Season 1: Episode 6: MEDEX Northwest PA Program - Terry Scott, MPA, PA-C

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  
The work that we've studied and read says that diversity brings strength, not weakness.

Unknown Speaker  0:27  
Well, today we speak with Mr. Terry Scott Terry's Program Director in session head of the medics Northwest PA program at the University of Washington in Seattle. We're excited to hear from Terry today about his path to becoming a PA from his roots as a young person in rural East Texas. Terry remembers the struggle for equality in the disparate health care in his community. And those early experiences impacted his path and the work he ultimately did to change that dynamic. He is a graduate of medics class 25 from 1993, where he served as their class president, and he has learned and worked in both rural and urban communities in Washington State. He has also worked in HIV vaccine research and has provided primary care to HIV positive patients. He joined the medics faculty in 1996 and became their director in 2015. We'll hear of his career as a PA his work in civil rights and about the medics PA program which has strong historical roots to the beginning of our profession. Terry, thank you so much for joining us today. It's really an honor and a privilege to have you on and I've really enjoyed our conversations over the years and your insights into the profession. I know you have a really rich history and how you became a PA. So I'd like to start by having you tell us about your path to the PA profession first.

Unknown Speaker  1:41  
Well, thank you. First of all, it's a pleasure to be here. And thanks for reaching out to me. I've been a PA for almost 30 years. And I can tell you my path was one that started when I was in high school as a sophomore, my parents moved to Seattle, Washington, and I went to local high school inner city high school. And while there, there was a program there that allowed inner city kids to get some work experience. And I was fortunate enough to get a position at the University of Washington after school during the school year and full time during the summer for a couple of summers. And I chose to the health professional path. Primarily because of my experience growing up in the rural south. I'm old enough that I was at generation that was one of the last to experience segregation. So I remember the disparate health care in my communities, and the lack of access to health care, such that common things like common cold that lead to pneumonia, oftentimes led to poor outcomes because of access to health care for

Unknown Speaker  2:46  
from my community. So I was struck by that.

Unknown Speaker  2:50  
And so when my mother moved out to Seattle, I had the opportunity to be part of the Seattle Public Schools work training program, which was a program federally funded program by the Carter administration back in the 70s. I had experienced as a lab technician, and I was kind of trained as a lab technician. So that allowed me to get a position after high school as a lab technician at the University of Washington. And it was there after several years that I learned about the medics program at the University of Washington. And frankly, it was a revelation to me because I had never heard about PDAs, although I had CPAs at Group Health, the local HMO for my own health care, you know, there was never a conversation about their training or their experience, but they were medics graduates, as a matter of fact, many of them from the first couple of classes. And so that led me to explore this more. And ultimately, in the late 80s, started working diligently toward meeting the prerequisites to getting into the medics program. And fortunately, I got in and became a PA and it's been a wonderful and glorious opportunity for me, I feel very fortunate, and that I was able to get in the medics program almost 30 years ago, 30 years ago now. And to be able to get that experience and become a PA has been life changing.

Unknown Speaker  4:15  
And how cool is that to come full circle and come back to being a director in 2015 for that, that really prestigious

Unknown Speaker  4:21  
school.

Unknown Speaker  4:22  
Thank you. Thank you, you know what I consider it an honor and a privilege to one have had the opportunity to become the director but I'm calling more importantly to have met Dr. Richard Smith, who was the founder of our program who became a close friend and mentor who probably 10 years before I became the director said to me that you should get your master's degree because this program is going to need you someday and I'm my jaw dropped but when that when someone like Dr. Smith's stature and wisdom says that to you, you take it very seriously even though you feel so unprepared and that he's got to be wrong in this case, but looking back I'm thankful to have known and thankful that he shared his wisdom and insights with

Unknown Speaker  5:05  
me. Yeah, and that just goes to show how important mentorship is. And when we get into these roles, how important it is that we kind of circle back and help other people step up into kind of opportunities. So you brought up Dr. Smith, your program is historic. It was one of the first PA schools to enter the profession. And Dr. Smith was a historic segregation figure himself. You want to talk a little bit about the history of MedX. And his impact not only on civil rights, but also on the inception of your school and and also just the ultimate breadth and depth that you've attained through all the different satellite programs that you have all developed?

Unknown Speaker  5:45  
Absolutely, absolutely. So first of all, I got to meet Dr. Smith, when I first joined the program, because he at that time was in based in Hawaii doing some of his international work. And we met because we he came back and to the medics program, we met him doing just kind of a roundtable discussion. And then we invited him back for our graduation. So he was back at our graduation. And that started our friendship, and we kind of stayed in contact from that point forward. So Dr. Smith, as a physician, graduate of Howard University, prior to him going into medical school and becoming a physician, he spent time in pre Castro Cuba, and as part of a church mission to help the people in the rural parts of Cuba. While there, he saw what he witnessed was something between a nurse and a physician that provided a lot of care to the population that planted a seed in his mind. And he came back change majors and Howard from music to medicine, graduated with a medical degree and went on to become a member of the US Public Health Service and spent time in Africa did some wonderful work there, but was chosen in the early 60s to help lead the Medicare Medicaid rollout as that became law, and he was chosen specifically, as an African American, to go into the south to help desegregate some of the hospitals, we bet we're going to be getting some of this Medicare funding. He and I shared ours around this story, because the first place that he was sent was President Johnson, Lyndon Baines, Johnson's wife, Lady Barry Johnson's hometown of Marshall, Texas. Well, Marshall, Texas is probably 60 miles away from the area in which I was growing up as a town. So I know that segregation and the challenge is very well. And he and I shared the story because his impacts where he went in as part of the public health and successfully desegregated the hospitals throughout the south with his team, but he did not. And he talked very, frankly, about the challenges he faced and the death threats that he received as a part of that work. But I can tell you, it was such a touching story, because his work had impact in the lives of my people in my family, because that desegregation of those hospitals meant that access to care was going to change. So Dr. Smith and I lives crossed, even though we did not know each other. Isn't that ironic, isn't it isn't it. And so, he ended up, desegregating the hospitals. And it was well over an 18 month period of maybe less, it was phenomenal work. And ultimately, he when that work was done, he left the Public Health Service to come to the University of Washington and establish the MedX program. And in starting the Manage program, he traveled throughout all of rural Washington state meeting with physicians, etc, to really lay the groundwork, what he called the receptive framework for the medics program. And he did that successfully, and established the medics program in 1969. And he took military corpsman or former military requirement as the first class. And from there, the medics program began. And he stayed for several years, and then went on to create what he's what he called MedX International.

Unknown Speaker  9:22  
So what were some of the countries that he invested in early on?

Unknown Speaker  9:27  
In January 2017. We have an entourage of ours, went to Honolulu has his a residence and met with him and actually flew and members of his team have met X International. And it was the first time they've been together in almost 25 years. And we had to sit down with them and ask them some of these questions. And the response was, it's probably easier for us to tell you what countries he didn't go into in terms of those low resource countries because there were over 80 countries that he and his team went into, but some of the first or Micronesia the Federated States of Micronesia, he, they were invited into South Africa during apartheid, which is a very phenomenal story. We actually met some of his team African American who said that during a time of apartheid, that his team was so well thought of and needed, that they were given honorary white status in order for this African American led team to come to South Africa and do some of their medics international work. Wow. And I can tell you some of the stories there, but one of the individuals was a physician, who was one of the Civil Rights individuals who did one of the first city in in Tennessee. And so you can imagine that this individual as a young physician, now part of Dr. Smith's team being invited into South Africa with apartheid, that he I actually met him, he said, you know, we went in, and he said, Okay, I'm an honorary white, well, we're going to test this. And they almost created an international incident. That's the type of talent and that's the type of people that Dr. Smith had around him. He had the best, and they were doing phenomenal work. But the Federated States of Micronesia has reached out to us prior to the COVID pandemic, and has asked if we could help facilitate training, and then COVID hit and everything got put on hold, but reengaging again, but also some American Samoa and Guam have showed interest as well.

Unknown Speaker  11:26  
That's fantastic. So it seems like his lived experience of going into the south during segregation to desegregate hospitals, led to a fearlessness if you will, to be able to go into a country like South Africa with apartheid.

Unknown Speaker  11:42  
Yes, yes. And you know, when we met with him in January of 2017, little did we know that he would pass away a couple of months later. But what he did share with us was some of the stories, you know, that the threats that he received, and surprisingly, South Africa wasn't as dangerous a place for them. As it was for him when he was doing the work in the South. As well as here he said that one of the things that struck him was he received a postcard after doing the work in the south to desegregate the hospitals, he received a postcard from Savage Maryland. And on the postcard, it just simply said, your next. This was after the assassination of Dr. King.

Unknown Speaker  12:24  
Wow. So I was

Unknown Speaker  12:27  
so useful for him to be nearly I guess, in his mid 80s or so at that point. And he was so coherent, he was so clear on that one I you could tell that this was witnessed stayed with him all of his life.

Unknown Speaker  12:40  
What an incredible honor to his legacy that you and your team have continued and really lead the conversations nationally, and diversity, equity inclusion, tell us a little bit about why diversity is so important to our profession and to our world. And when it comes to healthcare and healthcare workforce, and maybe you know what the additions because you for many years, we talked about diversity. But now we're adding the concepts of equity inclusion, which obviously have a real reason why as well. So can you help our listeners understand those three things? Absolutely. Absolutely.

Unknown Speaker  13:13  
So first of all, I think that, for me, personally, as I said earlier, having grown up in a segregated south, where access to health care was very limited. And then understanding that the work that our founder Dr. Smith did, and desegregating hospitals, which started breaking down that access to health care issue to some degree, better than what it was previously not as good as it needs to be even today, but better than what it was

Unknown Speaker  13:38  
that that was so important. Diversity is so important,

Unknown Speaker  13:41  
because as you as we all know, our nation and our world is a diverse place. And Access to care is dependent upon having a workforce that looks like and represents diversity in all of us dimensions. And for for too long, we we've just had incremental success around that. And so diversity as a concept is so important, because you need a workforce that looks like the people that they are serving, you cannot continue to have an a modernized looking workforce serving a diverse population. And so diversity is important for the for those reasons. And now the concepts of Equity and Inclusion when you've had individuals who have traditionally been excluded, and then to say, well, let's have equality happen equal proportions, then then you're really not addressing and understanding the seriousness of the issue. Now, I think Dr. King and his words over 50 years ago stated that he who is behind in a race must forever remain behind our run faster than the man in front. Well, that concept is true. And I think for for too long, we had individuals who did that, but that meant we only had a few extremely talented individuals who would would make it to the level of medicine. But that's not good enough. If we're really going to make a commitment to diversity, we have to recognize that equity, which means that individuals who may have had a greater challenges than than others may require or need greater attention and resources in order to be able to get to the finish line. And that work of equity versus equality is so important that inclusion is so important. So I really want to emphasize that, yes, diversity is important. But that concepts of equity and inclusion is vital to the work of diversity,

Unknown Speaker  15:39  
what we're doing is we're just leveling the playing field, we're making it so that everybody has an equal opportunity to have the same success you're making so that the starting line that starting block in the race, so to speak, is equitable.

Unknown Speaker  15:52  
Exactly, exactly. We're not what we're not what we're not saying, you know, it goes, the argument oftentimes is that, oh, you're giving somebody who is not qualified to be here, yada, yada, that's not the case. What we're really trying to say is that we are determined to ensure that we have a workforce that looks like what America looks like in reality. And when I say that, I mean in all of us dimension. So what we want is to say now, in order to get there, we need to really work do the hard and gritty work of outreach to communities that have traditionally been excluded, traditionally been hamstrung in terms of that disadvantaged pneus. And to overcome those and ensure that we have the resources and the energy to ensure that they are included and receive the fairness and equity that they need to be successful. One of

Unknown Speaker  16:43  
the things I think our two programs do really well, is our pipeline work that kind of you just talked about reaching out to communities, so many programs are inundated with 1000s of applications. And they could just sit back and wait for people to come to them. But then their pipeline of people that they're able to select is not being cultivated, and procured in a way that reflects the diversity of our communities in our country. So can you talk a little bit about your experience with pipeline and why that's been so successful for you?

Unknown Speaker  17:14  
Absolutely. Well, first of all, I think that your pipeline is so key, because if you're just waiting for these individuals to find you and come to you, that's that's not It's not adequate enough in these days. So for us, I think it's important to start not only in high school, but in middle school, talking to him about the PA profession, reaching out to military installations, where there's a lot of diversity, because a lot of times the way out of the ghetto, or the way out of an impoverished situation is through the volunteer military, which folks of color and other other folks from diverse backgrounds tend to go in in greater numbers than others. And so for us is having these outreach programs deliberate and intentional toward these communities. And in addition, we're now we're even reaching out because COVID has taught us that you don't have to do these things in person, we're actually reaching out to HBCUs, which tend to be in the eastern and southern parts of the US, not a whole lot in the Pacific Northwest. But we are reaching out and doing outreach to those colleges and universities, letting them know about the history of the medic program started by an African American man who had this historic history of being a fighter for justice, equity, diversity and inclusion. And so for us, it's having those outreach programs that are deliberate and intentional, and not just one dimensional. So we're reaching out to high schools and K through 12. We're reaching out to military installations, we're reaching out to community colleges, we're reaching out to places where we know that diversity tends to be exist in higher numbers. And so rural parts of our state, forming communities in the Yakima Valley places where we know that those individuals live and reside and need to know about this profession and need to know how they can get access to this. So as a public university, that's a very important for us. And that's the work that we do to do and we're always looking at

Unknown Speaker  19:15  
how to do it better.

Unknown Speaker  19:17  
And Terry, you served on the various committees with PA and I suspect the academy as well related to diversity, equity inclusion in the past, and one of the best things to come to our profession in the past several decades was the new standard by the accrediting body that is requiring programs and sponsoring institutions to support programs in defining diversity and demonstrating compliance towards a more diverse health workforce. So maybe from your perspective, because your program has done so well for so long. What are some of the recommendations that you can make for other program directors and educators to help them think about and enact processes or programs that are going to help meet that and serve? Well,

Unknown Speaker  20:01  
thank you. That's a very good question. So I can say that yes, I served on the on the physician assistant education Association's

Unknown Speaker  20:08  
Yeah. Mission advancement commission, I think the Mac, the DI D iMac,

Unknown Speaker  20:13  
diversity inclusion mission advancement committee. So yeah, I served on that for a couple of terms. And we really were trying to help work with any of our constituent organizations. I think even a our CPA came and met with us a few times. And I'm glad to see that Stan came out a few years later, the issue around this was trying to ensure that programs understood that they were in the driver's seat to some degree, they get to, as the AICPA does, as it's up to the program to tell the RPA what a what is it that we say we're going to pursue around this diversity standard. And for the metadata program, it was a fairly straightforward when we looked at our large university, we have diversity blueprint that specifically spells out all the goals that we're trying to pursue and trying to increase diversity. And particularly, we're looking at underrepresented populations and those undergrad for us underrepresented in medicine, we were looking at groups that were traditionally disadvantaged, like LGBTQ communities. And so for us, it became very easy. But I think for the standard, it's written in such a way that and when the work we did on the diamond was so that folks that felt like, well, we don't have diversity in our community was like, No, you just need to look a little closer, a little deeper. And then you get to start to determine what that work of fulfilling that standard looks like. But once you didn't state it now, you must have goals and objectives to meet that. And so I think the standard is written in such a way like all the standards are was meant to be somewhat open, so that groups can, our schools don't have to feel like well, and we faced this challenge. When that when that we were talking about this as well, we don't have large Latino and African American populations, and you fill in the spot, area of the nation. But what do you have, because I can guarantee you that there's not a spot in this nation that doesn't have some level of diversity. And it's just defining it, and doing the gritty work of going out and pursuing and including it. And so I think that is written to be in a way to help programs have some flexibility, and yet being clear, to actually have some outcomes at the same time.

Unknown Speaker  22:33  
And so if you look down the road, let's say, because that standard came out, I think, maybe year and a half ago, maybe less, but ultimately, 10 years down the road, what does success look like with that work?

Unknown Speaker  22:48  
Well, if we're if we're successful with it, we will have a we will continue to move toward a more diverse pa classroom and workforce. While we have individuals who are not will have identity diversity that's increased. And when we move the needle on on diversity, I want to be clear, we're talking about diversity in all its dimensions, and particularly around those have been traditionally excluded. So in 10 years, I would say that we would like to see a workforce that's moved toward greater diversity, including identity diversity, in terms of candidates, applicants and the workforce. Also, we would hope to see programs because not only talking about candidates are talking about faculty, we would hope to see a greater number of diverse individuals, amongst the faculty in PA programs amongst the staff in PA programs. I think that that's that would be our hope.

Unknown Speaker  23:40  
Yeah, yeah,

Unknown Speaker  23:41  
I agree. And I, I've often felt the arguments from the MIT research around diversity and excellence, the I've often felt that we are shooting ourselves in the foot by not having a strengthened diversity of perspectives around the table for all these really challenging issues that we're dealing with. And so I think there's a real real importance to this work, not only from reflecting the workforce and providing a culturally humble workforce that has lived experiences in the communities that they serve in, but also in the greater thoughts in terms of solving the most difficult problems that we have in our in our world.

Unknown Speaker  24:19  
I can't agree with you more. I think that what I think I hear you saying is that the work that we've studied and read says that diversity brings strength, not weakness, and yes, it requires a lot of work and effort, because when you get a lot of people from diverse backgrounds and diverse opinions, you usually get a lot of tension, but that tension is necessary. That tension is what brings out the best in all and and so I think that when we get the right people at the table, and have a diverse environment and diverse backgrounds of individuals at the table, then yes, cures for cancer challenges that we face in this country and this world are a Approach from different perspectives because that diversity brings that different ways of looking at problems. And that's a good thing to have. And so I think that as we can, my hope is that we can help alleviate the fears that some folks have around diversity and inclusion and equity. Because I think some of the biggest challenges, if we're very frank about it is that for some, it feels like in order for some folks to get our be included, they can feel like something is being taken away. And that's not the case, what we're really saying is that we are giving all individuals an opportunity to have a seat at the table, and be included in the discussions and be included in the in determining their destiny and outcomes. And so when we approach it, that way, we can start to help ease some of the fears that some folks might have that if someone gets something that somehow that's um, being taken from us. That's that's not the case.

Unknown Speaker  26:00  
One of my favorite poets is Maya Angelou and I love her poem where she talks about how we are more alike than we are unalike. And the more diversity I've had around me, in my life growing up, the more I've realized that that's true. Absolutely. So, Terry, let's talk about medics a little bit more. So what what sets your program apart? And what are the things that bring you great joy and pride from what you're doing up there.

Unknown Speaker  26:23  
So what set medics apart, I think what sets medicine apart is our founder and the work that he set in motion over 50 years ago, I say that I'm a current caretaker of his dream and his vision. And I do believe that to be the case, what is in the DNA of the medics program is service to others. And I always add like that, that with Dr. Smith, what motivated him most was loving service. And so that's what also has motivated me in my life to make some of the decisions that I've chosen to do as well. What sets our program apart if we see a problem. And in our, in our state, when he came here, he saw a problem that was a national problem. And that was Primary Care Access. Rural communities had Doc's leaving in the middle of the night, because they were overworked and couldn't sustain the load that they were bearing in some of these rural and underserved communities. And so what he said in motion, we continue today, and we're very much a mission driven program, which is to reach out and serve those communities provide access to health care, recruiting individuals who actually understand that and want to pursue being a PA for something more than money or status, who want to go about serving humanity in a way that betters all of us. And so I think, as a PA program, and as the medics program, if I thought about it today, and even the work that we're doing currently, even considering some of our international work, the work we're doing with distant campuses, is done with that with that in mind, and that is, how do we continue to improve access to health care in our region and in our world. And so at the end, in a nutshell, that that is it. And that's what our founder did with his work. And his life was a living example of that. And that's what we continue to do. So our faculty are very much mission driven, our students very much mission fit. And our graduates very much on mission fit and are going out there continuing to expand his hands, so to speak.

Unknown Speaker  28:38  
That's great. So when you have applicants who are coming in front of you to get your wisdom, on strengthening their application to get into your institution, what are your top two or three things that you remind them of as they're crafting their, their message to you?

Unknown Speaker  28:53  
I think any candidate is applying to PA school, especially one that have a mission, like our programs, they have to really delve deep into why they are doing this. And I think a lot of candidates know why they're doing it. And they have a passion as to why they're doing this. But they get caught up in the technical aspects and forget about the passionate aspects of it. And I really think the first thing they need to ask themselves is do that three levels of why? Why am I doing this? Why am I going through all this, this this preparatory work to try to get into the PA profession and go beyond? I'm here because I want to help others. Well, why? What does that come from? What's that motivation? Because if they explore those levels of why then being able to prep their application, their personal statement, will start to come across on paper that captures us as the reader that says, This is somebody I want to meet. This is someone who I want to sit down and have a discussion with. Now of course we want to ensure that they that they gotta have the decent grades. They got to have Have the prerequisites, they've got to have the clinical experience and things that we advertise and clean on our website about having to have but but I'm speaking to how do you stand out and rise above the routine in terms of a candidate? And I think the first thing they need to think about is they really need to, to do some soul searching as to why am I interested in doing this? What motivated me and for many of our folks, and through the years of experience, the ones the stories that stand out, are those that have had either personal experiences with the healthcare system that put them on a path that says, I want to make a difference in this world, I have seen this or I have experienced that, or I simply have this passion for trying to alleviate suffering. And I think it's a folks can do that the depth of soul searching as to why what is it that prompts you to do this, and do that to a level of why to at least three or four times, oftentimes, they'll get it to that really, if they're honest with themselves again at that core, that then allows them to express now the other thing is, that's that takes vulnerability. Once you've once you dig that deep, then are you going to be comfortable enough to then share that you got to get comfortable with sharing it. Because if you hold it close to you, and we've seen those candidates where they have it, but they're they they're this not willing to go that extra step and doing the doing the application or the interviewer to share it, then they're doing themselves a disservice. So do that level of soul searching and then start to come to terms with being able to tell the world why you want to do this? Because when you do that, then it becomes to us as the person sitting here trying to make the tough decisions on who exempt who not, you know, we'll look at the grades but that's not the end all be all right Don wants to once they reach a certain GPA and GRE score, you know, you're like they can based on paper, they can do the program, but we're looking for something more. What is it that motivates them? What is it that drives them? What is it that shows them in that level of emotional maturity, that says they're doing this for something more than money or status, and if they can do they can share that with us, man, that is a day that in that fills your tank as a PA educator.

Unknown Speaker  32:20  
Terry, I just can't thank you enough for taking the time to share your story with us and then help us hear what's going on up and MedX but also really understand the the core DNA issues of diversity, equity inclusion for our profession as well. reading your bio, you started life in East Texas looking for problems to solve. You move to Seattle and continue that process. And here you are in a position of authority and power that allows you to actually impact more and more communities. And I just congratulate you on your success. And thank you so much for your leadership for our profession as well.

Unknown Speaker  32:55  
Thank you so much. It's been a pleasure.

Unknown Speaker  32:57  
What a privilege to speak with Terry about the medics Northwest PA program at the University of Washington in Seattle, and about their passion for service. The story is one of our founding fathers and his impact on the world was a treat. Tune in next week when we speak with Paula Phelps, who is a professor and the former department chair for the Idaho State University Department of PA studies. She now serves as the Associate Program Director and service learning coordinator and practices clinically as a PA at the Pocatello free clinic in Pocatello, Idaho. We'll learn about her work in Idaho, her thoughts on what makes an applicant shine, and we'll delve into her service learning

Unknown Speaker  33:39  
focus.

Unknown Speaker  33:45  
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 and do not necessarily reflect the official position or policy of the University of Southern California.