Expert Insights from Program Leaders
February 28, 2022
Season 2: Episode 29 - The Irish Model

We speak with Dr. Lisa Mustone Alexander about the physician associate profession in Ireland. Dr. Alexander shares her insights on the differences between the Royal College of Surgeons' programme and most U.S. PA programs and she explains the challenges ...


We speak with Dr. Lisa Mustone Alexander about the physician associate profession in Ireland. Dr. Alexander shares her insights on the differences between the Royal College of Surgeons' programme and most U.S. PA programs and she explains the challenges and rewards of helping the profession grow in the Emerald Isle.

 

Irish Society of Physician Associates: https://www.irishsocietyofphysicianassociates.ie

PAEA Story on Irish programme: https://paeaonline.org/resources/public-resources/paea-news/first-irish-trained-pas-graduate-rcsi

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 Arizona.

Transcript

*Transcripts are provided by Otter.AI. While they are becoming closer to reality, there may be some editing errors that are transcribed by the software. We apologize for any discrepancies.

 

Season 2: Episode 29 - The Irish Model

Sun, 2/27 5:24PM • 49:25

SUMMARY KEYWORDS

pa, profession, ireland, graduates, pdas, students, gw, apa, hospital, workforce, education, dissertation, dublin, consultant, opportunity, lisa, medical, experiences, spoken, leadership

 

00:01

We respectfully acknowledged the University of Arizona is on the land and territories of indigenous peoples. Today, Arizona is home to 22 federally recognized tribes, with Tucson being home to the Ogden and yaqi. committed to diversity and inclusion the university strives to build sustainable relationships with sovereign Native nations and indigenous communities through education offerings, partnerships and community service.

 

00:36

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.

 

00:52

I always thought P education was accelerated until I came here.

 

00:59

Well, hello, and thank you for joining us today on episode 29 of season two. Today we're going to learn about the Irish movement for PDAs from Dr. Lisa mudstone. Alexander. Dr. Alexander is a professor in the Department of PA studies at the Royal College of Surgeons in Ireland, and she's the director of their Physician Associate Program. She is a well known national leader here in the United States, having served at George Washington University School of Medicine and Health Sciences for several decades. And she is a former president of the physician assistant Education Association and a well known leader for the American Academy of PDAs. And the PA foundation. Lisa shares her perspective of the curriculum in Ireland as it compares to the US curriculum. And she talks about some of the challenges that she's been experiencing in setting up the PA profession in Ireland. As always, you can learn more about our guest on our website at pa pap podcast.com. We thank you for joining us.

 

01:59

How are you? I'm great. Are you enjoying yourself? Oh, yes. Having a great time. I would imagine what a great gig. I'm so happy for you. Oh, thanks. Yeah, it's, uh, you know, a little frustrating, I would say moving to a new country has its pluses and minuses. Right? You know, you've given up quite a lot. But I think that, in return, I've been given an opportunity that, you know, is really, you know, once in a lifetime, so why not grab? Why not grab it? Well, Lisa, thanks again, for joining us. Let's go ahead and start with your path to becoming a PA because you have a very interesting story and you're gonna pay for a long time. So can you tell our listeners about when you first decided to become a PA why and then what that path ultimately became for you? Sure, Kevin, it's great to be with you today. And thank you so much for your kind invitation to participate in this terrific resource that you have made available to pre PA students and young professionals. As they begin to think about their journey as a PA. I'm one of those legacy pa days, I saw a episode of medical center that profiled a medic from Vietnam who had come back to work. And for those youngsters that are listening Medical Center was a, I don't know, Sunday evening, medical drama that was on I don't know, CBS or ABC, one of the big three. And the story was about this orderly who had been a medic, and he was essentially running a clinic in the basement of a church and he was pilfering from the hospital, all his needed supplies. And the resolution of this particular episode was that the hospital decided to sponsor him to begin a new career as a physician assistant. And I saw this episode and I scratched my head and I said, I've never heard of such a thing. I was all of 18 years old, and I was about ready to go to college. I was going to study to become a medical social worker. And I decided once I arrived on campus, after having done all this research about PHS that I would change my major and study biology rather than medical social work. So that started my journey. And I was one of those students who was not your prototypical pa student in the mid 70s, mid to late 70s. I had to get used to rejection. And I'll say that with almost as a badge of honor, because I think it somehow demonstrated my resilience and my grit, but I was not accepted into a PA program until I applied three times.

 

05:00

It was my third time that I was once again hoping that some program would accept me. And I always found a reason, after the rejection letter would come, I tried my best to understand why they didn't accept me. And then I worked very hard to correct that aspect of my application. So I was one of those people who persevered. Nonetheless, I finally got in, I had finished college, I had worked for a year and a hospital. And then I started my journey. And it was terrific. I was so proud that I, you know, I did not come from a family where there was one medical provider in our family, I was first generation. And yet, I had this real strong sense that I wanted a career somehow in medicine, but I wasn't quite sure what role I would eventually find. And it was truly that sense of fit. I think that I was listening to one of your podcasts with Bill Cole happ I think, and he was talking about the team. And if you are not consulting with other members of the team, then you're really doing a disservice to your patient. And I thought to myself, you know, I would have been a member of the team as a medical social worker. However, I had different aspirations. So I was truly lucky to eventually realize my dream. And then I had a journey that took me from clinical medicine, to academia, higher education administration, like yourself, and it's been terrific. So I've been a staunch advocate for this profession. And I think sometimes when you work so hard to get somewhere, it has so much more meaning attached to it.

 

06:58

Yeah, and I think I think our profession is very interesting in that, at least in speaking to all the leaders that we've spoken to in the podcast, there, there's such commonality about a, a goodness to see others succeed. There isn't this selfishness that you see maybe in other professions, the profession was very collaborative in the early stages. And I've spoken to several GW faculty over the years. And that's been part of that culture, too. So I suspect that, you know, that's a big part about you, and your success at GW. Oh, absolutely. I would say that faculty that were real pioneers, they had, you know, I had Jim quali, as a faculty colleague, Walter Stein, Craig deat, Lee, Carr, Kevin cattle, John, these are individuals that really were part of the early days of the profession, and they, they were heavy, heavily influenced my journey. And they set the bar very high. And I think that when you're in a situation where the bar is very high, you either try to jump over it, or you decide that it's not really a great fit for you and that you feel better off doing something different. Yeah. And you've also I think there's a leadership culture at GW that you followed, because you lead many of our national organization, state organizations, local organizations in DC, do you want to talk a little bit about your passion for leadership? Sure. You know, it's funny, I was, I didn't think I was a leader in the sense that, you know, I, I wasn't the one who wanted to always be up at the podium with the microphone. However, I did have role models in my parents that were incredible. And I say that with a great deal of pride. My mother was in politics. My father was a self made businessman who was very successful, despite being diagnosed with multiple sclerosis when he was 40. I had five brothers and sisters. We were all very competitive, but we always had to really work for what we wanted. And so I think that I can remember when I was a 16 year old, and I wanted to be a lifeguard, and there were no female lifeguards in the town that I grew up in. And I knew that if I wanted to get a job, as a lifeguard, I would have to essentially exceed the qualifications of all the male lifeguards that were that had populated the workforce in that highly coveted job, wearing the white pith helmet, standing around twirling your whistle, and I said, I am going to be a lifeguard and I went and got all these added qualification so that when I apply

 

10:00

They had to accept me. And not only accept me, but they made me a chief, or a head lifeguard, right out of the box. Because I had exceeded their basic qualification. I share that story only because I'm of that generation of women who had to prove themselves and do it.

 

10:23

You know, while, you know, holding children and nursing, you know, of course, all those things that over and over again. Yeah. So when I got to GW, I really fit right in and I emulated the individuals who provided me with opportunities. And I was, like you said, in a system that had a culture that I think that we were one of, you know, those first PA programs. And we wore that badge very proudly. And

 

11:00

the first director that I worked for in the PA program, as I said earlier, he had high expectations. And I worked very hard to,

 

11:12

you know, follow his lead, if you will.

 

11:15

And I was also fortunate that during that time, we were only, we were only trained at the undergraduate level. So I was very fortunate that I could get a master's degree, because I was an employee of GW. So I was able to finance that education through tuition benefits. But I understood that in order for this profession to move forward with the credibility that it to fit into the sort of medical hierarchy, I needed more than an undergraduate degree. And at that time, you know, we were floundering and a sense that we had no prescription benefit, I mean, prescription privileges, I think the regulatory process was in its infancy. So at the university, we were at the forefront trying to push the push the policy agenda along, and I realized, you know, from working with Jim Collie, how important policy was, and how important leadership was, if we were going to advance this profession. I remember one day, because we're so close. And I think this helps with the idea of the system or the culture at George Washington, we were so close to the APA, that it was very easy to get, say, the president of the Academy to come over and give a lecture to the students, or the CEO of the APA. And one day, I remember the president of APA came over and he said, oh, we need someone to sit on some NIH committee for blood pressure. Lisa, would you like to do that.

 

13:00

And then that started a 12 year appointment to the National High Blood Pressure education program at NIH. And

 

13:10

that really threw me in to

 

13:14

a research culture that was, you know, very, very

 

13:19

new to me. So it gave me the opportunity to have my name on a J and C report. And it also helped those members at the table to understand the contributions that PDAs were making in the health care sector.

 

13:37

You you've been involved in the AAP leadership you've been involved in you were the president of PA EA, what was probably the most valuable lesson you learn from those experiences in leading those national organizations? Well, I can say that at the APA. I think that when you have these ancillary experiences, whether or not you're sitting at a conference for NIH, I did a sabbatical in Trinidad and Tobago, where I did some hypertension research. And I was an avid consumer of medical scholarship. And those different experiences, I think, really informed me as a PA, and allowed me to bring what I've learned to the table so that for instance, I became quite interested in the notion of quality and patient safety. And I was the

 

14:38

I was the first chair of the quality and patient safety committee for APA because I had heard so much about medical errors. And I had been exposed to evidence based practice at NIH sitting on that national committee. So I think that what I learned is

 

15:00

We bring our experiences, to leadership to help, I would say, to help elevate the profession in a way that we all benefit from. And that's one of the things about the PA profession is we don't operate in isolation. You know, we do work on a team. And we have to have experts across our professional field, that study things like patient safety and medical errors, or clinical reasoning, or PA education. So there's a myriad of topics that

 

15:41

I think as leaders we become sensitized to. And by learning more about it, we enrich our own professional cohort. So then he took this leadership experience that you you've gleaned over the decades of being a PA at GW, and then for the profession, and you decided to move to Dublin. So let's talk about that decision and start to talk a little bit about the evolution of the PA profession in Ireland. Sure, I would say that one of the things that GW provided for me, was a wonderful exposure to global health, and the APA as well. So for instance, APA sent a group of peers over to South Africa, I would say easily 25 years ago. And again, they said, Lisa, would you like to go to South Africa? Well, of course I would. And they were just starting the PA profession there. So there were a number of PhDs from the DC region that were selected to go. And then a few years later, I was asked by my dean at George Washington, if I was interested in going to Rwanda, and they had just come out of the genocide, their medical workforce was depleted. And they needed some solutions. And one of the things that, you know, Kevin, one of the hallmarks of our profession is this rapid transformation. And we are able to be a solution for workforce in a way that many other professions can't do that. So I went to Rwanda, I was a, I was on a team of individuals who represented physiotherapy,

 

17:31

medicine, and we consulted with the government, help them identify

 

17:38

opportunities and help them overcome some challenges in their medical education system. And it was from that experience that I was able to get a Fulbright scholarship, go back to Rwanda, and help start the PA program at the University of Rwanda. So that was terrific. And I would say that after two sabbaticals in Trinidad, I became very sensitive and and intimately aware of some of the challenges in their medical workforce, as well as some of the other Caribbean islands and help did some consultation with the people in the Bahamas, related to develop in PA workforce there. So I've always had this affinity, I guess, for travel, and looking at different cultures and the health systems that are embedded in those cultures and systems. And when this particular opportunity at the Royal College of Surgeons in Ireland came up, I was thinking about retiring from GW having served in many different capacities from program director to faculty to Assistant Dean. You know, there were so many great experiences that I had, but I did feel that it was time for a change. I would not be the prototypical pa just to retire though. And I come from a family. My dad was 92 when he died, but he was still working. Not that I would

 

19:11

not that I would say I've been working at 92 as a PA however, I saw this as an opportunity to come to a country that again, there's no language barrier. So that would be you know, that was a definite opportunity since that barrier wouldn't be there. And also because the UK had been successfully training physician associates for almost 20 years now. And Ireland because they were a republic, and no longer part of the United Kingdom. They weren't part of that pa expansion that was going on in London and all throughout the England, Scotland and Wales and Northern Ireland as

 

20:00

Well, so the leadership at Royal College of Surgeons determined that TAS would be a significant bonus to the health system here in Ireland. And the reason is Kevin, many, many of the consultants here in Ireland, whether or not they're cardiovascular surgeons, or cardiologist, or dermatologists, or trauma surgeons, orthopedics, many, many, many of those individuals trained in the US or Canada. And so herein lies the link. They had a taste of what a PA team could be like. And they came back to Ireland, and said, Why don't we have pa here? Yeah. And I'll credit our CEO here at RCSi. He's a surgeon by the name of Karl Kelly. And he was one of those people who had early exposure to pa s. And he heard from his colleagues that the Irish healthcare system could be transformed by adding this new breed of health professionals to the system. And that's why I believe we have such tremendous as I call them physician champions, you know, because when I did my dissertation, on the identity of the PA profession, it was those physician champions who are so instrumental in moving our profession forward. And that's what I see happening here. So I've been in Dublin now for about 15 months, we have a relatively small program, we are the only PA program in the Republic of Ireland, and I right now we have, as of the end of this month, when our students graduate, we will have a grand total of 52. Pa is

 

22:00

amazing. On the island. I am how many total classes has been to make that 52 We have graduated five classes. Okay. Yeah. So, so easing into this?

 

22:16

Yes.

 

22:17

Yeah. Totally different environment. We have to be strategic. And you know, when you introduce a new professional into the workforce, you've got to be somewhat sensitive to the supply demand curve, if you know what I mean. Absolutely. You don't want to get into IT folks that can't find employment. Exactly. So one of the metrics that we're starting to track right now, which this year has been superb is the number the percentage of students at graduation who have found employment. So right now we are probably sitting at about 70%. That's great. And I can say that even last year, at this time, maybe 20% of our graduates had a job when they graduated. So I think that's it's similar to the US model in that many of those employment opportunities were coming out of the preceptorships or rotations are all there. Yes, well, we call them clinical placements.

 

23:21

But our, but I will say that it is not unusual for a student to go to a new hospital. Say for instance, one of my students, he went to Cork, which is the second largest city in Ireland. And he did a three week placement there in medicine. And when he was leaving, after three weeks, he had three job offers. That's amazing. And he has since decided to stay in Dublin. He was offered a position at a hospital doing colorectal surgery with a consultant who had obviously done some work in the United States and Canada, and was very familiar with the role. And he was also sponsored by uh huh, that hospital. So he was given a scholarship to attend the PA program, and in exchange for his funding. He's working at that hospital for the next two years. That's a great, that's a great partnership. I don't know what more than that don't do it. Yeah. So that's what we're trying to do. Because many, many hospitals now are realizing that in order to be competitive in order to recruit these graduates who are so highly sought after, maybe they should think about sponsoring them for one or two years of their education, and then they don't really have to go through that selection process and recruitment, and that seems to be resonating with many hospitals. So that's very exciting.

 

25:00

Yeah, that makes a lot of sense when you have somebody who's proven as a member of your workforce team, prior to going to PA school, they already know your culture. So you don't have that period of time where they have to be kind of indoctrinated into the way you like to do things, right, you send them to school for a small expense, you have a guaranteed person to start for you that's already going to fit in effortlessly. Right?

 

25:26

And smart. And I can, I can, you know, I can tell you that my plan here is to grow the workforce nationally, not only in Dublin, because there are so many hospitals and primary care centers across the country that would benefit from the PA role either in their a&e department, or surgical service.

 

25:55

I can tell you, that's what's fun. That's what's sort of giving me a reason to go to work every day, as they say, is all the people that I can meet. And, you know, I feel like I'm that traveling salesperson

 

26:11

who gets off the train

 

26:13

and speaks to the masses about the benefit of PDAs. And I have, I have Grand Rounds scheduled at cork in February, Limerick in March, I am just going wherever they will listen to me. And I am trying to sing the praises and demonstrate the utility of PA in a variety of different settings across the healthcare system.

 

26:40

Some kind of researches is being done on the 52 graduates that are already out there contributing to the health care system. Well, I'm just ready to launch our first graduate survey. And it is fashioned, if you will, after the UK census that I believe Tammy ritsema, and her colleagues at St. George's, were instrumental in the development of that tool. And so we feel even though we have a tremendous relationship with the Irish society of PDAs, they are still in a relatively nascent period in their maturity and development. So the program has done a great deal to help support that organization. I've helped them with, I've helped the board with developing bylaws and developing a strategic plan, you know, all the things that I learned along the way that I can now share with motivated individuals to who really want to own this profession, in a country like Ireland. So the Irish society of PDAs, they would very much like to conduct a census. But there's a capacity issue when you only have 52 people across the island represent the entire profession, even though you know, they're all motivated to contribute. I do have that research expertise that they don't have, even though I will say our program requires and I'm using the vernacular here in Ireland a dissertation. It's at a graduate level degree with a master's degree with the dissertation. And that dissertation is a very, very challenging process. But it's a quality improvement project that the student takes on in collaboration with a sponsor, whether it's a consultant at a hospital, or in a primary care clinic, and it's a very long and arduous journey. But you cannot graduate from the PA program here without completing that dissertation. So the students are well schooled in the area of research. But nonetheless, the program I think, has little bit more capacity to assist their research endeavors. So it benefits us because we'd like to know what our graduates are doing. But it also benefits the profession. Yeah, and the communities too, right? Because if you get them that are armed with that, that skill set, they can start to do those kind of project improvement research projects in their communities. And it only helped to benefit the profession, I would imagine. Oh, absolutely. And that is one of the highlights when we talk about the profession. I would say that as a whole. The profession of medicine here is very research oriented, much more so than I would say

 

29:37

in the US, but it's a smaller island. Things penetrate so much more, so much more easily, more deeply. And the culture is all about research and answering asking questions and finding answers. So it really is a terrific opportunity for PhDs to become the leaders in some regard.

 

30:00

So yeah, for sure. Curious sorts. Oh, yes, definitely. Yeah. That's great. That's great. Out of curiosity, what, what is the sense that you're getting of those graduates? Are the majority going into specialties? Are they going into primary care or a mix of both? Well, we don't have as many PhDs in primary care, or what they would call here, general practice those, but there's so much opportunity, I mean, the number of GPS that are going to be retiring in the next five years and the replacement pipeline, there's a tremendous mismatch. So we see a great opportunity, or PA is to go into general practice. The problem right now is the profession is not regulated, nor is it regulated in the UK, these things take time. But the indemnification or the malpractice coverage, for PA days, when they're not regulated, and working in a private GP setting is a little bit problematic when they work in a hospital as part of surgical team, or an a&e department or you name it, they can be covered by the hospital's umbrella, if you will, of indemnification, we're working very, very hard. The one or two providers of indemnification for PDAs and general practice, we really, really are trying to develop strong working relationships with them, and also giving good guidance to the general practices. So for instance, there's one, there's a, something that we're pretty familiar with in the US, which is there's a consolidation, if you will. So there's one large organization that is buying up general practices across the country.

 

31:50

And they have a vision, they have 60 GP settings, they want a PA in every GP office that's promising.

 

32:01

I'd have to start training them very, very quickly. Yeah. However, they have already sort of worked out the indemnification issues. So. So that's great. As far as the folks in the non GP or primary care setting, I have a graduate just start, she's just interviewing next week for a job in mental health. So I have spoken to a lot of the local mental health providers, mostly psychiatrists who have community mental health services. And they see a huge role for PHS in that, because a lot of the workforce here in Ireland are

 

32:39

interns that rotate medical doctors who have completed an MD degree. And they are in a, what they call, like an internship program, that is a stepping stone to a further training, whether in a residency or fellowship, but those residences and fellowships are relatively small in number. So these trainings, posts are very highly competitive, and some people might not be successful. So they continue in this rotation, providing medical services as what they would call like a junior doctor or a sh O, Senior Health Officer, but a lot, but because they rotate, there's no continuity of service. And this is like you can imagine in the field of mental health, continuity of care is critical. Absolutely, it's almost like the the residencies here in the US where the P is have played such an important role being the backbone. So that's right, can move around. So that's similar. And I think that that's, you know, that's one of the lessons we learned from critical care, for instance, in the US, those PA is that work in those units, they become instrumental in the education of those fellows that are coming through. And so I think that, in fact, I spoke to the head of the ICU here at our

 

34:11

university's hospital. And he's very keen on identifying or developing a role for PDAs. But again, these these opportunities are terrific. We just have to keep training people to make sure that there's that we can deliver the workforce that is so desperately needed. So he said, tell us a little bit about the curriculum. How does it compare to the US model? What's different that you really like about the Irish model? Things of that nature? That's a great question, Kevin. I always thought pa education was accelerated until I came here.

 

34:49

And here it is very accelerated. Let me tell you, I am so impressed. We have eight months of heavy data

 

35:00

We start in January, we finished at the end of August, we have 1516 months of clinical placements. And our students are provided with tremendous opportunities, different health systems across the city and outside of the Dublin area. And I will tell you that that clinical immersion is, so from, I'd say September through December of their year one, they are placed in a variety of different medical and surgical subspecialties. And their skills at history taking and doing physical exams and developing management plans and taking part in clinical reasoning and understanding investigations such as radiography, and imaging, and laboratory investigations, all of those things start to fall into place for them. So it's a very, it's a different model in some ways. And in other ways, it's very similar. We don't have any rotation exams or anything like that. I would say this is a more traditional academic program that reflects the educational system here in Ireland. So we have one semester where it's introduction to basic medicine and surgery. And students go through multiple placements. And at the end of it, they have one very high stakes multiple choice exam. They have very one very high stakes ASCII exam that includes five stations, I think. And then they have a very high stakes, long case exam, they call it, but it's more of, you're given a patient, standardized patient or, or an actual patient depending on availability. And they have to take the history do the physical and discuss with the consultant, what the differential is how they might investigate this particular set of symptoms that consultant will discuss with them. What is where radiographic, what might you expect to see if you have this condition on x ray or CT scan? So it's, it's fairly intimidating. And it it's a it's a unique, it's a different model than I was accustomed to. But it really reflects, I think, the training. So that experiential learning is really tested in the assessments that are used. And again, that's one module. So it's a three month module, like I said, no interpretation exams, just three big assessments at the end. And that's the case for each and every semester. What of the model that you've experienced so far, would you recommend PA programs in the US consider adopting? Well, what's interesting is that I always, you know, we always were afraid as educators, how much more can we add to the curriculum, right?

 

37:58

We'd love for them to have x, but we just can't find a place for it. And what I would say is that, in this model, what I'm what I am doing is I am taking what I've been, what I've inherited, basically what was built, but I'm enhancing it. So for instance, we're introducing radiology and EKG interpretation prior to them going out on clinical rotations. However, once we get into the clinical rotations, we're going to the hospital on site as faculty and meeting with the students in what we call tutorial sessions. So there's a much heavier presence of PA faculty in the hospital providing instruction, but a more clinically relevant level, if you understand what I mean. So I can make rounds with them. I could have a session on EKG, I can, we're really next year, we're going to start having students presenting cases to one another. So we really feel that, you know, I would I remember at GW we would love to have our students have more clinical exposure during their first year, but it was, it was pretty difficult because the curriculum had already been set in stone. So I guess my my experience here is that you just take what you have, and you try to adapt to it and enhance it the best you can. And I have had very positive feedback and just I've only been here 15 months, but I have had very positive feedback from our consultants, even our graduates who have said, Wow, those first year students, they're more like second year students. Yeah, you know, so say they have given me some qualitative feedback about our first year students and they attribute it to the you know, educational enhancements.

 

40:00

We have provided both myself and my colleague, Sean Robinson, who also came from George Washington, and our other faculty member Pauline, who is a nurse by training, but she oversees the whole chi project and works very heavily with the students in their dissertation phase. So I guess that's part of being a PA just being adaptive and creative. And with a goal in mind, and the goal for us is to have that high bar to really sort of convey to the students that they are the pioneers, I'm going to tell you a funny story about the word pioneer, because this is a perfect cultural.

 

40:42

How should I say a misstep, but it was an amusing one. So I was down in Waterford, at the Waterford Institute of Technology, which is a feeder program, they have an undergraduate degree in Applied Health Sciences. And so they have,

 

41:02

they had some pre pa that they wanted me to meet. And I actually was able to bring one of our graduates with me. And

 

41:12

so I said to the students, I said, so to be a PA in Ireland right now is pretty much to be a pioneer. And everyone started to sort of

 

41:24

laugh and chuckle to themselves, and even their advisor who was in front of the room, she was sort of laughing herself. And she interrupted me and she said, Lisa, I think we need to clarify what a Pioneer is. And I said, Oh, why does it have a different meeting here in Ireland? And she said, Yes.

 

41:45

A pioneer in Ireland is a,

 

41:49

a young adult, say 18, who decides to be abstinent from alcohol?

 

42:00

That is a very different meaning Yes. And they wear a pin on their jacket, or whatever. That's signals to their friends that they're not going to drink until they're 21 or something along those lines. So here I am trying to sell here I am trying to sell them on a career as a pioneer PA, and

 

42:22

their advisor said, Lisa, I don't think they'd really want to become part of the your profession if you require them to abstain from alcohol.

 

42:33

Yeah, that would be counter to the culture of Ireland as we know it. So that's, that's wonderful. What a great story.

 

42:40

One last question for you, which is, you're you're in a unique place right now. Because you of course, started out as a PA, when the profession had many programs that called TAs, physician associates, that was changed in the 70s, with the AMA's. Right out of influence, but now you're in a country, and joining to the UK model word Physician Associate is the normal term for PA. So I wonder if you could talk about just from your national leadership in our profession here in the US to your European leadership now about that name change that the APA voted down in the House of Delegates last year? And just what's your take on it? And what do you think the consultants in the Irish model? Have a sense of what that name, if anything? Yeah, you know, it's interesting. Kevin, recently, a job posting from a hospital here in Dublin was made public and much to the chagrin of the PDAs. Here in Ireland, they actually used the physician assistant label as they were recruiting. Now I have a feeling that this may have been an oversight by the Human Resources Department. And the hiring manager maybe was looking at some postings from jobs in the US. But I can tell you that the TAs were very, somewhat disappointed here that the hiring manager couldn't get the name, right.

 

44:10

So they're very proud of their of their title, physician associates. And I think there's some unification if you will, you know, you have the UK. Obviously, we don't have reciprocity now. But at some point in the future, we're hoping that we can find some common ground to have that reciprocity because we are so close to them geographically, but be that as it may, I think, from the US perspective, it was a battle you and I both know, it was it was brewing for so long, and I just think that it's complicated by the fact that the US is so much larger than the UK and Europe. I mean, I have colleagues in Germany and

 

45:00

Switzerland and the Netherlands. And we're very, very proud of the Physician Associate title. I do think when you get right down to it to translation, and the word assistant here in Europe at least has it is not equivalent, if you will, to the postgraduate degree

 

45:25

of education. I mean, your level profession has done right, you would never think of calling semi assistant that is writing a dissertation, if you will, you know, right. Yeah. So I think in the US, it was complicated. And it's complicated, I think, by the sheer numbers and the different factions, and the just the large S, of the US healthcare system and the different bodies. So I do think that, you know, there was changes difficult. And, you know, the PA name was a was a controversial topic for many, many years. It's finally, you know, for, whether you like it or not, it's resolved. But I can tell you when I was president of PA, and I was attending one of the APA meetings that they had convened at one of the national conferences, and we had people from Canada, and we had people from the, the UK in different places. And, you know, I think that, unfortunately, the US took a very US centric viewpoint, and just said, you know, we're going to change our names when we don't really care what anybody else thinks, as we were in the business of exporting this model. But nonetheless, I'm, I'm at the, I'm at the end of my career, where I'll enjoy seeing this profession, solve yet yet another challenge that's put before them. And I, but I do think that there's some valuable cohesion, if you will, because point of fact, I have a couple of graduates of American programs that are coming over to Ireland, I just was talking to one of them today. And her, her husband is coming over and works for a multinational company, and she's going to be able to work here as a PA. So I know the GP that hired her is extremely excited, because her skill set he believes is so finely developed. So perhaps there's just, you know, a little bit more cohesion when everyone has the same title. Yeah. Well, Lisa, I can't thank you enough for taking time from your schedule over there to join us and share with us about the movement in Ireland. We're excited to see how things roll out. And, of course, you know, I'm sure I speak on behalf of most MBAs that we are excited to see our Irish colleagues grow in a similar fashion to what we did many, many years ago. And you know, who better to help them with that than somebody like you. So, thank you so much for your time and candor, and we wish you the very best of luck. Well, thank you so much, Kevin, and I look forward to the day where I can introduce you in person to my students. Oh, well, you are welcome anytime.

 

48:24

We want to thank our guest across the pond, Dr. Lisa stone Alexander for joining us today. She had much to share about the Physician Associate movement in Ireland, including their origin and curriculum. There are exciting things on the horizon for both Ireland and the European pa communities. Tune in next week as we speak with Dr. Marcus Hoffman. Dr. Hoffman is a family physician and founder of the PA profession in Germany, and I talked about his experiences in building the profession in Germany and his perspective about the expansion of the profession across Europe.

 

48:56

Until next time, we 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 Arizona.

Lisa Mustone Alexander, EdD, MPH, PA-C Profile Photo

Lisa Mustone Alexander, EdD, MPH, PA-C

Lisa Mustone Alexander Bio Sketch

Lisa received her PA training at George Washington University, where she also completed a Master in Public Health and doctoral degree in Education.

She is currently a Professor in the Department of PA Studies at the Royal College of Surgeons In Ireland and the Director of their Physician Associate programme. Simply stated, her responsibilities include oversight of the programme and advocacy for the profession. These are critical roles, since the PA profession is relatively new in Ireland. As of December 2021, only 39 PAs are engaged in clinical practice, with another 28 in training.

Lisa is Professor Emeritus at the George Washington University School of Medicine and Health Sciences, awarded to her after a long career leading the PA programme and serving in many roles in the university and medical center. During her career, her leadership and advocacy work extended far beyond the PA program…by developing community outreach and pipeline programs to develop and diversify the future healthcare workforce. During her career at GW, her grant portfolio exceeded $13 M from government and non-governmental funders. She was the first funded PA educator to develop a proof of concept curriculum in service learning for PA students, after only 6 years as a PA educator.

She has extensive front-line clinical experience as a PA in major hospitals and safety net primary care clinics. She was the 1st medical director for the student run inter-professional clinic for uninsured patients at GW and has always been a champion of experiential learning that facilitates professional identity formation. Her doctoral research focused on the identity of the PA profession.

Dr. Alexander has a long history of leadership and service at the local and national levels, with the PA Education Association, American Academy of Physician Assistants, and the PA Foundation. She also has a longstanding relationship with the clinical officer profession in Rwanda and served as a Fulbright scholar where she assisted with the development of the curriculum launched over 10 years ago.

She views her greatest accomplishment as being a mother of 3 children, one of whom is a family medicine PA in North Carolina.