those who have settled among us to raise a family in a culture foreign to them—our own. Many of the invisible faces may or may not seek out help or resources, leaving them with less than we have to offer. Many of the needy are native Mainers.
There are two opportunities that I have recently looked into and am hoping will allow me to become more involved. There are homeless shelters across our state, and across our nation, that house and/or support people who once had much and lost their way somehow and now struggle to live. They need our eyes to look their way, see them and seek how we can contribute something to enrich their lives. So I look forward to providing medical care once a week to those who reside in a homeless shelter that is housed within a church in Skowhegan, Maine. I've visited. I've seen their eyes, heard some stories, felt their sometimes cold hearts. I hope to provide more than medical care, but hope as well.
The other opportunity I hope to become involved with is the Maine Migrant Health Program. This group is headed up by Barbara Ginley out of Augusta. They provide medical care to those migrant populations that travel to Maine for seasonal work each year, mostly from Jamaica, other Caribbean countries and Haiti. The agency's ability to reach out and provide care depends on the volunteer efforts of people in our communities who step out and offer what time they have to give. One of their most regular volunteers, who has been involved with this program over the past few years, is a UNE PA Program graduate. I hope to be part of their volunteer staff as of next spring.
There are many, many opportunities across the state to make such a difference.
Who lives in an area where there are many Somalis? Is there another ethnically rich neighborhood nearby that could use that intercessor – that bridge builder – in order for people to better access health care and/or other opportunities where we live and work? Are there other groups with limited access to health care who could use your help?
Would you like to become more involved? If so, we would like to speak further with you as we look at building a Diversity Committee involving our PA colleagues throughout the state, who might share a similar passion to serve the underserved!
Please contact one of us: Kirsten Thomsen (email@example.com) and/or Laura Corbett (firstname.lastname@example.org).
Splinters From The Board
Oct 09, 2010- (by Noel Genova, PA-C, Board Secretary)
The following issues, which may be of interest to the general membership of DEAPA, were discussed at the October 9, 2010, meeting of the Board of Directors.
The DEAPA Board formulated a position with regard to proposed changes to the BOLIM's Chapter 2 rules revisions, which govern PA practice in Maine.
--With regard to mandatory registration with the Prescription Monitoring Program (PMP)--PAs with Schedule II prescribing authority should be mandated to register with the PMP, with the expectation that they will review their prescribing profile with their supervising physician every 6 months, at a minimum. All other PAs are strongly encouraged to register with, and utilize, the PMP.
--With regard to PA ownership of a practice, with payment to a physician for supervision--this should not be regulated by the BOLIM. The BOLIM should be notified of this arrangement.
In addition, DEAPA has been asked to comment on proposed legislation regarding the PMP. The hearing on this legislation is scheduled for November 1st. DEAPA will be represented at least by Gordon Smith, and possibly by a member of the Board. DEAPA fully supports the work of the PMP, and supports the change which would allow non-licensed personnel, such as Medical Assistants or Practice Managers, to access the PMP via sub-registrations. This change might allow busy clinicians to access the PMP in a more timely and consistent manner than is practicable now.
Alternate Delegates are sought by Chief Delegate Shawn McGlew for the AAPA Annual Conference in Las Vegas in May. Any interested Fellow Members should get in touch with Shawn.
DEAPA's Ethics and Impairment Committee, chaired by Bill Head, with members Melanie Dumont, Mark Hanson, and John Raymond, is a vibrant committee, which meets quarterly and is an excellent resource for any PA issues related to Ethics or Impairment. There will be an article highlighting their work in the next DEAPA newsletter. The Ethics side of their work includes issues of professional integrity and values. The impairment side coordinates closely with MMA's MPHP, which offers confidential services for PAs (and other medical professionals) who struggle with addictions and other impairment issues. Members with questions on either ethics or impairment issues are encouraged to contact any member of this committee.
There is a bill which has been introduced to the Legislature regarding radiology assistants. Gordon Smith, Alan Hull, and Susan Kepes will keep track of this legislation, and report back to membership for comment, as appropriate.
Website designer Paul Nichols (husband of PA Karen Nichols) has done a beautiful job redesigning the DEAPA website. Members are encouraged to check it out!
Student Board member Emily Battson, who will be remaining in Maine after graduation from UNE in 2011, has set up a DEAPA Facebook page! Here's the link-http://www.facebook.com/group.php?gid=161058303921512. Please check it out, and refer comments to Emily, or to Staff Liaison Barb Farrell.
With the resignation of Patrick Enking from the DEAPA Board, a Director-At-Large position was open. Kirsten Thomsen, currently the interim clinical coordinator at the UNE PA Program, was nominated and unanimously voted as a new Board member. Kirsten comes to Maine from Washington, DC, where she was on the faculty at the George Washington PA Program. Welcome, Kirsten!!
Splinters From The Board
Jul 10, 2010- (by Noel Genova, PA-C, Board Secretary)
The following issues, which may be of interest to the general membership of DEAPA, were discussed at the July 10, 2010, meeting of the Board of Directors.
DEAPA welcomes Kirsten Thomsen, who has just moved to Maine from Washington, DC. Kirsten has been very active in AAPA activities, has worked in New Mexico, and has just come from the George Washington University PA Program, where she was on the faculty. She now lives in Portland, with her husband.
With Kellie Slate Miller’s departure from MMA, there will be changes in DEAPA’s staff liaison arrangement with MMA. Kellie was presented with flowers by leadership of the Board, in thanks for her excellent service to DEAPA. Gordon Smith presented a plan to cover DEAPA’s administrative, CME conference planning, and Executive Director roles to the Board. A final proposal will be made to the Board soon. At this time, Barb Farrell (email@example.com) is handling DEAPA’s administrative needs, and Warene Eldridge (firstname.lastname@example.org) is working with the CME Committee, planning the winter conference to be held at Sunday River.
Bill Head, Chairman of DEAPA’s Ethics and Impairment Committee, updated the Board on the Medical Professionals Health Program, now located at Dalco House, near MMA’s administrative building. Bill is a member of the Program’s Advisory Board, and meetings are now web-based. For information on the Program, or on how to make a referral, call 623-9266. You can also find information on the Program on MMA’s website, at www.mainemed.com. Click on “Medical Professionals Health Program” from the menu.
There will be universal vaccination available in Maine, due to changes in reimbursement made by the Legislature. Immunization rates in the state are expected to rise.
There will be a public hearing on the rule changes proposed by the BOLIM. The Chapter 2 Rules governing PA practice in Maine will be opened. This process allows any and all changes to be made. Major points of discussion will be the requirement for review of the PMP, and the issue of payment for physician supervision by a PA who owns a practice. DEAPA and MMA are following this process closely.
Chris Ross has stepped forward to be DEAPA’s Treasurer, which he has done before. Heidi Lukas, MMA CFO, will continue to prepare the monthly reports. Chris also volunteered for the open position of Delegate to the AAPA HOD. Bill Bisbee offered to serve as Membership Chair.
Strategic Goals for 2010-2011, in no particular order. –Following the changes in the Chapter 2 Rules through either the rule-making or legislative process. –Restructuring of Committees, including consideration of a diversity committee, and engagement of non-Board DEAPA members on those committees. –Continue to work to increase membership. –Continued outreach to the UNE PA Program and its students, and to other students with an interest in working in Maine. –Continue to work with the Osteopathic Board toward congruent rules for PA practice.
Splinters From The Board
Apr 10, 2010- (by Noel Genova, PA-C, Board Secretary)
The following issues, which may be of interest to the general membership of DEAPA, were discussed at the April 10, 2010, meeting of the Board of Directors.
Much discussion ensued on the Board of Licensure in Medicine’s PA Plan of Supervision and the need for DEAPA to bring this issue to the membership. The President charged the Legislative Committee to identify concerns among the membership for action by the Board prior to the upcoming legislative session.
Website redesign was approved by the board to ensure a complete redesign. Current webmaster Paul Nichols will be leading this project. The new website will be unveiled by late summer or early fall 2010.
The Maine Medical Association/DEAPA Management contract was unanimously approved.
Meeting dates for the BOD for 2010-2011 will be October 9, 2010, February 3, 2011 (in conjunction with the DEAPA Annual Winter CME Conference) and April 9, 2011.
Spotlight on Laura Corbett, PA-C—Haitian Experience “His Hands for Haiti”
Apr 01, 2010- Over the past few years I've been privileged enough to travel to Haiti on a number of occasions to provide medical care to our Haitian brothers and sisters. During my first trip in March of 2007, I participated in health screening/updating profiles for children in a child sponsorship program called His Hands for Haiti. This was an amazing firsthand look at a country deemed as one of the poorest with significant health care and disease implications. On subsequent trips I have participated in patient care in a variety of medical clinics mostly in smaller villages of northern Haiti. I've been privileged to learn from a wonderful physician, Steve James, who has served in Haiti over the past 20 + years and who has willingly offered to be my mentor. I have learned much about life, faith, serving and more from this brilliant yet humble man who is an absolutely wonderful source of medical knowledge.
I recently returned from Haiti a few days ago. I did not go to Port au Prince but rather to Cap Haitien in the northern part of the country. This is the second largest city in Haiti and has certainly felt the repercussions from the earthquake in an increase in population, injured patients displaced from Port au Prince, PTSD in those who have either first handedly experienced the devastation of the earthquake or lost family or friends in the quake and there were the occasional physical structures that received enough damage to cause them to be unsafe to enter. I participated in one day of a three day conference designed to assess the psychological needs since the earthquake and develop a structure in which to support these needs of the survivors. I heard stories from community health workers who were devastated themselves and were at this conference to learn how to address the needs of their communities. I met a group of 13 young people aged 22 and less who made up an "orphanage" otherwise known as a home that a local lady opened to house them and who is providing the basics of food and has the young children in school. The 22 yr old is a 3rd year nursing student who witnessed the crumbling of her school that enveloped her classmates, none who survived. She hopes to finish nursing school. We gave her the money she needs to do so. She and the other 20 some year old have decided to hold the 13 young people together as a family, since they have no one else.
We visited another “orphanage” which was a vacant, yet sturdy building that now housed 36 young children and about 10 adults, all refuges from PAP. They slept on scattered mattresses donated by another missionary. They lived from day to day wondering if they would have food to eat. It was chaos to me as we tried to deliver some Crocs and a few needed items along with candy and beanie babies to the younger children. Come to find out, our arrival as “blancs” in this neighborhood, delivering gifts, caused more havoc than good. A lesson learned.
Now back in the states, my team members ask “Why? Why do we have so much and they so little and now the devastation from the earthquake…why?” They try to find ways to deal with their own feelings of ingratitude for what we have here and wondering how they can continue to help. And I pray. There is so much yet to be done.
Splinters From The Board
Jan 10, 2010- (by Noel Genova, PA-C, Board Secretary)
The following issues, which may be of interest to the general membership of DEAPA, were discussed at the January 10, 2010, Meeting of the Board of Directors.
Gordon Smith, Esq., Executive Vice President, Maine Medical Association was present and is very interested in working with DEAPA staff to develop a joint marketing endeavor for membership, outlining why Maine PAs should join DEAPA and offer additional resources that MMA provides, as they recruit physician members.
Board discussed why employers see PAs as less employable than NPs and the board is interested in hearing from the membership on this issue.
UNE PA Program reported that they have established 8 new rotations in Florida.
The DEAPA Board discussed the number of Directors-at-Large on the board. The unlimited number of Directors was intended to allow input from as many people as were interested, but many Directors have accepted the position without attending meetings, leaving the Board without a quorum which is necessary to conduct business. This discussion will continue at the April 10th Annual Membership Meeting and Board of Directors Meeting.