Drury readies PA studies program for fall launch

Jake Condren: Physician assistants have quite a bit of autonomy in patient care.

Even as Drury University recently wrapped its 2022-23 school year, officials are already looking ahead to the fall semester when the school’s first health-related master’s degree program begins.

It’s been a roughly two-year process to launch the university’s new physician assistant studies program, said Kathleen Flach, who was hired in 2021 as the founding director. Flach, a nationally certified physician assistant, has over a decade of academic experience in PA education in addition to 17 years as a health care provider. She’s hired five faculty members, helped establish the classroom, lab and cadaver spaces, as well as developed the program’s 27-month curriculum. Two more employees are expected to be added to the faculty next year, and six of the seven are full-time positions.

Drury has invested roughly $2 million to start the program, she said, adding that covers salaries, equipment, and classroom and lab spaces.

“Starting a PA program is a massive investment,” said Flach, who previously was the founding academic director of the PA program at the University of South Florida in Tampa. “If we want to teach someone how to do a lumbar puncture, we have to buy a trainer. A lumbar puncture trainer can be around $3,000.”

The program was provisionally accredited in March by the Accreditation Review Commission on Education for the Physician Assistant, the independent accrediting body for PA programs in the U.S., Flach said. The process took about 19 months and was a substantial application effort, she added.

“By the time we put the entire application together and uploaded it to ARC-PA, it was 4,800 pages. I wrote ‘War and Peace’ four times,” she said with a laugh. “No wonder I was up night and day.”

The inaugural class, which Flach said has a waiting list of an undisclosed length after filling up with 30 students, begins in August. It will function as a cohort, as students go through the 27-month program together. The program will begin with classroom and laboratory instruction, followed by clinical rotations in behavioral medicine, emergency medicine, family medicine, internal medicine, obstetrics and gynecology, pediatrics and surgery.

The program class size will expand to 40 students for the following school year, she said, adding all applicants must have a minimum 3.0 GPA and a bachelor’s degree from a regionally accredited university in the U.S. To obtain a license, PAs must graduate from the program and pass a certification exam. Maintaining the license requires PAs to take a recertification exam every 10 years and 100 hours of continuing medical education, according to the American Academy of Physician Associates.

“We had to prove to (ARC-PA) we had 40 preceptors for each rotation,” Flach said, referring to licensed clinicians who supervise students during their clinical rotations. “We have seven required rotations and two electives. It was over 280 preceptors we had to identify from all different hospitals across Missouri and into Kansas and Arkansas.”

CoxHealth, Mercy Springfield Communities, Citizens Memorial Hospital, Freeman Health System and Jordan Valley Community Health Center are among the health care systems that will host clinical rotations.

Two learning spaces were created for the program. One is a cadaver lab in the Trustee Science Center on Drury’s campus. It can hold eight cadavers that will be dissected over the fall semester. At Cox North Hospital, a post-operation intensive care unit was converted into a classroom, which includes a physical diagnosis lab.

Meeting need
The PA profession is a relatively young career path in health care, established in 1967. Today, there are roughly 168,300 PAs working in the U.S., according to the National Commission on Certification of Physician Assistants. PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal health care provider.

“There’s huge demand,” Flach said of educational PA programs, of which there are roughly only 300 in the U.S., according to ARC-PA. “Often, there are hundreds and hundreds of applications for very few slots across the country.”

According to the U.S. Bureau of Labor Statistics, the median salary for a PA in 2021 was $121,530 per year. The BLS projected employment is expected to grow at a rate of 28% from 2021-2031, much higher than the national average growth for careers overall.

Jake Condren has been employed as a PA with CMH in Bolivar since 2017. He’s worked the past six years with Dr. Troy Morrison in the CMH Orthopedic & Spine Center, housed in the Douglas Medical Center. Condren said his workweek rotates between seeing patients in the clinic and the surgery room at the hospital, which is across the street from the medical center. He serves as the surgical first assistant to Morrison on all surgeries, he said.

Condren said PAs have quite a bit of autonomy and can make decisions on patient care without consulting a physician. A recent day at the clinic had 60 patients, he said, adding that total is close to the recent average.

“We basically just divided and conquered. I see half the patients and (Morrison) sees half the patients,” he said. “That way, if there’s ever any questions, you can always collaborate with each other and bounce ideas off each other as you’re going through the day.”

The orthopedic practice has four PAs and seven physicians, which Condren said isn’t necessarily the norm for staff numbers. The balance of those numbers can depend on the specialty area, he added.

“A lot of times in primary care settings, there can be a substantial amount of PAs and fewer physicians, so you’re kind of filling some of that void,” he said, adding he works an average of 35-40 hours per week. “In a surgery setting, the way we have it set up here at CMH, it’s one-on-one. I work specifically with one physician.”

Condren said there’s a huge need for PAs, noting recent BLS projections of nearly 40,000 more employees needed for openings by 2031. A program such as Drury’s “definitely will help” fill the need.

“Especially in rural areas and a lot of the primary care settings, that’s where there’s definitely going to be a need,” he said. “All areas of health care could utilize PAs.”

One advantage to people choosing to be a PA rather than a physician is the schooling time commitment, Condren said. With residencies and fellowship, a person studying to become a physician could be in school up to 14 years.

“As a PA, typically you’re looking at somewhere around six years in schooling,” he said. “You can get out substantially quicker and help fill that role.”

A 2020 study by the National Library of Medicine projected a primary care physician shortage in the U.S. exceeding 23,000 in 2025. However, delivery system changes and full utilization of midlevel health care providers, including nursing practitioners and PAs, could effectively mitigate the shortage, according to the study.

New start
While Flach said being a PA is a highly satisfying job, it can also be a consuming one. When she worked in family medicine, she saw roughly 4,000 patients a year.

Part of her goal for the program is to teach students to not just be clinicians but to be leaders in the PA profession.

“We don’t have a lot of representation lobbying for us. That’s not true for just Missouri; it’s true for across the country,” she said. “One of the things I decided when I wanted to develop this program is that I wanted our students to graduate with the idea that I’m not only a PA but I’m also able to be a leader. I’m able to sit at the bargaining table and represent my fellow PAs.”

With the preparation work mostly complete, Flach said she’s excited to have students on campus to learn about the profession she loves.

“It is an amazing journey to take people who enter PA school who maybe have a medical vocabulary of 50 words,” she said. “Over the timespan they are with us, they change, they mature, and their vocabulary develops. They function like a PA by the time they graduate. Watching that progression is the most job-satisfying thing I have ever done.”