Making Medicine

 

Introducing the Next Generation of Health Care Providers – Right Here at Home

 

The light at the end of this very dark COVID-19 tunnel may be getting brighter by the day but so is another reality for Western Maryland.  The end of the pandemic may also mean the end of many physicians’ careers.  It has already been reported in national news that when this health crisis reaches its end, weary health care providers who have been delaying retirement over duty will finally bow out of the profession.  And no one can deny-- especially in this last year – that they have not earned the peace and quiet.

But what happens next? Where do they “make” new physicians? Who will be the next generation of health care providers to lead us not only through another global crisis that impacts us on a local level but who will “take care” when our general practictioners and family physicians retire?  In Western Maryland in particular, the average age of a physician is 58.  While that may seem young, for a health care provider, it’s closer to retirement than medical school and over the course of a person’s medical history, a decade away from closing a practice is a heartbeat on a chart.

And so…where exactly will we find new doctors to take over when our older doctors retire in the next ten to twenty years?  Where do they “make” new physicians?  As it turns out, the answer to both questions is – right here at home.

A program just three years old at Frostburg State University is intensely training new health care professionals in the local area – people in their 20s and early 30s—most of whom have made a commitment to stay local and work locally upon graduation. The Physician Assistant Program at FSU is an educational experience unlike any other offered outside of a medical school setting. And the only one within a three hour radius to another university offering the course work.  

“These are people who upon graduation will be fully trained medical professionals.  We are governed by the same medical profession so yes, these are professionals who are working alongside doctors and can see patients and can make medical decisions for their patients. Physican Assistants are also eligible to open their own general practices. Some PAs have even decided to be mobile and make house calls,” says Beth Smolko, director, of the department of PA medicine at Frostburg State University.

“Being a PA itself is a big decision. Many people don’t understand the program. It is Physician Assistant. Not physician’s with the possessive. We belong to no one,” Smolko says. “Our profession came out of a dream by Eugene Stead. He was in World War II and we came out of the war with a doctor shortage. He developed an intense three year program that would put new physicians in the field as soon as possible.  During the Vietnam War, there were many doctors who were on the battlefield and then came home with practical experience. The first class of PAs graduated from Duke University in 1967.  PAs graduate at the same time and the same rate as nursing practictioners.”

The Frostburg State program was born from an idea by a local dermatologist who heard of the program at another college and then found he was experiencing the need for staffing in his own practice several years ago.

“I looked around and saw that other colleges had physican assistant programs and Allegany County didn’t,” says Dr. Sean McCagh of Western Maryland Dermatology. “And I thought – wait a minute – we have a four year university here. Why can’t we have a program that gets these folks into the field? And so I talked to Frostburg.”

“Sean McCagh came to us about seven years ago and told us Western Maryland had a PA and nurse practictioner shortage and what could Frostburg State do to help that out,” Smolko adds. “Only 260 universities in the world sponsor a PA program and Frostburg is one of them.  I came on board about three years ago and then started to get people on board that we needed.  Just last year our first class graduated and went into the field.  This came about to fill a need in Western Maryland.”

And the classes filled up immediately.  The competition to even get accepted is high.  Typically, the program has 600 to 1000 applicants a year and only 25 students per year are accepted at Frostburg.

“It can create a situation that means it’s harder to get accepted into this program that Harvard Medical School,” says Smolko.

Travis Miller of Cumberland is one among one of those 25 local applicants accepted. He began his studies in 2018. He is expected to graduate from the program this May after three intense years of study.

“I started with sports exercises sciences at Frostburg State University and so my bachelors is in that.  I was a personal trainer and I was training a client who actually is involved with Gonzaga Health in Lavale and he mentioned this program to me,” Miller – who looks like he was sent by Central Casting to play the part of a young physican on a new drama -- says.

“There is absolutely a need for it.  Our mission is to serve the underserved and help someone with their health.  To go into this, you have to have the right heart and be of the right mindset,” Miller – a 2012 Fort Hill High School graduate --  says. “Staying here and making a life and a career here is all about the people you will meet. It’s all about forming those relationships. I would say most of us in the program are local and want to stay local. I want to stay local. My wife and I would like to eventually start a family and when we do, she would like to be a stay at home mom for awhile and this is the kind of job that here at home will allow us to do that and also make a difference in our community.  This is really the next generation of health care professionals in this area.”

While going to school and getting the education and training, the PA program at Frostburg State University is very intense and demanding. PAs don’t get the summers off. They work through the holidays. They might get a few days to relax or as much as a rare week but students are either constantly in the classroom or in the field working.  PAs have classroom work for a year and then they enter Phase Two where they are required to complete 2500 hours of clinical experience in two years. They obtain 117 graduate credits of college education. PAs have to have a bachelor’s degree to even apply to get into the program. And their cumulative GPA must be extraordinarily high. The program also means three years of intense study with little personal time.  Before graduating from the program, PAs must have all their classroom and clinical hours completed, and pass a state board examination which is a 10-hour test.

“They pretty much eat, sleep, study and work together once they get into this program.  And they go out into the field together,” Smolko says. “PAs become fully formed medical professionals who can do the same duties as doctors. There is a lot of misunderstanding about what PAs do and can do – we are generalists who have the ability and mobility to go from one need to the other.”

A program like this locally also means that normally some folks who might be at a disadvantage economically for medical school might have an advantage in entering this program.  It creates an advantage for people who are local to the Western Maryland area to get into this program. 

“We want students from Allegany, Garrett and Washington Counties and when they apply they get an advantage,” says Smolko. “The objective here is to train doctors and train these PAs and then they will stay in their hometowns.  One student – a very brilliant young man—came into the program and said his whole intention was to stay close to home.  He said he was born here and he wants to live and die here.”

The student to which she refers is Logan Robertson – a 2014 graduate of Berkeley Springs High School.

“I was trying to find all the programs close to home because I really wanted to work near family and near my hometown,” Robertson says. “I also wanted rotations that were in the area so I could learn more about the health needs of the population that I wanted to serve. I live in a rural area and even though there are a lot of bigger areas a few hours or so away we still need more health care providers close to home for those who can’t make those trips all the time.”

And to Robertson, the need to “stay close” was the biggest selling point of the Frostburg program. He could train here, work here, do his clinical hours here and then stay here.

“I don’t plan on leaving the area. I may move to a neighboring town potentially depending on where life decides to take me though,” he says. “I have a desire to medically serve the people of the community I grew up in and I also believe that being close to family and friends is more important than living in a potentially more robust area.”

Moreso, he sees his future occupation in health care as filling a void in his hometown.

“All the surrounding communities are in desperate need for more heathcare providers. Our class is passionate on becoming excellent providers in the future, and for meeting the needs of communities that have few resources and people,” says Robertson. “Not only has the program taught us how the social determinants of health can impact the care patients are receiving, or not, we have been given opportunities to volunteer and reach out to medically underserved individuals. These opportunities emphasize the impact we can have and what an honor it is to be a PA in this region.”

The program also needs partnering physicians.  While Western Maryland Dermatology and UPMC Western Maryland and Meritus in Hagerstown are a few of the sponsoring providers opening their doors for the clinical hours needed for the students in the program, more are always welcome – giving students and opportunity to work in a specialized field.

“The program also needs hospitals and doctors to sponsor the PAs and we are fortunate that UPMC here in Cumberland and Meritus in Hagerstown were willing to be a part of the program,” says Miller. “And in that system, we move around to areas of different interests to see where we might want to end up.  I can request different speciality areas. And then you go into those areas and you do your clinicals.  For right now, my main focus is emergency medicine and orthopedics.  Both of those are in Western Maryland. And I want to stay here. My wife, Morgan, and I want to stay here when I finish the program in May and make our life here.  This is home.”

“We have a few people from the area go through the program and going through the program now and they are all rock stars,” says Smolko. “They’re all out there working.  We need Western Maryland to open up to these students.”

And while television programs like Gray’s Anatomy and The Good Doctor may glamourize the decisision and the hard work in a hospital setting, the local students in the Physician Assistant Program know the grueling demand on a personal life the decision makes.   

“Our medical training is identical. We were created to do what physicians do,” Smolko says.

“In Maryland, when you are PA, you have to have a physician sponsoring you. You can write prescriptions and you can see people but right now, in Maryland, anyway, we need to be connected to a doctor’s office,” explains Miller. “In Maryland, you need a four year undergraduate degree to apply.  You apply online and when you do, there are a list of schools you indicate you are interested in applying to.  And you indicate the one you are most interested in and if your application goes through, you go in for an interview.  When we are done with the program we are six to eight hours short of a doctorate.”

Is this the face of the future of local health care? 

“Yes, there is a generation out there that when they want to see a doctor, they mean they want a doctor. Physician Assistants can do what a doctor can do except perform surgical procedures and around here, chances are you would see a specialist for that anyway,” Miller adds. “But your PA can be in the operating room.  Doctors now are going the route of specialists.  PAs are generalists – people you see when you just need to see someone.  We can also get into any field.”

There is also the added incentive of a lucrative salary to consider when applying for the program. The starting salary for a first year physician assistant is more than $110,000.

“Those folks can be an economic force in Western Maryland. Of the 25 we send out into the work force, I will be realistic and say some of them will move to bigger cities but many of them will stay and they will end up contributing in big ways to their communities,” says Smolko. “That $110,000 a year goes a long way when you decide to stay in your hometown of Western Maryland. You can make a great living in Cumberland, for instance, with a salary like that. And that is the intent – to train young medical professionals so they stay close to home and serve their own communities who need them.”

But it is also more than the financial benefits the salary that comes with the position commands. Being a health care provider is a serious calling, says Robertson.

“If you have a passion for something that means it must be stirring your soul. I would take that to the Lord and if you still feel that way about it you pursue it with everything you have,” he says. “If you try your best, work hard, and don’t give it up you will get where you went to be. That sounds cliché but it is true. You’re going to fail at something you wanted to get right and you’re going to have a lot of days where all you did was school stuff and nothing else. However, once you’re at the end of this hard path you’ll be in a position to not only be proud of what you were able to withstand, but you’ll be able to better serve those around you in a way they desperately need. That’s worth more than I can put into words here.”

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