Season 2: Episode 36 - An Author and a PA

Season 2: Episode 36

Unknown Speaker  0:01  
We respectfully acknowledge 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 autumn and Yockey. 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.

Unknown Speaker  0:36  
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.

Unknown Speaker  0:51  
I was the first PA to be president, organized medicine entity at the state level I was president of the North Carolina Medical Society Foundation.

Unknown Speaker  1:03  
Well, hello, and thank you for joining us today for episode 36. We speak with Dr. Justine strand D on Nevada about her path to becoming a PA her path to becoming a division chief at the Duke University PA program. And her new path to becoming a fiction writer and author of an upcoming novel, The moon is backwards. Justine has led for the profession at the state, national and international levels. And her insights and candor provide for a great discussion. As always, you can find out more about our guests at the PA path podcast.com. It's so good to see you.

Unknown Speaker  1:46  
I mean, it's kind of unbelievable how time flies.

Unknown Speaker  1:50  
I know I know. I don't even remember how long it's been. But it seems like a couple years ago. And I know it's been a lot more than that. So it's thank you so much for doing this. I'm excited to hear about your your novel and stuff. And maybe we'll start with your history as a PA and all that kind of following our usual format. But I'm really, really excited about that. So I look forward to hearing more. And again, we try one.

Unknown Speaker  2:14  
Oh, good. Even better. Yeah. Well,

Unknown Speaker  2:18  
Justin, thank you so much for joining us today. I am so excited to see you after all these years and hear what you've been up to. But let's start with you sharing a little bit with our audience about your path to becoming a PA How did you end up getting into this profession?

Unknown Speaker  2:32  
Well, my first career was actually in theater. And it was the college level and local community theater and Boulder, Colorado, University of Colorado. And I sort of decided to go a different direction, but I didn't know what direction and took a job working for a doctor, an internal medicine doctor and I was what in those days they called a gal Friday, which means i He taught me everything I drew blood gave injections, answered the phone filed insurance claims did the bookkeeping. And he was a teacher who loved having students sending always had medical students and PA students. And I've never heard of PAs, but he had PA students from Baylor and Yale. And I was really taken by the profession and just how accessible it was potentially in terms of entry compared to medical school. And I also have fallen in love with medicine, just the sort of mystery of it and the excitement of it, you know, puzzles and solving puzzles and diagnosis and all that. And this doctor showed me a lot he would call me in to show me you know different rashes or different conditions. So I learned a ton of medicine while I was with.

Unknown Speaker  4:02  
Sure. So that was kind of the trigger for you. Then you started to look at what programs were available at the time. And where did you end up going?

Unknown Speaker  4:11  
Well, it's very interesting because I was not from a family of great means. And I have really been on my own. One of the reasons I did okay at university was that I had a scholarship but like a tuition scholarship for acting and I lived in I was in Florida. So I ended up going up to University of Florida Gainesville to do all my prerequisites because obviously if I was studying theater, I didn't have chemistry or biology or any of that. So it was quite a challenge for me not having really studied that way or or doing those kinds of quantitative things. So I went to University of Florida and I managed to I kind of barely passed. But then I started digging myself out of a hole when I learned how to study and I learned how to actually control my test anxiety. And so I there was a PA program that there's a really good PA program at Florida. And in those days, it was not quite as prestigious as the one now. But all I was going to do was apply to Florida because I was a state resident, and I didn't have money to go in. So my best friend said, Well, where are you applying to PA school? And I said, Florida. And she goes, and and I said, Well, what do you mean, I can only afford Florida? She goes, Okay, listen, you got to adjust your thinking here, what's the best PA program in the US? And I said, she said, that's where you need to go. I was like, Oh my gosh, I'll never get into Duke. And she said, Well, you never know if you don't try. So I ended up applying to six programs interviewed at five and was accepted at four. And I just love Duke so much just the way they treated us when we interviewed and so forth. It was just so relaxed and gave us heart with students on our own. And I just fell in love with you guys. Okay, if if I don't get into Duke, I can turn all the others down. I'm going to apply next year. But happily, because you really have to apply multiple times. You know, in those days, everybody would say, Oh, you'll never get in. It's really hard. And I really vowed at that time that, you know, I said when they interviewed me one place, and they said if you become a PA, I said excuse me, when I become a PA. That's great. And they accepted me Believe it or not, after being quite so saucy, you know, but, but I really I really wanted to go to do can happily they accepted me the first time around. So you know, I really I tell my friend that I owe her for that.

Unknown Speaker  7:14  
Yeah. So you started at Duke and you ended it Duke in terms of your us experience as a PA educator and a PA Correct.

Unknown Speaker  7:23  
That's true. That's true. It's not something I ever imagined doing becoming an educator or whatever. But so I shall I go just real quickly through

Unknown Speaker  7:34  
where I've worked. Yeah, please. Of course.

Unknown Speaker  7:37  
When I graduated from judo, my first position as a PA, I was at a migrant community health center in Colorado. And I was there for two years. And then I went overseas to Brazil to work for Westinghouse corporation because they hired me because I was fluent in Portuguese. And I worked there for a couple years, not you, there are no pas in Brazil. So I was practicing just taking care of the employees and their families and working with a satellite phone to the doctor and in Pittsburgh, and then came back and took a position in Austin, Texas in OBGYN. I was there for 10 years. And at the end of those 10 years, I had two young patients who were young women who I had taken care of during their pregnancy as teams. And they were really getting their lives together. They were just doing really well. And these two patients started having these very strange, frequent infections and things. And this was 1991. And I diagnose him nos, both of them with HIV. And they were the first in our practice. And they were the first even in our huge, multi specialty clinic. They were the first cases because I think a lot of people will just weren't testing. They weren't thinking of it. Yeah, I was devastated. By this. I mean, it just broke my heart. And I really decided that I had to get into prevention. I had to get into public health. So I took a huge cutting pay, and took a position at the Durham County Health Department as a manager and working in a sexually transmitted infection clinic and the HIV clinic was under my management, as was the lab HIV testing many other that was a huge span of control. And I was there for two and a half, three years. And then I was recruited to do they had a faculty position that opened and I just wasn't really thinking Got a working in education, but I was back in Durham. And, you know, I ended up going into education and became later head of the PA program. And I practiced in family medicine there one day a week, the whole time I was on the faculty. So

Unknown Speaker  10:17  
yeah, yeah. And you weren't the program director for a period of time, but you also rose in leadership at Duke.

Unknown Speaker  10:23  
Okay, so what I the role that I moved to, so I was a PA program director, but also what's called division chief, their organization's a little different. And so I was pa Division Chief for a number of years. And that would be a chair, a dean, probably in other settings. But then I was promoted to vice chair for education for the Department of Family Medicine. So that was scheduled. Yes. So that was, and there had not been a PA in that kind of role. And a number of other things that I did during that time. I also had a secondary appointment in the School of Nursing, did my area of researches workforce, and did a number of studies and publications with my great colleagues in the School of Nursing, and also was an affiliate with a global health center.

Unknown Speaker  11:17  
Wow, wow. So your academic career was really broad, in terms of the things you were able to get involved with and make a difference on?

Unknown Speaker  11:26  
It was very, very exciting. It was great. Yeah.

Unknown Speaker  11:29  
Let's talk a little bit about leadership, because you're one of the first leaders that I had the opportunity to work with that PA and your leadership passion was evident from the moment we met. And I wonder if you can talk a little bit about kind of your evolution of thought as a leader from Duke and, and moving on into PA education and also the PA profession.

Unknown Speaker  11:52  
I think being in a leadership role, I think it's important to be the kind of person that you would want to report to, and to be consistent ethically, with your moral compass to back people up and to support people and to to help people grow, even if it means they leave the organization. And I think a lot of people are afraid of that. But I just really believe in being good to people and being honest with people wonder problems and not playing games.

Unknown Speaker  12:28  
Yeah, very direct. Well, yeah, I

Unknown Speaker  12:31  
mean, direct without, without being harsh. Yeah,

Unknown Speaker  12:35  
those servant leadership is kind of a Greenleaf talks about servant leadership, it sounds like you saw your role as a leader was to really raise those around you up to make the situation where you're supporting them, for them to become their own successful stories. And as you said, you know, it's hard to lose good people. But each time you do, it's another opportunity to bring in somebody else that you can help mentor and support. Is that accurate?

Unknown Speaker  13:01  
Yeah, I think it is. And I think that it also makes your part of the organization a place that people want to be, you know, I always encourage people to, to talk to everyone in, in the division and in the program, to get their honest take about what it was like to be there. So it's hard, you know, if you're really doing leadership, you're gonna make decisions that people don't like, probably the hardest one I had to make at Duke was to say, we needed to expand the program. And by expanding the program, we got our own building. And the building was off campus. And I mean, it's a wonderful building. Everybody loves it now, but it was like, Oh, how dare you take us off campus? What a terrible thing. And I said, Well, you know, okay, show me the error, my thinking, where's the real estate here on campus that I haven't noticed? That someone is going to give us because, you know, we're not going to get a great facility. I mean, our situation was just not ideal in terms of our location. Prior to that we didn't have an identity, and we didn't have adequate space. But in order to do that, we had to expand and I really was bullish on the profession and our ability to contribute to access to care, and I felt it was the right thing to do. But honestly, nobody, nobody likes nobody.

Unknown Speaker  14:33  
Yeah, that's not the most popular decision in PA leadership. But I think your point is, well, well made in the sense that if you have a really good product in any other business in the world, you're gonna expand the production of that product. Right? So and to do that, effectively, you've got to build more warehouses. So you essentially we're staying ahead of the curve and saying, Look, we can make a difference in the communities of rural and urban North Carolina and Beyond, but we're only producing X amount per year. Let's increase it. So we have more money coming in. So we can expand the resources we have. Right? Exactly. Yeah. Yeah, yeah, that those are hard. Those are hard calls to make. I agree. They're never popular because of the perception of clinical rotations.

Unknown Speaker  15:19  
Well, that's the rate limiting step in the equation. And that's, that's a tough one, because you really can't short that you can't short clinical experience. And, and every everyone has the same idea. Everyone's expanding. I mean, it's like an amoebas. Sooner or later, it gets too big to continue growing. So it's, it's it's a real challenge.

Unknown Speaker  15:45  
And so as you look back to your leadership roles, as a PA leader, what are the things you're most proud of?

Unknown Speaker  15:52  
Well, stepping out of my comfort zone and agreeing to be to serve as president of the Texas Academy and PAs, back in the day when we really had a horrible practice environment in the 1980s. And I ended up being thrust into a lobbying role to lobby for indirect supervision and prescriptive privileges. And that was just one real exciting adventure.

Unknown Speaker  16:23  
I would imagine.

Unknown Speaker  16:25  
It was that and I think, in so many situations, I, during my time at Duke, and in North Carolina, I sort of became a go to person when they want to APA in a role, which, you know, is is an honor, don't get me wrong, but I was the first PA to be president of organized medicine entity at the state level, I was president of the North Carolina Medical Society Foundation. And during my time, my time in that role, really raised $18 million to support our community Practitioner program, which was a loan repayment program for doctors, pas, nurse practitioners who served in medically underserved areas that didn't have National Health Service Corps, other options for them. And that was another adventure and just very, very rewarding. And so it became a self funded program that exists to this day, when in fact, when I came on board, it was sort of spent putting down a previous endowment. So and there are a number of other sorts of roles like that I'm, I was called upon to speak, I was the keynote speaker at a doubling and see Association of American Medical Colleges meeting, you know, things that are like scary. Yeah, scary. But but you know, you just have to rise to the occasion. So it was it was a all those years were stressful, they were exciting, challenging, and each thing that you try to accomplish if you're able to do it, if she had the courage to do the next thing. Yeah. One of

Unknown Speaker  18:13  
the things I've been very fortunate to experience in my leadership is to serve with many very strong leaders, who are women. And you had Ruth Baldwin and I talked about this back in December, you know, when you're kind of at the cutting edge of the PA profession, and you're a woman kind of navigating in that male dominated Medical Society, that can be challenging. I wonder if you could give some insights into how you successfully navigate that, because clearly, if you were leading that organization, you figured out the secret sauce?

Unknown Speaker  18:44  
Well, I mean, I think probably the main thing is to just not take yourself too seriously. And not get too upset when things don't go the way you had hoped. And to be ready to compromise and maybe, you know, I really think half a loaf is better than none. And I was in a number of situations where half a loaf was what we had to accept. I remember a PA had moved to Texas and called me, you know, my number was there as president and said, these laws in this state are so stupid. And, you know, I said, Oh, well tell me more. You know, I sort of wondered why the person had moved to Texas if it was so stupid, but I'd done the same thing. So I couldn't really point a finger. And I said after they told me what they thought I said, Well, you didn't see how stupid it used to be. It's stupid now, but it was really stupid. Because, you know, we couldn't we couldn't get prescriptive rights but only in medically underserved areas. Okay, okay. For that it was It got a lot of criticism but you know, people in those areas pas in those areas were able to prescribe and and help people in community health centers. You know,

Unknown Speaker  20:09  
lift. Sure. And I imagine that gave you data, really strong data to show safety down the road when you went for full prescriptive authority.

Unknown Speaker  20:17  
Yes. And the other thing that showed was that there was one rural health clinic in Texas, and it was going dwindling. And two years after the law was passed, there were almost 200, because the law required a halftime PA or NP, to be on staff in order to get cost based reimbursement under the rural health clinics act. And they couldn't do it without the PAs and NPS being able to prescribe. So yeah.

Unknown Speaker  20:51  
Over the course of the career that I've known you, you've always had a passion for international work. And you've, you know, I think you kind of alluded to your experience as a PA early in your career. And also, you're fluent in Portuguese. And you've always been looking, I remember you were looking strongly at Puerto Rico, when we were on the board together, you are obviously living in Portugal now. So could you maybe share a little bit about that passion for international work and where you see the PA profession moving these days?

Unknown Speaker  21:19  
Well, I think personally, I, I love international experiences, just because they're so enriching, and exciting and challenging. You learn so many new things. And I've always liked languages. I've always done languages, because I love them. I'm floating, Portuguese, and Spanish. And I've used my Spanish and all my clinical work over the years. But I, I sort of like I always wanted to have a way to put together all the different things, my international interests, my language interests, public health, medical, health professions, education, and so forth. So a great opportunity that was presented. And this was through University of Washington, Seattle, through my friend Ruth Baldwin was an opportunity to work as a lead technical adviser on a program in Mozambique. And Mozambique is southeastern Africa, just north of South Africa. And it's a former Portuguese colony. So it's Portuguese speaking countries. So I think faculty development, yeah, did faculty development there. And I also it was called on a couple of years later to head up a curriculum revision for this group called a technical stupid sin, who are basically I call them ta analogues. So you know, we can't call them pas in the same, they're not the same thing as a PA in the US. But that was a great opportunity. And I'm mostly retired, but I have a faculty appointment here at the medical school and I do a little bit of teaching, helping with publications, evaluations, writing tests, exam questions, things like that. So I think it's an interesting question. I often am contacted by PA students, or fairly recent graduates who are interested in doing international work and actually functioning clinically practicing clinically in other countries, in most cases, is a non starter. Now, I will mention that during so I, I retired from juke and I went, I was recruited to Bart's in London, to help them start a new PA program. And during my time there, I practice one day a week in what's called GP surgery, which is family medicine, primary care clinic in East London, and in a very diverse and medically underserved area, just a wonderful experience. So that is maybe the one exception has been the UK has, has historically allowed pas from the US to practice there, as they get licensing organized, there that will look somewhat different and probably a little more restricted. But other than that places, we can't just go somewhere in practice, nor should we if it's not within the legal framework. So I think that most pas are better off setting their sights on helping with capacity building. In other words, using our skills to help lift up professionals to help improve the capacity to provide care and some of these middle and low income countries.

Unknown Speaker  24:58  
Sure, are there Are there things that concern you about the movement of PAs in other countries? Or is your sense that there's a lot for us to learn from the way they do things?

Unknown Speaker  25:06  
Well, I think the main thing is we Americans, sometimes because of our belief and exceptionalism feel that the way we do things is the right way. And it's certainly the right way for the US. But it's important to the culture, the health care system, what is the epidemiology? What are what are the community needs? I think we need to be very humble, and be open to understanding that different models work in different places. I mean, one example was, you know, I thought I had a lot of humility that I brought to the project in Mozambique, but I remember talking about, oh, should we do some work with the frail elderly? They looked at me, and they said, We don't have frail elderly. We have people in their 50s who have trouble with mobility. But it's just not the same where people live so long. And they have so many resources like in the US, they live into their 80s and become frail. That's not common. The reality. Yeah, I mean, it's just I my whole thinking was was wrong. And then at one point I, I said about the curriculum, well, shouldn't we say here referred to Dr. And one of the public health guys looked at me and he said, Well, Justine, if you say that, then what you're really saying is go home and die, because you can, there's no doctors send the person to. And I, you know, I don't think that's necessarily true, I don't want to I don't want to paint an overly grim picture of Mozambique. I mean, they, they have developed more medical schools, and I think they've, they've really increased their capacity since that time. But my point is not, you know, a point about this particular country, it's just our point of view, really doesn't fit. And a lot of times, we don't recognize, you know, my own experience practicing in the UK, which has National Health Service, and also, being patient here and teaching at a medical school, we just don't realize how many things we do in the US that we don't need to do that we do just because of billing, like doing all kinds of vital signs. They don't do that anywhere else in the world. But you can't have a level three visit if you don't do it.

Unknown Speaker  27:31  
That's true. So

Unknown Speaker  27:35  
I mean, it's it, there's so many things that we spend a lot of money on, and, and I've really adjusted my thing. I've adjusted my thinking about my own health care, you know, and learn to just sort of roll with, with how they do things here. And then Portugal has a lot of challenges to its healthcare system. But anybody who becomes a resident is covered by it. So yeah, so I at least I know that if an emergency happens, and I'm taking an ambulance to the Faro hospital in the big city or nearby, I won't go bankrupt. Yeah, I won't have surprise billing, it just it'll be uncovered under the healthcare system, I hope doesn't happen. But it's a really different sense you have living in another place.

Unknown Speaker  28:26  
Yeah, totally different perspectives. I've seen that from some of my colleagues in other countries where they just they just kind of chime in and say, you know, the different ways and always the bad way. Especially, especially in this country, we love to argue about the National Health Service in other countries. But, you know, I've had several guests on the podcast that have demonstrated that they still have a very good living, despite maybe paying slightly higher taxes for the relief of free education and free health care. Yeah. So yes, we need to listen more and stop talking here in this country more. Yeah. Well, let's, let's shift gears one last time and talk about your new career. Because I'm so excited to learn about this. So you are now writing or actually have finished your first novel and it's coming out in July. The moon is backwards. Can you tell us about kind of where you? Was it your medical writing that led to the your passion for this and and tell us about your novel, if you don't mind?

Unknown Speaker  29:21  
Oh, thank you. Thanks for asking. It wasn't really, that my medical writing led me to write fiction. But I had a couple of stories. I wanted to tell that that were fiction stories. And so I think my medical writing helped me learn some about writing but writing fiction is a whole different deal. So I took a course on writing novels that City University London and my teacher from that time is continues to be my mentor and editor. A Tour. And I continue with the writing circle. But the story that I wanted to tell was about Brazil. And so my novel is historical fiction. It's set in mid 20th century, Brazil meant the construction of the new capitol called Brasilia. And the subsequent military dictatorship and the main characters of a young woman. Basically, we follow the arc of her life, from age seven to in the 1940s, through the 1980s. And it's been released and paperback and ebook that I actually plan on narrating my own audio book. Oh, me, and I'm having it. It's very exciting. And I am having a translated by a translator in Brazil, because even though I'm fluent, it's a whole different deal. It's a whole literary process to sure, you know, to shift to another language. So I hope that we'll be ready for release also in July. And so I'm very excited about that. And then I'm working on a couple more. I'm what I call my palate cleanser. Because fiction, that's historical. It's quite a bit of work and research. So my, my current work in progress, the working title is murder at Margrave. And it's a murder mystery set in an academic medical center. Oh. Oh, yes, I'm having so much fun. My writing circle says they could just hear me laughing inside, right, if they read what I wrote, you can hear me laughing. So that's fun. And I'm working on the research for a new historical fiction set in Brazil in the 1860s. And the working title of that is Americana. And it's about a group of people who were part of the Confederacy in the southern US. And after the Civil War, they ended up moving to Brazil and starting this whole community. That's true story. And very exciting. So I get to research all that. And then, on top of all that, I have to write my memoir, which my working title for that is mid century modern.

Unknown Speaker  32:39  
That's why that is keeping you busy. So you're in the same time that you're researching one novel, you're still writing another one. And you have to kind of separate that out and shift gears.

Unknown Speaker  32:50  
I mean, that's just a different thing. Because the whole research process, it takes quite a while and I don't want to not be writing during this time, plus I part of this writing group, class, and we're called to punch, we have to submit an extract of our writing every few weeks. So

Unknown Speaker  33:12  
yeah, that's great. It keeps you keeps you on track them.

Unknown Speaker  33:16  
Yeah, yeah. It's wonderful.

Unknown Speaker  33:19  
Wow, that is so exciting. So that has been kind of your new passion. Now that you've had a chance to dial down on the PA education part and the leadership part. It sounds like

Unknown Speaker  33:29  
yes, yes, yes. And we're enjoying our lives here. I do some gardening and we're sort of in a semi rural area, but not far from major city. Here in the hills of the Algarve, which is southern Portugal, and just we've met a lot of new friends and I've been involved we are part of a group that supports classical music and we have concerts every month here nearby and that's just a wonderful variety of things to do. And my husband is an avid cyclist and this is like a place where crows cycle so he just loves it here and so we you know, we stay busy. We were locked down here. We moved into this house a week before locked down and locked down here was serious. Yeah, locked down here was very, very serious. They were they were wonderful. They would come by with these audio trucks. And they would say in Portuguese and English. Stay in your house. Do not come out only to go buy groceries. If you are having problems and you need help. If you need food, or if you're just lonely. Please call bla bla bla. So different culture, it's just a whole different culture. Neighbors are really friendly people help each other. Our neighbors are always bringing us produce for from their gardens, you know, invite us to go into the orchard and pick much fruit as we want. It's really the Garden of Eden.

Unknown Speaker  35:08  
That's wonderful. That's wonderful. Well, I when you do release the novel, when it's out, please let us know. And we'll put it on our website and I can't wait to to get a copy and give it to my daughter's and and read it myself.

Unknown Speaker  35:21  
Great. That's wonderful. Thanks so much.

Unknown Speaker  35:25  
Thank you, Justin. Take care and have a great summer. I want to thank our guests Dr. Strand d'oliveira for her time and insights. It was so incredibly interesting to see where she is heading in her retirement from the profession. And we hope you keep an eye out for her novel this July. In fact, we will be highlighting it in our socials when it stands to tune in next week as we speak with Dr. Kevin shore from the University of Kentucky. Kevin talks with us about his program is national leadership and his music career.

Unknown Speaker  36:01  
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.

Transcribed by https://otter.ai