Season 1: Episode 7: Idaho State University -Dr. Phelps

Unknown Speaker  0:08  
Welcome to this episode of the PA path podcast. I'm your host, Kevin Lohenry. We are glad you could join us as we seek to better understand the PA profession.

Unknown Speaker  0:20  
And I say to my colleagues, I'm like you get it like just because you change the words and a lot. You think like all of a sudden you're free and you can just practice medicine without supervision is like, that is not the case. And that is not what the Board of Medicine thinks.

Unknown Speaker  0:38  
Well, there you heard it from the very first and only PA to serve on the Idaho State Medical Board in history. Today we speak with Paul ITOps. Paul is the former department chair and current professor in service learning coordinator for the Idaho State University Department of PA studies. She has an impressive history writing successful grants that have supported numerous innovations with their programs, and she has published her findings in a variety of different journals over the years. She is a graduate of the University of Utah PA program, and has been practicing since 1996 in family medicine, public health and women's health, and she now serves the Pocatello free clinic at least one day each week. She's an avid runner and certified lifestyle medicine provider who has some very interesting things to say about her experiences in Idaho. Well, Paula, thank you so much for joining us today. We're really excited to hear about Idaho State and about your career in Idaho in the work that you're doing in the community. First, I'd like to ask if you could tell us about your path to becoming a PA.

Unknown Speaker  1:41  
My path to becoming a PA as long as Mr. Curtis. So I grew up in Cleveland, Ohio, and I always knew I wanted to be in medicine. And when I was 16. I was shadowing a doctor in inner city, Cleveland, a family practice doctor. And she was just really about service. And I would take multiple, like buses and trains to get to where she was. And I was like, I want to be like her. And I went on to college and I still was interested in medicine. I got a little bit lost in my undergraduate and thought really about exercise physiology and workplace fitness. Ended up with a double major and biology and sport movement studies, which is a fancy way of saying physical education. I pursued that for a little while until I met my first PA and I went to a small liberal arts college in Indiana. I'd never even heard of a PA never ever. I worked as a medical assistant for a little while towards the end of college. And then also right after college. And then my husband and I moved to Idaho. And of course, Idaho is a great place for physician assistants and I met my first PA and I thought wow, that's super cool. That's everything I want. And I think I'd like to pursue it. And I I knew at the time this was you know, early 90s. I knew at the time I spend the rest of my career explaining what a physician assistant was. And I thought, well, there's no prestige. And I was okay with that. But what I really wanted to do my dream job was to work in Stanley Idaho, which is population 75. And then it kind of explodes in the summer as a tourist place. And it's in the middle of sawtooth and it's one of most beautiful places, and never did get that job. But anyways, that was my dream was to be overall Idaho, Pa I applied to two PA programs. And in the early 90s in the Northwest that all we had was Utah and met X Northwest. That was it. And so I applied in the first year, I didn't even get an interview and they said well, what can I do? Well, you need more clinical experience. And I was working doing bench pharmacology actually at that point at the Boise VA. And I was able to become a clinical research coordinator and started coordinating multicenter drug studies for big, you know, Losartan actually, that was one of the drugs I was working on. It hadn't come to market yet. And got to have a little bit of patient experience. Of course, they didn't think that was quite patient experience enough. And I did things like taught myself EKGs and took ACLs and the days when people would yell at you and make it really, really hard. And eventually I got in and I got into University of Utah. I interviewed at both schools, I got into University of Utah, and that's where I went 93 and graduated 95.

Unknown Speaker  4:37  
That's great. We share we share a couple things in that story. One is I too applied to MedX when I was first applying to PA schools and I didn't get in there either. So their loss our gain I guess. And you know what's really funny is I also had a dream of being a real PA. When I was first interviewed my dream was to move to Montana and work in a small community and

Unknown Speaker  4:58  
I'm living close to Rural pa that you are in LA, I would like to point that out.

Unknown Speaker  5:05  
Yeah, you are much closer to the dream than I am. So tell us about your various roles that you've done as a PA when you graduated, what did you first do and what led you to that and maybe what led to some changes if you if you moved into other roles?

Unknown Speaker  5:19  
Well, interestingly enough, and 95, my husband was finishing his doctorate here at Idaho State and I had seven job offers. And somewhere in rural Chalice, which is about an hour from Stanley, and salmon, Idaho, which is also rural ahead of rural job offer in Wyoming, I had a clinical research position offer the university, some other clinical jobs. And I was offered a position as Academic Coordinator for the brand new program that was opening. August 95. I graduated June of 95. And at that time, Walter Stein who I know, you know, wow, was brand new program director here, he came with 20 plus years of experience from the East Coast, Brooklyn and GW to this little tiny place in Pocatello, Idaho, and was opening a program, and he had me interview, the first class that came, he just needed like pa student, I was doing my clinicals here. And he started offering me a job and he's like, No, I'm serious, you should come work for me and I, I'd run into him in the video store blockbuster eight. And he would say, Hello, I'll give you another $5,000. And I looked at him and I said, I'm only going to come work for you. If I'm pregnant. And I met it, my husband and I were trying to start a family. And he looked at me said I don't care if you're pregnant. He said you can work from home if you want to. And in that moment, I realize that all those clinical jobs, they couldn't say that they would care that I was trying to get pregnant and start a family. But I recognize immediately the flexibility I would have early in my career to start a family and and that that would be okay. And so the goal was, my husband was going to graduate with his doctorate and two more years, I'd work at Idaho State from 95 to 97. And then we'd hit the road, he'd be a professor someplace, and I'd be a rural PA and that was going to be great. And here we are 26 years later, and fell in love with teaching so and fell in love. I tell people that one I'm a dinosaur, because I'm the first faculty hire, and I've been here the longest. So I tell them, I'm the dinosaur of the program, when they apply, so you can ask me anything, anything you want. And the other thing I tell them is my husband and I have two daughters, and that the PA program is my third child. And so I've raised it 26 years old, the summer, I don't know, I guess it's a labor of love. And as far as jobs, I was Academic Coordinator for five years, there was just two of us for the first 10 months or so it was just the program director and me. And I had to coordinate all the courses, get people into teach. I remember constantly apologizing to my students. And like, I'm not really sure about this. I just graduated and I read in my first set of evaluations, you need to stop apologizing, you know more than we do. And so I tried really hard to exude confidence, even though I still felt like oh my gosh, I'm just a new grad, how can I be doing this. But then I did that for five years, we got a new program director in about 2001 2000 2001. And I became the clinical coordinator. I did that for 10 years. And then I became the Program Director in 2010.

Unknown Speaker  8:37  
That's, that's great. And it looks like from your background, you've also continued to practice clinically on the side, I would imagine a day a week or something like that. I've always

Unknown Speaker  8:46  
practice one day a week, being a new grad and come into education. I convinced Walter that I really needed to practice a little bit. I also was given a loan repayment as a PA in underserved area. So at the time, our county, this part of the county was underserved. And so I could qualify for loan repayment, but I had to have like a minimal percentage of time. And I think at that time it was 20%. And so I convinced Walther that I needed one day a week and I even still have a letter that says you can do this for two years. But you only need to practice for half a day a week to keep your skills up which I've never believed our program has always had our faculty released a day a week to practice it's written into their offer letter, and it's something we tout all of our all of our faculty are clinically active. But as far as what I've done, I started out in first five years and family medicine. Then I went into obstetrics, OBGYN and was actually doing obstetrics Of course not delivering, though it is within our scope of practice. It's super hard to get through the bylaws of a hospital and I would see pregnant patients one day a week, but I'd see them one visit. And then the physician would see him the next day. And we just switch off until they were ready to deliver. And after that I did public health. I did a lot of family planning at the health department for multiple years, went back to obstetrics a local clinic, lost their physician and is owned by a hospital of the way. And the hospital bought out the practice. And they came to me and said, Will you run this practice? And they met full time and that's like, I got a pretty good gig at the university. How about if I do this a day a week for six months. And if I love it, yes, I'll leave the university but I was already tenured at that point. And then I was the only provider of seeing the patients. And I would see obstetric patients again, and I would see them up to 28 weeks and then I transfer their care, low risk patients to Blackfoot, which is 20 miles away. And then the physicians that gynecologist obstetricians would take care. And I've worked in migrant health, family practice migrant health, and internal medicine where I was the main working for a female internist. And she just didn't want to do women's health. She's like, I'm a woman. And people keep coming to me because they think I'm a woman, I'm going to take care of that. And she said, I don't want to take care of that. So I would do all the women's health care for her practice. I also got really, really good in that practice at thyroid, and menopause, those messing with people's hormones got really sort of the bread and butter of my practice for about seven years. I returned to migrant health and now and then I came back to Office gynecology, that office gynecology practice, I loved it was a great fit for me, the physician and I were about the same age, we had sort of the same philosophy of taking care of patients and really, very patient centered, she still use paper charts. And then COVID Hit she had her own set of chronic diseases and problems. And she just said, You know what, shut my doors because a COVID and basically took early retirement. And I thought, wow, I'll just sit out COVID For a few months and go volunteer at the free clinic. And I've been there ever since. And it also is a perfect fit.

Unknown Speaker  12:27  
So one of the things you've done for PA is you've actually spoken about how to get a HERSA grant, you have several HERSA grant that you've achieved. Can you tell us a little bit more about your HERSA grant,

Unknown Speaker  12:37  
I can talk to you about grant work and lifestyle medicine. And I can put it all into like yesterday at clinic and tell you about seven different stories. One is my grant work. And so my most recent grants called the Great grant. And so it's increasing the effectiveness of rural physician assistants. And it has to do with resilience and all that good stuff. But anyways, the great grant has Roets row it is a rural opportunity interdisciplinary training grant. And we're paying Idaho State University does not pay clinical sites, except for my grants are paying. We're paying places like the Pocatello free clinic to take a PA student and another discipline. So we have athletic training students, PharmD residents, and PA students they are continuously and as a great source of income for a free clinic. It's also an unbelievable opportunity for interdisciplinary training. And so that was there yesterday. i What else did I do yesterday? Oh yeah. My previous HERSA Grant was called the pipeline diversity. And I I know you want to talk about pipeline stuff. So my pipeline to diversity grant, we just finished our sixth year this summer. And it was one portion there's multiple facets to but one portion was reaching out to the local high schools, the rural high schools where there's high Latino population and teaching dual enrollment, medical Spanish and in those and then exposing those students two different career paths, physician assistant, PA, nursing, dentistry, all the different things. And yesterday my interpreter was a student who has started in think River High School about 25 miles from here. She is a first generation Mexican American and planning to go to dental school, so I didn't win her over for my career path. She is now a senior at Idaho State University has just submitted her dental applications. And she was my interpreter yesterday because I still see about 30% of our population that we see is undocumented immigrants who mostly speak Spanish. And so that was pretty awesome. And then the medical assistant is one of My grip scholars from my new grant, she is a sophomore at Idaho State. And she was actually in I shouldn't say she's in our second year Idaho State. She was offered early admissions what our grit program is. And so we offer early admission decision to people who have Junior status. And we have 24 spots a year 12 College of Idaho, which is our law, liberal arts, college partnership and Caldwell, and then 12 Here, she was one of them as an incoming freshman. She already had 39 credits because of dual enrollment and AP classes from her small rural high school. And she was also one of my pipeline students. Then she was accepted into our grit scholar. She was given a scholarship for undergraduate as well as early decision. And part of her scholarship is given her experience places like the free clinic, she's working as a medical assistant. So yesterday was pretty awesome.

Unknown Speaker  16:00  
That's great. That's so you had mentioned that you listened to the the podcast with Terry Stratton. And obviously turn I talked about pipeline. We also talked about the aarC standard on diversity. And it sounds like Idaho State is meeting that through these kinds of HERSA grants that have really built programs that have supported your pipeline work.

Unknown Speaker  16:21  
Absolutely. And Idaho State has a long history of HERSA grants back to our first director. And we you know, for many years, we were supported by her son, Pa training, I imagine was what they were called at the time. And then, gosh, I want to say more than 15 years ago, we received a grant force, and it was a HERSA grant. And the main focus of it was service learning. And that's carried forward today. And so at the time, and Walter Stein's really un-pc way of saying things, he was just like, yep, we want to take care of crazy people, incarcerated people, people of color, and he'd go through this whole, this whole list of people. But in essence, the service learning program was set up at our very white bread, Idaho school, to give exposure to our students of different cultures, different backgrounds, different socio economic backgrounds, living conditions, all sorts of things. And that's since grown into us really wanting to create diversity in our program so that our program looks more like the patients we serve, and the demographics of Idaho. So our next major grants had to do with pipeline for Latino students. And then we also received the great grant and the great grant from HERSA was also early decision enrollment. And again, really focus on Latinx population. However, in Idaho and 2020, about March, there was a law that's passed that no state institution can give preference, scholarships, anything to any of the protected classes. And so we really had to in order to keep the money, that the feds are giving us over a million dollars almost almost 1.5 million over over five years. For a Latin X for it scholarship for rural students from migrant families. We had to rewrite the demographics. And you can look on our website and it's, you know, Pa isu.edu/grid. And it'll show it's like rural students who speak a second language whose families are from agricultural background, so who have great knowledge and experience of different cultures. And you know, and so anyways, I'm in the Morrill

Unknown Speaker  18:55  
Hall. That is awesome. Talk about grid, you figured out a way around the system?

Unknown Speaker  19:01  
Oh, I know. We, I gotta tell you right up front. I live in a crazy state, the fallout from the great grant and the one not at all in favor of that law that was passed. And it's an anti affirmative action laws. Basically what it is, the fallout for that is the people who apply it to some super cool people who never would have been eligible the first time. One was a person who was first generation refugee, and he spoke Arabic, Arabic, French and Spanish. He grew up in Twin Falls, Idaho, and he identified as an individual as bisexual. And I was like, Huh, you know that there was a great background he was he really wants to help people from multiple different cultures and underserved populations. There was another individual who applied the first year, who was from rural Idaho, who was a medical assistant at a local emergency room there. It's called Gooding, and it's right next to the Idaho School for the Deaf and Blind. And she said, there's such a huge need for American Sign Language. Again, I wouldn't have thought, Oh, we did American Sign Language in rural Idaho, I wouldn't have thought that. And so I, unfortunately, the two individuals I just mentioned, for other reasons didn't, didn't qualify, but it really opened my idea. My eyes, I should say, to the idea of us really being broad. And really, you know, when we talk about diversity and inclusion, I really want to think broadly, I had when I wrote the grant, an idea of ask, there's such a huge need and a to help. We have so many underserved rural populations. We need Spanish out there. We need people who come from the community, so they go back to the communities. But it has been broadened to more than I had really thought about.

Unknown Speaker  21:07  
Yeah, wow. Well, it certainly shows your creativity and trying to navigate some, you know, really challenging political perspectives. And kudos to you and your team for continuing to advocate for, for those words, that you can't use diversity and inclusion. How crazy is that? Let's, let's shift gears, tell us a little bit about your role on the Idaho State Board of Medicine because I think that's a really unique role for a PA to serve. And you were the first PA on that board.

Unknown Speaker  21:37  
I was appointed summer 2019 by our governor. And as you said, I'm the first PA to serve on the State Board of Medicine. It's it's very eye opening, for multiple reasons, I now tell my colleagues, I am truly the most conservative pa in the state. I'm pretty sure that's why I think Governor chose me. But part of it is my age I you know, like graduated from PA school in the mid 90s. And the era in which I was trained, I was trained as a physician extender going into a practice with a physician. And now that's not what medicine is anymore. It's corporate. And I sit on the Board of Medicine with people who are trained in my generation or or older for the most part. And when I hear my colleagues talking about, wow, we need new legislation, which by the way, Idaho just passed new legislation. Now we have a collaborative physician agreement, we no longer have supervising physician status. And I say to my colleagues, I'm like you don't get it like just because you change the words and a lot. You think like all of a sudden, you're free. And you can just practice medicine without supervision is like, that is not the case. And that is not what the Board of Medicine thinks. And so it's very eye opening, because I get it. And when I sit with the 10 other people who still want to say, well, that person's not a physician, how do they have the expertise to do what they want? Show me the evidence, we have to keep coming up to the table and saying, This is why we can do what we do. And it's not just about changing the knee. And I'll say that to my national colleagues, too. It's not about changing the name is there's a lot more conversation that needs to take place. And so that's one of the reasons it's been eye opening is really about the reality of changing a culture in medicine. For us to be truly accepted as partners, and for people to truly understand our scope of practice is a lot. And I thought, Oh, we're going to Physician Associate and everybody's like, rah rah, yeah, who cares? It doesn't make a difference. There are many other many other areas where we need to be doing education. So that's one eye opener. And then the other eye opener is the amount of suffering that clinicians are going through both in all clinicians our Board of Medicine serves physicians, PDAs athletic trainers, registered dieticians, respiratory therapist, and now we have naturopaths as well, that was new last year. And across the board, though I mostly see it with physician assistants and physicians is the amount of suffering as far as addiction burnout is really tough. And so the reason is that people come before the board of medicine or their cases come before the board of medicine are really sad. And I see cases for people I've never ever ever known. And I also sosi cases after training over 1000 PhDs in this state, for people I know who at one point were super healthy. They had balanced lives well as balanced as you can have and peaceful, but what is it that they were well, and they were sober and they weren't burned out. And they're now coming before the board for other reasons. And it's it's very sad. And so I look at some of the things that we're doing right now. persa just, you know, put out an announcement and grants are due end of August, for resilience, for a grant for resilience and for training clinicians. And PA is nurses, all healthcare providers, physicians, everyone in resiliency. And that's part of what my my great grant is, as well. But there's, there's such a need, and especially after COVID. It's it's very, very difficult.

Unknown Speaker  25:55  
Yeah, I agree. I served on the NCCPA review committee for a couple years when I was on the board of directors. And we saw the same cases, because once they lose their license, their certification is up for question. And you're right. It's heartbreaking to see these PhDs who have worked on an average of seven to 10 years to get into PA school and become a PA, who have, you know, seen it all in jeopardy from really difficult life choices related to stress again, and just bad judgment, certainly, to your point, impacted by the incredible stress that they're experiencing. So tell us about Idaho State, you've been there for a long time. What what what makes Idaho State standout from your perspective? And what are you looking for in applicants who ultimately are successful in getting into Idaho State?

Unknown Speaker  26:46  
I thought about this question, since you sent it to me ahead of time, and I thought about it. And I always think, well, I always tell applicants, there's two things that set us apart. But as I set back and really thought about it, I thought there's four things that set us apart. And the first two things that we've always told people is that we're a program that's both high touch, and high tech. And what I mean by that is, we're very casual, you know, people come to interview and we talk about mountain casual, you know, we're, we're Mountain State, we're mountain casual, and not super, super formal people call me Paula, our lobby is a place where people will take naps on couches, you know, it's it's, it's informal. And every student has, you know, relationship with the professors and with their classmates. So that high touch and being very, very student focused. And then the high tech, because in 2007, we grew from Pocatello to Meridian, which is a three hour drive. And then in 2014, we grew again to Caldwell, which is four hours from Pocatello. So we transmit our program simultaneously to three campuses, and there are three campuses. And this was done long before anybody was doing zoom. We actually picked up zoom a few years before the pandemic. And when the pandemic came, you know, our, our president close the campus one day, and it's like, you know, as a Friday, the March 17 2020. And we were up and running on Monday, like seamlessly, and we were able to deliver our curriculum, and we continue to use other high tech means, but we really focus on how to use technology. That was just part of a grant for rural telehealth and how we can put different components of that into our curriculum as well. So high touch High Tech is one. Absolutely. Our Spanish for health profession as a second we are known throughout the country has been a it's been a place for people to come, who really want to experience more medical Spanish and get their graduate certificate in Spanish for health professions along with their PA, certificate and degree. And so people come I've got an incoming student right now from Annapolis, Maryland who sought us out and he's like You are my number one choice. He then applied to our Latino health track, which was initially HERSA funded and now it's privately funded for students once they're in the program, they receive scholarship, they work on their their their graduate certificate, and they do five of their eight rotations in Latin X communities where they can practice Spanish. That's two, three is lifestyle medicine, which we haven't talked about at all that five bar actually six of our our faculty are certified diplomats and from the American Board of lifestyle medicine and American College of lifestyle medicine. We've incorporated that into curriculum and are hoping to open a postgraduate residency in lifestyle medicine, which will be the first one in the country for PDAs. I don't know if it'll get passed the Board of Education, whoever knows about these things, but these sure that's. And then finally, with our donor, I realize we're in a very unique situation with scholarships. So we have our Latino health track scholarship, we have our grit scholars, which is undergraduate scholarship, and the early admission decision. And then we have $10 million, that's going to be given out in large chunks every year to every student who's enrolled. And so those are the four things that set us apart.

Unknown Speaker  30:45  
That's fantastic. I mean, certainly, you haven't struggled to have applicants before this five jazz, but I suspect that anybody listening is going to add your school to the list, just hearing about these opportunities. That's really phenomenal. Paula, thank you so much for taking the time with us today. This is really interesting. And what a great niche you've carved out for yourself there now and really, also, Congrats to all the success of Idaho State. It sounds like there are some really exciting times ahead for you and your students as well.

Unknown Speaker  31:14  
Thank you very much. It's been an honor and I'm still tickled that you invited me here. So thank you.

Unknown Speaker  31:21  
I want to thank our guests, Paula Phillips for sharing her insights about the Idaho State University Department of PA studies and about all the innovative programs they have implemented to serve the communities in and around Idaho. Tune in next week as we speak with Dr. Don Morton Riaz, President and CEO of the National Commission on certification of Physician Assistants. We will speak about the role of the NCCPA in our profession, her experience as the first pa leading that organization, and as a woman of color representing our profession in a variety of different roles throughout her career. Until next time, I wish you success with whatever path you are walking in life. And thank you for joining us. The purpose of this podcast is to provide news and information on the PA profession and is for informational purposes only. The views and opinions expressed in this podcast are those of the speakers and guests can do not necessarily reflect the official position or policy of the University of Southern California.