>> From WXXI Connections.

I'm Racquel Steven filling in for Evan Dawson.

In this hour, we take a look at health care professions that are for for some may have flown under the radar.

The field of advanced practice providers.

If you scheduled a doctor's visit and can't be seen by the lead physician for some reason or the other, you'll more than likely be rerouted to the next best thing or person.

A nurse practitioner or physician assistant will greet you and proceed with almost the same tact as your provider.

These individuals are trained at the highest level to be just as good, but there are limitations to which state legislation is pushing to remove.

But we'll discuss this a little later.

But these positions are expected to continue to be highly favorable, and the need for these providers is growing.

According to the Bureau of Labor Statistics, employment for nurse practitioners is projected to grow by 46% between 2023 and 2033, ranking it as the fastest growing occupation in the U.S.

Similarly, employment for physician assistants is set to rise by nearly 30%.

As a matter of fact, the future demand is so high in significant that some universities have already added programs to their curriculums.

Nazareth University's has added a new hybrid physician assistant Master of Science degree program, set to kick off in January.

Why are these positions in such high demand?

How are institutions of higher education helping to fill the gap?

And are we really in good hands with these providers?

To help me answer those questions?

I've called on some experts joining me in studio for this discussion is Heather Grotke.

She's a clinical assistant professor and director of Nazareth University's physician assistant program.

Thank you for joining us, Heather.

>> Thank you for having me.

>> I have Duncan Wurzinger is a senior director of advanced practice of for Rochester Regional Health.

Thank you for joining us, Duncan.

>> Thanks for having me.

>> And remotely, I have Bonnie Walden.

She's also a clinical assistant professor and chair of Nazareth University's nursing department.

Hi, Bonnie.

Thank you for joining us remotely.

>> Hi.

It's wonderful to be here.

>> I love I love this screen here.

If you guys can see it, you will love it too.

To all my listeners and like always, we welcome you to join us in this conversation.

Call us at 1844295 talk.

That's 1-844-295-8255.

Or at ( 585)263-9994 or email us at connections.

Or you can just comment right in our YouTube channel.

I want to start with you, Duncan.

tell us about the feel of advanced practice providers who qualifies as an app?

>> Right.

So I know you know, over the years, that term has kind of like come up and been in development for literally decades.

So what we as kind of an industry decided was, you know, what does that encompass?

So, you know, you would go and see this thing called a nurse practitioner.

You would go and see this other provider called a physician assistant.

but what do they do?

How are they different really?

In reality, they both do the same thing.

So as a, you know, an organization and as an industry, we decided we will call these folks advanced practice providers.

Now what do they do?

they provide high quality care.

you know, they write prescriptions, they see you in urgent care.

They are the first assistant surgery.

They see you at the internal medicine office.

They see you in the hospital on a daily basis.

So everything that your physician typically would have done you know, advanced practice providers will will do.

Now, over the decades, the realm of what an advanced practice provider could do had certainly changed the responsibilities and the legislation that has enhanced advanced practice provider roles over the years has really, you know, we can get into this in a little bit, but it has really expanded to a degree that I think decades ago that, you know, folks would have never imagined.

So I liken it to the the first officer approach of like, an airplane, you know, it's like you've got the captain, you've got the first officer, but the first officer has all the same responsibilities, has all the same level of authority and has the ability to fly the plane.

And that's essentially what advanced practice providers are doing for patients.

>> Yeah.

So you do have the ability to fly the plane, but you you must be able to consult with the the pilot first.

>> Right.

That's that's correct.

And we can get into a little bit of the nuances of that.

But, but in collaboration and close you know, a multidisciplinary approach with our physician and operational colleagues.

>> Yeah.

And we joked a little bit off air about how we pronounce PA's.

Right.

It's not physicians assistant.

It's not possessive, it's physician assistant.

But a lot of people get that confused because physicians, physician assistant, they they must practice under the scope of the physician.

There is a little nuance there that kind of separates them from NPS, right?

>> Right.

So so nurse practitioners, at least in New York state, and this varies state by state, you know, with different regulations.

There's nothing federally that kind of mandates, hey, NPS have to do this, PA have to do this.

So it's state by state in New York state, nurse practitioners a number of years ago were granted the authority to practice independently.

So, you know, your primary care provider could be a nurse practitioner for physician assistants.

That kind of legislation.

I know we're going to get into that a little bit is in the works.

but that's something that right now for physician assistants, you work under the direct, you know, collaboration and supervision of a physician in your area of practice.

So if you work in the emergency room, you know, you work in collaboration, not just with one physician, but really the group as a whole.

you know, that has the same level of competency privileges, those kind of things that you do.

>> And while, you know, overall healthcare workforce shortages, like they persist, right?

We hear about nursing shortages.

these professions are growing rapidly.

These PA and NPS 46% increase in employment.

Why why is that?

Why are we seeking out Pas and NPS, the fastest growing occupation right now in the U.S.?

>> so.

Well, the fact of the matter is, so, you know, I know we've done, you know, or you have done rather multiple, multiple talks about the baby boomer generation and demographics as king.

And, you know, we know that we're you know, our population is getting older.

The fact of the matter is that there just are not enough physicians to take care of the growing populace that needs healthcare.

And you know, people are living longer than they used to as well.

So as those kind of gaps have developed naturally in this economy and in this industry, physician assistants and nurse practitioners have filled that role.

because the fact of the matter is, we need people to be seen.

We need access, we need high quality care.

And it just turns out, at least in this country, that physician assistants and nurse practitioners, you know, fill that role.

>> Yeah.

And, Heather, I know you're a PA as well at Rochester Regional.

where do you see the significance in PA or the role they play in NPS in the the health care model?

>> Yeah, I think that's a great question.

And, as we get into more into discussion about the legislator, we'll talk about collaborative team based healthcare.

But that's really the way healthcare is functioning.

so, you know, over, over the past decades, it's really kind of changed from this you know, physician led model to more of that collaborative approach.

And, and Pas and NPS, you know, really I think the key here is that we need to be able to practice at the top of our license.

We are excellently trained.

you know, and, and want to be able to, to do so without the administrative barriers.

and, and the fact of the matter is, Duncan said, is we can't train physicians fast enough.

We can't train Pas and NPS fast enough.

and so really, what we need to do is think about how can we as, as a society and specifically in New York State, how can we adjust to help, help fill the gaps?

you know, and again, as Duncan mentioned, our our population is aging.

There's more and more chronic disease.

We need to remove as much of the administrative barriers as we can.

And some of this is, is related to that supervisory relationship with a physician.

As we're going to talk about.

But, you know, it's not so much that Pas want to practice independently outside of of working with a physician.

In fact, the opposite is is typically true, but it's the inability to have enough physicians available for for us to be able to do that, especially in rural and medically underserved areas.

And so, you know, we we really want to see ourselves as as part of the solution.

>> And I know this is a big question, but where do you see APS are needed?

Most advanced practice providers, where are they needed most.

>> So and feel free to chime in Heather but as well.

But primary care, that's where it's at.

So you know so many folks and certain specialty services as well.

I mean, the the easy catchall is everywhere.

We need APS everywhere.

We need physicians everywhere.

But you know, primary care.

We, you know, we have a lot of you know, underserved populations.

we are seeing in the, you know, in the ecosphere you know, kind of the struggles of the rural community, especially when it comes to access.

You have patients that are needing to travel 50, 60, 70 minutes to go and see somebody.

And that's really tough, especially if you have a chronic condition.

Imagine grabbing your oxygen canister and setting up transportation, all of that stuff.

So those are things that we as an organization at Rochester Regional Health are focused on.

you know, I would say that once those referrals are made to primary care physicians and somebody goes and sees them now, the question is like, hey, does this person need a pulmonologist?

Do they need a cardiologist?

So those are the kind of things that we're focusing on is like, let's get the access and get them that initial in.

But once you're there, there's potentially 2 or 3 other specialists that you're going to have to see.

And it turns out that those specialists have the same kind of access.

needs that the primary care provider does.

So it's not just like, hey, let's get folks into the system.

It's okay.

Once they're in, we need to kind of plan for how are we going to get them to the people that they need to serve their their health needs?

>> So this this is going to be an ongoing demand.

Definitely.

And, Bonnie, I want you to chime in here because I know you're a you're an NP and we're surrounded by Pas.

I want you to speak on the NP and the importance of having a nurse practitioner and in the role the nurse practitioner plays in, in the health care model, care model.

>> Yeah, sure.

And just to correction, I am not currently an NP trained as a women's health nurse practitioner, but not currently doing that role.

>> so the nurse practitioner role has a very rich history in New York State and in particular in the Rochester area.

I'm not sure how many of our listeners are aware of that, but Dean Loretta Ford, the founding dean at the University of Rochester School of Nursing, where I did do my my studies to be a nurse practitioner, she was the co-founder of the nurse practitioner role in the United States over 50 years ago.

And so, yes, that role has been around longer.

but there are still challenges.

I mean, it wasn't until in New York State, until 2014 that the nurse practitioner Monitoring Modernization Act, it's a mouthful, was passed, which was granting.

I'm going to look at my notes here.

nurse NPS with more than 3600 hours of experience, would not need a written agreement or a collaborative relationship in order to practice.

That was temporary at that time.

In 2022, that was extended.

It was extended again in 2024.

And now if it's not extended in 2026, it will sunset.

So I know that Pas are having their struggles right now with moving forward with improving the ability to have the highest to work to their highest scope of their practice.

But it is still a continuing issue for nurse practitioners.

And the need is great.

I teach a course here that I've taught actually over 30 years.

on health policy and health care delivery and the United States spends the most on health care as a percentage of our gross domestic product than any other nation in the world that's developed almost 18%.

And the majority of that is because of our costs for how much we spend on medical services and administration costs.

And so being able to provide care and access to those who are in rural and underserved communities at a lower cost, benefits all of us as a nation and brings everyone's costs down in terms of their health insurance.

>> And I know sometimes when we go to our doctor's visit, right, we can sometimes get disappointed when it's not our doctor, it's a nurse practitioner that walks in.

It's a physician assistant that walks in.

What would you like the public to know about these?

These roles.

>> That these individuals have been trained at a very high level.

there are accrediting organizations for both Pas and NPS.

We must, in the education of these individuals, we must ensure that we meet those standards.

These programs are also registered in the state in which they occur.

So for New York, it's New York state by the New York State Education Department.

And so we do not even try to say that we are specialists.

That's not our role.

And that is the role of the specialist physician.

However, we are trained in how to do assessment, how to diagnose and then, if necessary, how to refer.

And so folks should be really reassured that the care that they receive by an NP or a PA in terms of primary care and even those, those roles are also in the hospital is very well regulated and we must report regularly to maintain our accreditation and our registration.

>> And I'm just playing devil's advocate here.

Right.

We have doctors that spend years, decades in school learning this stuff.

And now we have programs where you can become a physician assistant in 24 months, two years.

Should I be concerned?

>> You know, I, I, I can I can comment on that a little bit.

So you know, most not all, but most physician assistant and nurse practitioner programs it's not just those two years, you know, it's not like somebody just for your listeners to get an idea.

It's not like somebody just goes to high school and then they go to this program for two years and suddenly they're a physician assistant nurse practitioner.

Everybody has done an undergraduate degree.

you know, most programs now, with the exception of really just a very small handful, are master's programs where, they employ, you know, the medical model of medical school into you know, that practice.

There's little differences.

But, you know, the programs keep the, you know, the really kind of key disciplines, you know, in the education, you know, cardiology hospital medicine, internal medicine, you know, even dermatology, women's health, I mean, you name it, the programs have it.

I will tell you.

And as somebody that went through this and how they can probably probably attest to, you know, the PA programs, it is rigorous, it is intensive, and it is your life during those, those times.

holding, you know, another position or another job is something that you just can't do.

I mean, your entire life is in the, you know, in the world of medicine and education.

And it's to a, to a degree that you know, even I going through it didn't expect, you know, at the moment.

So I just want to reassure viewers that the education is super high quality, super intensive.

and coming out of it, the idea and the goal, like, you know, Bonnie was alluding to, is that once we have that initial interaction with the patient the key is knowing where to send that patient, you know, to the specialist, this person has an irregular heart rhythm.

We should send them to their cardiologist and get some of the labs and get some of the EKGs and all those other things.

you know, in the interim.

So, you know, I want your listeners to know it's not like, hey, you see a PA and that's it.

You see an NP, that's it.

It's like it's the whole package of healthcare that comes along with it, too.

>> The whole the whole system.

The whole ecosystem.

Yeah.

>> Yeah, I agree completely with Duncan.

And I think it's important to note that you know, he mentioned we trained we train in a physician model.

And so it's really a competency based education.

So you can't get through the program.

You can't graduate the program until you have shown that you are competent in all of these areas.

And being a successful PA, you know, we always kind of check our ourselves as a PA program, you know, do we want this person?

Are we comfortable with this person taking care of our friends and our family?

And really, that's what it comes down to is, is that really rigorous program, rigorous assessment to make sure that that our students are competent when they they graduate.

And and again, it's it's important to know, you know, what what the boundaries are.

And that's something that we teach our students as well.

And certainly as with any profession, I think experience is key as well.

So there's more oversight.

And what we're looking for is to have that oversight based on a PA and an NPS experience.

And you know, their their competency, their training to, to the level of their autonomy.

So, meaning how how much they can practice independently.

So there's more oversight for new graduates than there are for PA.

That's that's been in a, in a field for 30 years, for example.

and we have that team based care.

We have a physician that we're collaborating with.

And that's not something that that we as a profession are wanting to change because we recognize and truly value that.

you know, there's a true partnership there with, with the PA and the physicians.

>> And I know this will all be implemented into the curriculum for Nazareth's, PA program.

And I want to touch on Nazareth and what you're doing for the healthcare, the workforce.

Right.

Bonnie, how is Nazareth University helping meet the demand for healthcare professionals?

>> Well, we have a number of health professions programs in our College of Interprofessional Health and Human Services.

Nursing is one our current programs include a traditional four year nursing, baccalaureate program, a program for registered nurses who are going back to get a bachelor's degree, a program for licensed practical nurses who are going back to get an RN and a bachelor's degree.

And we are looking to add a nurse practitioner program for specifically to prepare women's health nurse practitioners.

we're planning that right now and hoping to implement that in 2026. the other health professions and I hope I can remember them all.

Maybe Heather can help me if I forget that we have here and have had for many years physical therapy, occupational therapy, communication and speech disorders, disorders.

Or as most people know, speech pathology.

creative arts therapy and music therapy, social work.

I think that's all of them.

Heather.

>> I think you hit them all except for PA as our newest oh, oh, Ma would.

>> Want me to remember public health.

We have public health as a major as well here.

so.

>> And we hear a lot about this, this pipeline.

Right.

And universities creating this, this pipeline for the workforce where we're getting students and then we're hoping to push them back out into the community.

Right.

Is this something that Nazareth is holding up as a priority?

>> It is.

And in fact we were very fortunate to receive funding from New York State through the Career Pathways Training Grant program for this year for our master's in social work students and for our RN to BS students.

And so we have students who are actually being able, at least I know in the nursing program to complete a program.

tuition totally covered and fees totally covered.

And again, it's just to increase that, you know, capacity to move people through and get people into the workforce.

you know, the conversation about nurses at the bedside is sort of simmered down a little bit since the pandemic, but we still have a nursing shortage.

And so being able to graduate as many nurses, even at that baccalaureate RN level, is important.

And for us, if we want to also be able to increase the number of nurse practitioners, they must first receive a Bachelor of Science in Nursing and then pass their nclex RN exam, which is our nursing licensing exam, national exam and be an RN before they can even apply to that master's program to become a nurse practitioner.

So we're trying to move that pipeline along as well.

>> So so why are we exploring PA programs first?

Why PA programs?

Why not an NP first?

>> I will let Heather pick.

>> That.

You know, I can't say.

>> That I have that answer.

I think, you know, initially it was that PA was a perfect complement to the other programs that that Bonnie had mentioned within the college.

I know that was something that was very important to Nazareth and, and one other thing I wanted to add to, to Bonnie's response is, you know, Nazareth really embodies the mission of our PA program, which is filling the gap for medically underserved and rural healthcare and rural areas for for healthcare needs.

And so we're really embodying that with with the design of the program all the way through to the clinical rotation experiences that our students are going to have.

And and that's one of the reasons that we designed the hybrid model was to really increase the access of a PA program to students that may not be able to readily relocate.

And I think that that's really important.

And we know that data has shown that students that are from rural areas or medically underserved areas, a large percentage of of those students, when they graduate, return to those areas.

And so that was really important for us as we were building our program and really priority to to really address the gaps, not just turnout, you know, more and more PA but but really being intentional about who we're selecting and, and what our ultimate goal is of of the program.

>> Yeah.

And I love this new this new hybrid model.

Right.

And accessibility there.

Can you can you speak on why hybrid elaborate more on that.

>> Absolutely.

So we are really on the forefront of that.

There's only a few other hybrid PA programs in, in the country.

certainly as as we know something happened in 2020.

There was a pandemic.

And and really things shifted.

And I think at that point it was almost like a light bulb where we said, hey, maybe we can teach PA students in in a hybrid model in an online format for some things, certainly, you can't teach students how to suture remotely.

You can't teach them how to intubate someone remotely.

you know, there there's both components.

And so basically what we're doing is the first year of the program is what we call the didactic education.

And that's really the the classroom work.

So that's learning about all about medicine.

And so a lot of the times the students are really sitting in a lecture hall, sitting in a classroom and learning about that.

And so, you know, we we really wanted to drill down to that.

And, and think, you know, is that something that they truly need to be on campus for, or can we remove some of these barriers for our students and, and teach those things in that, in that hybrid online format and bring them to campus for what we truly need them to be on campus for, and that that hands on training.

>> And I remember writing that Nazareth is doing this where you can they're it's for people of all ages.

>> Yes.

>> Right.

So if you started a career and you're, you're you want to shift careers, you can look into this, into this program.

So having people of all ages is this is this something that was intentional?

>> Absolutely.

I think you know, especially in the Rochester area, we have a lot of paramedics and EMTs and respiratory therapists and and like you said, folks that are not in medicine that that want to change careers, that, you know, have have found their passion and their desire to, to serve their community in that way.

And you know, this program is, is really designed for, for those folks.

>> And Bonnie, having people of all ages at your university.

>> How is that for you?

Yeah.

>> Yeah.

I mean, we have that now in our baccalaureate nursing program.

We have people who are going back to school who had a different career and are just entering nursing.

we expect to also be able to have people in our NP program who are of all ages.

The program will have a similar hybrid format as our PA program.

So it will be distance learning.

again, these are registered nurses who are probably working full time.

And so allowing them to do their didactic or lecture courses through the program in what we call an asynchronous format, which means that it's they can do it.

They'll be prerecorded lectures and they can do the work at the time that works around their schedule.

We will bring them in once a semester to do some in-person work with them.

and they will do their clinical precepted practica experience.

They have to do almost 700 hours of clinical experience where they live.

And so we could imagine that a nurse who works full time, let's say, in Texas or California, would be able to do this program.

And while they're working and may have other obligations, that it might be family based.

>> So this is for for students all over the nation.

>> Yes, yes.

>>, we will extend a national reach.

>> And Duncan, how do the universities creating these pipelines, how does it help our our health care system?

>> So, just going back just a couple of questions ago, I just want to say, like, you know, it's nice to have another PA program here in Rochester.

So, as you know, your listeners probably heard, there's several nurse practitioner programs and some in development, but I, you know, shout out to RIT Tigers.

I graduated from RIT back in 2013, but that's the only local physician assistant program.

So it's nice that that's expanding because the need and the access is there.

you know, I think that as we move forward in terms of how the pipeline works, you know, we currently at Rochester Regional Health have several you know, affiliations with with these physician assistant and nurse practitioner programs.

You know, we get the list of the students, we know who's coming in and we know what their obligations are.

We need to get them in the hospital, see patients.

We assign preceptors for those students that come in.

And we have a pretty rigorous orientation for those students, you know, hey, here's the New England Journal of Medicine articles that we want you to focus on.

Here's the key things that you're going to see.

You know, from an experienced provider telling their, you know, their student over the next, you know, five, six years of you working in your, your specialty area.

And then the idea is that once those students come in, I mean, I will exert a little bit of bias here.

We would love for them to stay with us and work at Rochester Regional Health, because I will tell you the need is there and the openings are there.

So getting these you know, apps in whether their nurse practitioner students or physician assistant students and integrated understanding our electronic medical record meeting our physicians, seeing our advanced practice provider, organizational structure and the high care that we deliver that's kind of the idea is that naturally, those students will go in.

But we do have contractual affiliate agreements with you know, a couple of different programs.

>> So at Rochester Regional, the need for NPS and Pas, you said is there.

>> Oh it's there.

Oh, yes.

Very much so.

Yeah.

So like I said, you know, when we heard that the Nazareth program was being developed you know, we are you know, I'll give you an example, you know, some programs, you have 40 or so students coming through a year, only a certain percent of those either live locally or, you know, would stay locally for whatever logistical or family reasons.

you know, so you can imagine we're already whittling down to out of a given program, maybe ten or so apps, you know, when you have a population of more than a million people you know, in the greater Rochester area, and everybody's getting older and demographics are changing.

ten apps is not enough per year, you know, so getting these extra programs into the system and getting those students integrated into the the healthcare network is is going to be super important.

>> all right.

We're going to we're going to take a little break.

And when we get back, we're talking about legislation.

When we get back.

Stay with us at WXXI Connections.

I'm Racquel Steven coming up in our second hour of connections, a coalition of local leaders has been working together to try to solve one of Monroe County's top health priorities severe maternal morbidity.

We talked to experts about what is causing the issue and what can be done to protect moms.

That's next hour on connections.

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>> And we're back with WXXI Connections.

I'm Racquel Steven filling in for Evan Dawson today, and we're talking about the importance of having advanced practice providers in our health care systems, including nurse practitioners and physician assistants, and our experts in studio, we have Heather Grotke.

She's a clinical assistant professor and director of Nazareth University's physician assistant program.

I also have Duncan Persinger.

He's a senior director of advanced practice for Rochester Regional Health, and joining us remotely is Bonnie Walden.

She is the chair of Nazareth University's nursing department.

Also former nurse practitioner.

She made it clear that she's not practicing anymore.

So so we're going to say former MP.

Bonnie, thank you for joining us.

And we're going to talk about legislation that's that's pushing for physician assistants to work at the at their highest level.

What does that mean?

Their highest level of training.

What does that mean for our PA's?

>> So I can talk a little bit about this.

the National organization, the American Academy of Physician Associates, is is really advocating for PA to work at the top of our license and to remove some of the administrative barriers.

I think it's important to note that the profession is not moving to change our scope of practice.

in fact, quite the opposite.

You know, we we again, as we've talked about earlier, really value the collaboration that we have in the team based healthcare, you know, specifically with physicians.

but really removing the administrative barrier.

And what that really means is legally, we are required at the state level.

we're required to have a supervising physician relationship.

And that's truly administrative.

That physician does not is not required to be on site with Pas, is not required to sign off on any of our charting, not required to sign off on prescriptions.

It's truly just this you know, really outdated statute at the state level that has just become a barrier and is not really reflective of what Pas do day in and day out.

you know, what's really happening, you know, on the, on the ground floor, so to speak.

>> It's the 50-year-old rule, right?

Five decades.

So things have changed significantly since then.

Duncan is this barrier how would this barrier really help our health care system?

Removing these barriers, administrative barriers?

>> It would be huge.

I mean, right now we've, you know, again, there's there's one thing, you know, in the legislation you know, in versus reality, you know, like you were alluding to, this is a 50-year-old statute that may have made sense at the time.

But again, we were talking when there was really a handful of advanced practice providers.

Now we're talking tens of thousands, like even just within our state.

but what it would do, I mean, really, whether we're talking about telemedicine, new innovations or just straight up access for patients you know, having an advanced practice provider, particularly a physician assistant that let's say, you know, is living in a rural New York that has a lot of patients that have to travel extended distances to see their their primary care provider.

You know, for that patient for a given situation, it makes more sense to deliver that high quality care closer to them.

So, you know, that's something that as we're seeing a significant physician shortage that is only going to continue to get worse.

That's just a fact.

you know, the question is, where are these gaps being filled?

And physician assistants, along with their nurse practitioner colleagues, can provide that access.

and, and really, you know, improve the, the care that patients need.

So I think that it's something that it just needs to be done.

It's already, as Heather's alluding to, it's really already happening in reality.

It's just a matter of getting that into a statute.

>> And I guess for.

Oh, yeah, go ahead.

Heather.

>> I was just going to add, I think, you know, we had you know, again, something happened in 2020 where it was really a pilot of that.

So, you know, the executive order removed that barrier.

And it's important to note how how much Pas really filled that need for healthcare during.

>> That time.

>> You know, removing those barriers and allowing PA to do what we do.

Well based on our training, based on our competency redeploying, you know, as Duncan can probably talk about, Pas and NPS were redeployed across the system to to fill those gaps.

And so you had, you know, maybe a family medicine PA who would have a physician, a family medicine physician as their supervising physician.

That PA can't go into the emergency room without, you know, the other administrative type of relationship.

But during COVID, we were able to do that.

And I think it's important to note that there were evidence, evidence shows that there were no poor outcomes.

You know, the outcomes for high quality patient care was the same was maintained with or without, you know, those, you know, again, those outdated laws.

>> I think to the contrary to without that executive order, I mean, outcomes would have been worse, much worse.

I mean, there's no there's no question about it.

>> I want I want you guys to take me back to that time during the pandemic where we're we're not trying to say that p word.

Right.

We're not trying to go back there, but that during that time as as a PA and a nurse practitioner.

Right.

How was that having to jump over those barriers and really perform at your highest level?

How was that time for you?

>> I think one thing I can say is that's unique about PA is we are broad based, trained, so we are trained as a generalist provider.

So as Duncan mentioned earlier, you know, we're trained in ob gyn.

We're trained in emergency medicine.

We're trained in you know, surgery, you know, across many, many disciplines.

And so I think we were very well positioned to be able to be redeployed to, to different areas and be able to really pick up and and practice, you know, maybe with a little bit more of a refresher, a little onboarding.

you know, for some more than others, depending on what discipline we were coming from.

But we do have that in our back pocket.

We have that really solid foundation.

and so I think, you know, we were well positioned to, to do that and really meet those needs that were so critical in that time.

And I think what we want people to know is we're able to do that outside of the pandemic as well.

>> Yeah.

And, Duncan, can you tell me how that was for you?

Do you have a moment where you can remember where your PA instincts, your highest level of training, came in and you felt like, this is what I. This is what I do.

This.

>> Yeah.

Oh, absolutely.

you know, so I my clinical time is spent in the medical ICU at Rochester General Hospital.

So particularly during that that p word time, it was pretty it was pretty chaotic.

But yeah, there was one instance where I was down in the emergency room working with multiple providers that had been redeployed there.

And, you know, at one point we had close to a dozen patients that were intubated on ventilators there, the emergency room.

And we have, you know, our ICU.

We only have a few people that are usually intubated at a time.

But but I remember just standing there and you see the people walking around you, and I was just like, oh, my, oh my gosh, this is just absolutely insane.

That being said, I want to emphasize to your listeners as well, everybody, whether they're physician assistants, nurse practitioners, nurses, respiratory therapists you know, this isn't just, you know, people doing a career just cause, you know, you know, folks decide that I want to take care of my, you know, companions and community being around very sick, contagious, and, you know, life threatening situations.

It's not something that you just go into you know, kind of willy nilly.

This is really something that people dedicate their time effort.

And you know, really do sacrifice.

So that was something, you know, as it was going on during COVID, everyone really quickly realized, like, hey, this is why we're in it.

So I think that nurse practitioners and physician assistants, particularly during that time, really excelled in showed what we could do during it.

>> I agree, I think, you know, that was a time where I was I truly was like, this is why I became a PA and my, my clinical role is at Rochester General as well.

And, and I work in the medical short stay unit there.

typically one day a week.

and, you know, I picked up a lot of time in the emergency department really trying to, you know, again, to fill in these gaps.

And, you know, I remember covering myself head to toe with all of that personal protective equipment.

And, you know, it was almost surreal where we're hanging I.V.

bags on picture frames in the hallway because we were running out of IV poles and, you know, but it was truly a sense of, this is why I do this.

And, you know, coming back home and taking all my clothes off in the garage so that I didn't bring any of that into the house.

And, you know, infect my kids and my my husband and but truly, that's why we do what we do.

>> Yeah.

>> It's surreal having to think back at that time, like we really lived through that, that pandemic.

>> now let's shift, you know, shift the mood a little bit here.

Bonnie, as far as creating this PA curriculum, how much of it is influenced by the legislation and having creating PA, producing PA that do practice at the highest level of training?

>> I would actually have you ask Heather that.

>> Yeah.

>> I was trying to get you in the conversation.

Bonnie.

>> Well, I can speak to.

>> NPS.

I could speak to NPS, but.

>> I yeah, sure.

>> Let's talk about NPS.

>> Okay.

Could you repeat the question one more time?

>> As far as NPS, what we can we can actually take it back to to COVID, right.

And the role MPs played during during that time.

>> Right.

Well, for nurses during COVID, you know, the ability to temporarily practice in other states where we are not licensed.

So for nurses, when we receive our first licensure, we pass that exam, that NCLEX exam, we are licensed and registered in a particular state.

So my example would be New York State.

So during that time the restrictions were lifted I'm being able to practice.

So staff nurses, nurses who are registered nurses could go where where there was help needed.

They could travel, be travel nurses and go to where was where the greatest need was.

And nurse practitioners also I believe and I might be incorrect, but I believe I'm correct to say that they could provide telemedicine or telehealth services across state lines as well.

And that really becomes an issue when it comes to prescribing authority and whether you can prescribe outside of the state in which you are certified or registered.

And so that was that was something that was happening during that time that really helped access to care for many people.

yeah.

>> So and as far as like creating curriculums, right where you do have your students, where you do produce healthcare workers that can practice at their highest level of, of training, especially with PA, is this what are we doing here?

Is this something that it's very significant and, and is intentional for us to create these PA.

Right.

>> Absolutely.

And I'll, I'll say, you know, designing the curriculum, we won't be doing anything different whether we change these, these laws or not.

You know, we're always going to be training these highly competent providers.

And as Bonnie said, you know, they they pass an exam, they pass a national certifying exam.

so that they're certified providers and they're licensed in their state of, of practice.

And, and so really, the goal is always to produce providers that we are comfortable taking care of our friends and family and our community.

>> And you have some high tech stuff going on over at Nazareth to, to ensure that this happens.

Right.

We have this entire interprofessional simulation center.

Yes.

can we talk about simulation and how this is playing a key role in producing great health care workers?

>> Yeah.

So I can start and Bonnie can jump in, but we have five high fidelity simulation mannequins.

We have a pediatric mannequin.

We have a mom and baby and three adult mannequins.

So, you know, essentially we want our students to be practicing you know, right from the beginning to the end on, on simulated patient models.

And, and they're, they're really good for, for having students practice things that you know, we want them to practice on a mannequin versus a live person.

So, for example, you know, you might not want to be the first person that they're practicing intubation on, right?

and so but it's a really good way to, to have the students make mistakes in a really safe place so that they're, they learn and we and we know that they're comfortable and competent when they when they do graduate and they, they do, you know.

>> Help.

>> Is there any shortcomings in not practicing on a real person?

>> So to clarify, we do both.

so our students have a requirement to do 1600 clinical hours.

so that entire second year, they're out in, in a variety of settings and disciplines.

practicing medicine with a preceptor.

So where there's, there's a lot of oversight.

but this is in conjunction with that.

>> You always figure it's better to start with the mannequin, just like the pilots.

They start in the simulator, you know, and then they go to the real plane.

>> So.

>> And Bonnie, can you can you brag a bit about NASA's, high tech, state of the art technology?

>> Yeah.

So we've we've had a simulation center for about ten years, but we because our PA program is coming, we were able to enhance that and add on to it.

I would just add one other feature that the PA students, as well as our nursing students will be using in simulation is the use of standardized patients wearing wearable simulation equipment.

So we're using that now with our acting students.

So it's been a wonderful collaboration with our theater department, our acting students are the patients.

And they will wear a prosthetic chest, for example, underneath their patient gown.

And the students who are doing the assessment will be able to hear abnormal heart sounds, abnormal lung sounds that really wouldn't be present on a healthy 20-year-old.

Or we can put some really nasty looking wounds on their arms.

And we have other types of wearable simulators.

We're really excited about that.

We got special funding for that.

And that is going to make it more real.

We've been using that this semester with our current undergraduate nursing students, and they're giving us feedback that, I mean, they love using the very high tech, high fidelity simulated mannequins, but this provides that what we call affective experience, where they actually have to explain to a real person what they're going to do to them, which can be scary when you're a student.

>> And so we have someone on YouTube who asked, and I think it's a great question.

can you be an NP and a PA at the same time?

>> I guess theoretically you could.

>> This is the overachiever here.

>> But yeah.

>> Why why you would do.

>> So I.

>> Maybe there's a I'm trying to think of like a niche where that would work, but I don't think that's necessary.

But yes, theoretically you could.

>> Yeah, I guess I guess the gist here is like what the difference between the what they're allowed to do.

Right.

And if is one more has more responsibilities than the other.

>> At least in New York State.

I mean, the biggest defining factor I know that we were talking about earlier that physician assistants are working on is that ability to practice independently, you know you know, open your own practice.

Nurse practitioners can do that.

Currently, physician assistants cannot.

but otherwise, when it comes to ordering, you know, blood products you know, in you know, certain other regulatory realms, writing notes, history and physicals, physically seeing the patients, making referrals, all of that stuff is very 1 to 1, at least in New York state.

There are some variations in other states.

but they're but they're really minor, you know, when it comes to the reality, it's it's essentially the same role.

>> Yeah.

And I know there's some people that are opposing this legislation.

Right.

What are you hearing as far as opposition and the concerns?

>> I think one of the biggest concerns that we hear is, is this scope creep campaign and, and that's why I've been really intentional about trying to say that that's truly not what we're trying to do.

We're not asking for an increase in our scope of practice, meaning what we're allowed to do.

These are all things that we you know, are always have been allowed to do and and are competent to do.

So I think it's really just some misinformation that's out there that I think, you know, just needs to be clarified.

>> And, Duncan, what would you say to people that are thinking that, that PA and NPS aren't, are not providing the highest quality care and are not giving the right diagnosis?

And there's fear there?

>> Well, I you know, I think that that's that's natural.

You know, change is something that's an entire science, but it is something that when you look at the data and you look at the studies, you know, they point to the opposite.

And in some cases, especially when we're talking about access issues, you know, it's like one physician for 10,000 people, for example, like, you can be the best physician in the world.

You can only see so many people and you can only follow up.

There's only so many hours in a day.

You had 2 or 3 advanced practice providers for that practice, and the quality actually goes up.

And that's been you know, seen in studies, especially when it comes to underserved communities.

so I would say to folks trust us, we're highly educated and highly innovative and you know, we are, you know, an excellent series of professions.

>> mm-hmm.

>> And, Heather trust.

>> Yes.

>> Trust.

>> Trust your PA and your NPS, ladies and gentlemen.

Thank you.

Thank you both for joining us.

Bonnie, thank you for joining us remotely.

kudos to our physician assistants and our nurse practitioners.

>> Thank you for having us.

>> Thank you for being here.

>> Thank you.

>> Yeah.

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