Empowering PAs: Expanding Roles and Opportunities in Healthcare with Brittany Strelow, President of the Minnesota Academy of Physician Assistants

[00:00:00] Welcome to the Chalk Talk Gym Podcast, where we explore insights into healthcare that help uncover new opportunities for growth and success. I'm your host, Jim Jordan. Join us as we explore the expanding roles and opportunities for physician assistants

[00:00:23] in transforming healthcare. Our guest today is Brittany Strelow, and Brittany is a distinguished fellow of the American Academy of Physician Assistants. She has over 13 years of experience in primary care and women's health, and she also serves as an adjunct faculty at Butler

[00:00:38] University's Doctor of Medical Science program. And also, she's the president of the Minnesota Academy of Physician Assistants. Now, in this episode, Brittany shares her insights on how PAs are uniquely positioned to fill gaps in primary care, rural health, and other specialty

[00:00:54] niches. She discusses the impact of recent legislation and the PA licensure compact on expanding PA practice. Brittany also explores the potential for PAs to leverage emerging trends like telehealth and artificial intelligence and hospital-at-home models to personalize care and address health disparities. Let's discuss the endless possibilities for PAs

[00:01:15] to shape the future of healthcare. So, Brittany, tell me and the audience a little bit more about yourself. Sure. So, my name is Brittany Strelow. I am a PA. I'm practicing out of Minnesota. I live

[00:01:28] in Rochester, Minnesota. I've been a PA for almost 13 years now. I originally went to PA school out in New York City in downtown, thick of Manhattan, in the financial district. So, I was a young girl from the Midwest in Wisconsin, and I moved out there to go to

[00:01:45] the Big Apple and did PA school, learned a lot there, and then came back to the Midwest to be closer to family again. And then I've been practicing in community internal medicine for the last 10, 11 years.

[00:01:57] So, you have a lot of credentials. So, can we go over those? What's a DFAA PA? Sure. So, the American Academy of Physician Assistants recognizes certain PAs, and they call it the Distinguished Fellows Program. So, there's only 2% of PAs that actually have

[00:02:14] that distinction in the U.S. and worldwide. For folks that might not understand the difference between a PA and a nurse practitioner, could you just maybe define that a little bit? Sure. I'll say in general, PAs, NPs, physicians, we all can diagnose illness, we can develop

[00:02:31] and manage disorders, and then we can also treat those disorders. It basically comes down to the education realm. So, PAs were taught on the medical model, and nurse practitioners are taught on the nursing model. So, just a little bit different pathway to it. But we,

[00:02:47] in the end, as NPs and PAs get to do very similar things as far as an end goal, there are some distinguishing features where PAs can do more in sort of surgical practices, potentially

[00:02:59] depending on the state. We can never be the actual surgeon as a PA. We could help first assist in that, but that would be a physician. We wouldn't be doing that. But then it just depends on regulations via the state. So, in Minnesota, we're considered a collaborative

[00:03:14] practice. I don't have a supervising physician. I collaborate with our physician colleagues, and I have my own panel of patients that I see and treat. In your clinical role, what specialty areas do you work in?

[00:03:25] So, technically, I'm in primary care, but I've started to get some niches within it. So, I do have a big women's health background, partially because I'm a woman myself. But my good friend and colleague opened this sort of GYN clinic within our primary care clinic

[00:03:41] so that it was easier for our primary care patients to get in. So, we would do IUDs, contraceptive counseling, menopausal symptom management, abnormal bleeding. So, we could do endometrial biopsies. So, I've done some of that. But then I've done a lot of work in women's health

[00:03:56] like QI realm. So, doing a lot of preventative screens related to cervical cancer screening and breast cancer screening too. So, you do the clinical, and then you're also adjunct faculty. In the time that you've been

[00:04:08] in school, how has that curriculum changed? And what are your particular faculty interests? For four years, I was part of a master's PA program. So, that's typically what most of the PA education is at a master's level now. It used to be bachelor's. We've switched all

[00:04:24] since over to a bachelor's program. So, I helped in the development of that program from start to finish, getting that off the ground. I've left now, and so I'm teaching at a doctorate level PA program. And so, that is not necessarily

[00:04:38] sought after by many PAs. If they're looking for more leadership training, more different things like the program I went to had a little bit more emergency management training that I didn't feel like I got in PA school that I thought would be helpful. And so, I teach

[00:04:53] in that part mostly the research capstone courses. And so, teaching PAs that you can do research, you can do quality improvement, here's how to do it, learning those aspects of it. But it has evolved, and I think that's medicine in general. There's so much we've

[00:05:10] learned in the last 12, 13 years since I went to PA school. And so, just trying to keep up with that and some of the technology like virtual reality, dermatoscopes is the new evolving things, POCUS, like point-of-care ultrasound. So, having to incorporate those

[00:05:25] into your curriculum, but then also teaching PAs that you can on the doctorate level, like do research, you can do leadership, but you can do these different things that you might not have got it in that master's program.

[00:05:36] And as if that wasn't enough, you're the president of the Minnesota Academy of Physician Assistants. Tell us about that role. Yes. So, volunteer role, so unpaid for that one, but we have about 4,000 PAs in Minnesota.

[00:05:49] And so, we have a state constituent organization where we can help represent the PAs in our state. And so, that might be helping with advocacy legislation that's going on. We just had a huge win this year where we put in for a licensure compact that's going around

[00:06:04] nationally. So, we're the 11th state to sign in on that. And then we also had a mental health class that was hindering some practice that we got removed from legislation, which

[00:06:13] was a big win. So, I help represent that, but I have a big board that gets to support lots of volunteers that are working on the background. But yes, in my free time, I do that as well.

[00:06:23] So, you've got these three different perspectives on the continuum of healthcare. How do you see your role in it when you pull all those together? So, I giggle and tell people that when I was in my undergraduate, I went to health careers

[00:06:38] fair and was like, I know I want to do something in healthcare. I'm just not sure what I want to do. And I was looking through things and found the PA and I was talking to the person

[00:06:45] like, oh, maybe the PA sounds pretty interesting. Like, I can change my specialty if I want to. And she was like, oh no, you don't want to do that. That is like a dying profession. It's

[00:06:53] not going anywhere. Now we're like the number one growing profession. We see all these gaps in primary care and rural settings. And PAs are one of those things that can fill that

[00:07:04] gap for healthcare in the US. And so, I see that as the profession in going. But I also, there's a lot of us practicing clinically and we see things where we can shape and change

[00:07:14] healthcare. And so, I think that's an interesting part for me. I've been in a number of projects where I've actually seen myself make change in healthcare and make it better for people. And so, that's exciting.

[00:07:26] Now, how do you get paid? I'm actually not familiar with how PAs get paid. It depends on the institutions. I'm paid salary is how I'm paid. But some do based on RVUs. They'll get paid based on that. So does your organization file a code for you?

[00:07:44] Sorry, with billing. So CPT billing codes too. So when you look out at physician assistants in general and you look at we're going to have this physician shortage by 2030. One of the things that strikes me as I do that

[00:07:57] analysis is the need for physician assistants to actually work the full scope of what their training was. And in some states, there appears to be resistance to that. How do you see that playing out in the next several years? Do you think that the shortage is actually going

[00:08:12] to help bring down some impediments that have been there that have been hard to solve? I hope so. Even in our own state, looking at the mental health crisis and realizing that

[00:08:23] there was this clause that was putting a hindrance to us being able to practice in that aspect. What was that clause? So it was very vague. I can look it up specifically. But it was just saying that as far as diagnosis

[00:08:37] and treating. And so it wasn't clear if PAs could diagnose and treat or not. But it was against some of the federal regulations that are in place. So it was counterintuitive. But I see in states where they do have a significant shortage and some of this legislation

[00:08:54] that's in place, that they might be more willing to take that away if they realize it's hindering their family members getting care or other individuals. I think that's going to start to shake things up a little bit.

[00:09:05] Now, what's the dialogue that's been happening around artificial intelligence as it relates to physician assistants? So probably similar to many of the other health care entities, it's come up a lot in my discussion regarding like patient education. And so can we use it to help give patient education?

[00:09:23] Is it accurate or not? We certainly use a lot of different individuals with nursing and patient care specialists and some of that to help us with some of the education. And so can we use it to help them augment what they're already giving? But I think the biggest

[00:09:38] thing is that actually accurate and does it still have that sort of personal touch to it? Some argue that if we do it right, the personal touch will go up. And I think that the challenge

[00:09:48] is that as you're looking at a patient, your natural instinct is to start within the call it the normal distribution of the disease. I know you also have worked in some pretty famous places and those folks see a lot of disease. And so they're very good at the

[00:10:02] tail of the distribution and identifying the things that are really unique. So there's been a whole dialogue about the benefit of artificial intelligence as it relates particularly to rural medicine, where there's not enough people, not enough resources, not enough time.

[00:10:14] I don't know if that's been something that your association has talked about or tried to put some rules or boundaries around. Yeah, I know there's some groups that are working, especially like ethical conduct within

[00:10:25] artificial intelligence and that aspect. So there's a lot of work going on that way. But I also, interestingly, in my work during the COVID pandemic did a lot of telehealth, which we weren't doing as much. And so I've still been doing a lot in regards to the COVID

[00:10:39] telehealth aspects. And so that was, I think, a catalyst for us doing things telehealth, AI, it pushed us out. And that's even where the licensure compact came into because we were crossing borders all the time. Then all of a sudden the regulations ended and

[00:10:54] we can only stay in our state. I do see, I'm hoping that AI will be a benefit to healthcare because I also do a lot of work in disparities. And so stuff that's in languages that's

[00:11:06] readable or images that agree with certain populations, I feel like that could be really great for us to utilize properly. When you look at your academy, what are your priorities in the next five to 10 years? And what are your challenges?

[00:11:20] So I would like to start with the worst and then go to the best thing. I think the challenge is one, just doing the status quo and not changing the momentum. But also it's even

[00:11:30] having volunteers or people willing to put in the work. I think is the biggest challenge for any sort of nonprofit organization is people willing to put in the effort and work. And so things don't just happen magically on their own. You need backbone to do that.

[00:11:44] So I see that as a challenge of having volunteers and that momentum going. But as far as things positive and growth and where we're going is obviously PAs are growing exponentially in our state. I do see some of the legislation changing.

[00:11:58] Our national body changed to Physician Associates to help our name, understanding what we actually do. And I see that as being a big piece and at least in Minnesota is switching to that new name change. And that's probably going to go nationwide. And then trying to figure

[00:12:14] out just where PAs best fit, where we can fill in those gaps, trying to fill some of that rural health disparities, populations and that aspect. There's some models emerging and people are just naming it health care at home when people are

[00:12:29] seeing people in their houses. Is that anything that's happening in your state? It is. There's a lot going on with even like hospital at home. So they get discharged earlier from the hospital and then doing that hospital care, but in their home,

[00:12:42] which I find fascinating because that's how medicine started way back in the days. I remember my grandma was living with us and Dr. Wally would still come to the house and see her. So that's not terribly long ago.

[00:12:53] Yes. And I've seen that for like even some of these telehealths and with PAs and NPs, like we could be that person that's going into the homes if that's where we can meet that patient

[00:13:04] or meet that gap. That might be what we need to do. So I can see CPAs filling in some of those areas and changing that. And they're doing some of that hospital at home or even like hospice

[00:13:15] and palliative care in the home versus being in the hospital. So there are some of that going around. I had a project to qualitative interviews of neurologists. And one of the things I walked

[00:13:25] away from that interview was that as it relates to diseases like Parkinson's disease, that these folks are actually with these people for 40 plus years. And they're looking out for so many things. They're looking at the caregiver, getting too tired. They're concerned about even things like

[00:13:43] being admitted to a hospital for something else. And if you missed your meds at a certain time, if you get them two or three hours later than normal, that could take that doctor three weeks

[00:13:52] after you get out of the hospital to get back on track. And so it struck me that we're at a time when we're trying to personalize care. And it seems to me in a lot of places that personalization is

[00:14:03] coming through the physician assistant. In this case, this practice had hired a lot of physician assistants to handle the medication balancing, handle the education, tracking the family and doing the education on the next phase of the disease and different things like that. Is that

[00:14:19] unique to the physician assistant practice? No, that day in, day out what our role is doing. Honestly, I also laugh because patients always tell me, oh, I have so much more time to spend

[00:14:29] with you than the physician. And I was like, actually, we have the same amount of calendar slot time, but it's the patient's perception of how we spend that time varies. So how do you keep current

[00:14:39] on the rapidly changing environment? I always tell students like know your resources. It's like the biggest win as a PA and resource can be a person or it can be a thing. So it's like where do you

[00:14:52] keep up with some of your clinical updates? What journals do you read to see what new information is coming out? But then it's also that person who may be more knowledgeable in that area. So like I

[00:15:02] have my people that I ask for different things. I have my ortho friend, my neuro friend, my endo friend that I go to or can I run something by you? And then the same goes with legislation. Certainly

[00:15:12] we have national kind of things we're going for, but we have some giants that have been working on legislation and obviously they're more informed than I am or have ran those pathways. And so

[00:15:22] keeping in tow what's working, what's going on in other states to can we do similar things or work together? So what are some of the more progressive states for a physician assistant?

[00:15:32] Minnesota is one of the best. So actually in the Midwest, we in general have some of the best sort of regulation like Minnesota and Wisconsin have some of the best. There's a

[00:15:43] couple out in the East Coast. So we track a little bit from the national side, like where some of the legislation is like who has collaborative agreements, who has these optimal team practices

[00:15:55] with it. And then we also like to share. So like Oregon this year just switched to physician associate. And so we all want to learn how they got that to happen and we're going to try to repeat

[00:16:05] it in our state. So the cool thing I think about the physician assistant just in general is we all are sort of team players, collaborative because that's how the profession works. And so then it

[00:16:15] also works in these other leadership realms that we kind of share and collaborate in that realm. Interesting. So you were talking about resources. What are some of the people or the organizations or magazines or blogs that you go to keep current?

[00:16:29] I have to say probably similar to many people up to date is like my I love to go to and read and see things in our institution. We also have an education resource that we can use with some of

[00:16:39] the experts within our institution that we can look at things or what they're using in their practices. Is it similar, especially in primary care? I don't do neuro day in and day out, but

[00:16:49] I can reach out to that neurologist or see what their most thinking is. And then as far as like journals and things. So we actually have a journal for PAs called JAPA, Journal of American Academy

[00:17:00] of PAs. And so that's fun seeing current things that go through there. And then we actually have a retired semi come back physician that's in our group. And so he will look through all the

[00:17:13] like recent journals that have come out and send us the most like interesting articles that have come through to our whole entire division, which is a really nice synopsis. So we're all reading through a bunch of different journals, but certainly like the New England Journal of Medicine

[00:17:26] is something I look at quite frequently for some resources like the Mayo Clinic proceedings. I've looked at that before for items and then it's depending on what I'm working on too. So if I'm

[00:17:38] working on a quality improvement project in like breast cancer, then I'm going to be looking at some of those journals to see what's coming out recently in that regard. So what is the biggest lesson you've learned thus far in all your roles?

[00:17:51] I think it's the word no is not a bad thing. So I feel like when I've heard no's or been told I can't do that's been the biggest learning point for me. So either it

[00:18:02] pushes me that maybe I needed to do that differently or think about that differently or propose it differently, or maybe that's not the right role for me and it pushed me to go

[00:18:11] do something else. So I feel like no's are a good thing, but everybody only sees the yeses. They only see the successes and the wins and that they don't see all these hurdles you've had to go through.

[00:18:23] That's some sound advice. So as you look forward at the category of PAs, I think I hear we're probably moving from assistant to associate, which I think maybe a lot of people don't think

[00:18:35] of as a big deal, but in the academic world you become an assistant dean and then an associate dean and that translation is assistant you're doing for the dean, associate you're hand-in-hand partnership. Is that some of the changes? But besides that, what is the biggest opportunity

[00:18:51] for growth and some of the biggest challenges in our healthcare system that you see that PAs can help with? Yeah. So I think the biggest growth is just the opportunity we get certified as this general internist. And so there's so many opportunities that you can specialize and do

[00:19:08] these different aspects. I just met a student who actually was a geneticist initially, went to PA school and now is getting to do a role as a PA in a sort of a genetic clinic. And so

[00:19:20] perfect avenue for that individual. So there's these niches that people can go into that we really can fill the gap in that aspect. I certainly see being able to touch populations that we

[00:19:31] haven't been able to be at disparities, be it rural, being able to tackle some of those population that we're not handling well is our cost conscious a little bit. And so there's an opportunity like we can do procedures and joint injections and things. And so we can

[00:19:47] bring good revenue into clinics. So I think there's aspects of that where we can help. I also think there's as you get several years into your career and you start thinking you want to try different things. We had physician assistants that were working with us in

[00:20:03] marketing clinical development, the medical device and drug companies too. So I think there's so many different avenues for people with that degree to go over time. Absolutely. Yeah. Cause there's education realm, there's the research realm, there's

[00:20:15] medical device companies or pharmaceutical. Like there's very different ways you can go. It doesn't all necessarily have to be clinical, but we know that in healthcare, we certainly have a need for clinical. Absolutely.

[00:20:28] Yes, but there's many other roles. And I think that's the part that I didn't know first about the profession and now I like very much know, but I like that I can change things up as my career

[00:20:39] changes, as my family sort of evolves, how that kind of works for us at that time. That's great. Anything else you'd like to share with the audience? I think maybe just that possibilities are endless. And I think a PA is a great role for anybody

[00:20:53] looking into healthcare. And despite what people might tell you, sometimes find out what works best for you, what makes you tick and find that role that really fits your personality. Perfect. Thank you very much. Appreciate having you as a guest. Thank you.

[00:21:08] Thanks for tuning into the Chalk Talk Gym podcast. For resources, show notes and ways to get in touch, visit us at chalktalkgym.com.