Expert Insights from Program Leaders
May 16, 2022
Season 2: Episode 38-Dr.Brian Lauf and the University of Nevada Reno PA Studies Program

We speak with Dr. Brian Lauf about the developing program at the University of Nevada-Reno. We learn about his path to becoming a PA and about his unique background in the profession. We also discuss the changes taking place nationally for the profession...

We speak with Dr. Brian Lauf about the developing program at the University of Nevada-Reno. We learn about his path to becoming a PA and about his unique background in the profession. We also discuss the changes taking place nationally for the profession and he shares his perspective from his 25 years as a PA.

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.


Season 2: Episode 38 - University of Nevada-Reno PA Studies Program


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. 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  0:49  
we are going to be things are going to be contributing to black.

Unknown Speaker  0:58  
Well, hello there and thank you for joining us for season two episode 38. Today we speak with Dr. Bryan law who is the founding Program Director of the developing Physician Assistant Studies program at the University of Nevada Reno School of Medicine. Brian is a 1997 graduate of the charter class at Oregon Health Sciences University in Portland, Oregon. He is a PA who's practicing real medicine he has led in industry and he has led a PA school for the past several years. Brian and I talked about the benefits of their program as the only state sponsored program in the state of Nevada. We talk about rural medicine, and we talk about leadership in the PA profession and discuss where the profession is heading. We'll be enjoyed this session. Hey, Brian, how are you? I'm good. How are you doing? Yeah, Happy Friday. Happy Friday. Thank you very much for doing this. We really appreciate the opportunity to highlight your program.

Unknown Speaker  1:56  
Yeah, Bill honored that was asked him I think it does a great service to your listeners to kind of get those wide perspectives.

Unknown Speaker  2:06  
Excellent. Well, Brian, thank you so much for joining us today we're excited to learn about the University of Nevada, Reno School of Medicine, PA school, your studies program, and also about your path to becoming a PA and some of the leadership things that you've done in your career as well. Let's start by learning about you first. So tell us how you ended up becoming a PA?

Unknown Speaker  2:26  
Yes, well, first of all, to say thank you. I'm incredibly grateful for the invitation. And to be a part of this vital project and share my story alongside some of the Great's of your former guests, including Stephen yourself. It's a great honor to be able to come today and talk with you.

Unknown Speaker  2:44  
Thank you. It's very kind. Thanks.

Unknown Speaker  2:47  
Yes. Also, as a listener, I have learned so much about the PA profession listening to your podcast, and I've been in this profession for 25 years. But I must say I've learned so much and I can only imagine what the prospective students are feeling after listening to these. So again, thank you for all you do. I really appreciate it. Thanks. Well, my story, I'll try to condense it down becoming a PA. We all have our unique stories. And I think that's important to prospective students is to understand that we come from a variety of backgrounds, and that's what makes us so great. And so I grew up here in Reno, Nevada, and single mom, low socio economic situation, went to high school where college was not really discussed, it was finished high school, get into the workforce, and off you go. So I took off the days of SCT and AC T and as that figuring this is a free day that kind of go out and head to the lake or do something fun. College was not in the mindset for me. In fact, I was a first generation graduate as well. My father went eighth grade so education was never stressed as something that you should pursue. Somehow, senior year or junior year in high school, I landed a summer internship at the local VA doing EKGs and during that time, I was so fortunate to meet several veterans. And during that time, I learned profound lessons not only in medicine that I can reflect on but just as a person and as a PA one of the things going into the rooms every day to these veterans they taught me a lot about one being a man but being a professional about being now veteran so it really interested in my increased my interest in the military. And finally just wearing a white coat were one of the beeper was super cool as an 18 year old so that to me was the biggest traction.

Unknown Speaker  4:47  
I can't argue with that. That that is it's pretty cool.

Unknown Speaker  4:50  
Yes. So that kind of pushed me in a direction of the military. So long story short, I learned the military had no idea what I was going They do. And the day that they were handing out jobs, they were security police or medics. And I said, Oh, well, I'll be a medic, I guess. And so that's where my medicine path began, I spent two years in Turkey. And I cried, when I found out I was going to Turkey, because I really didn't know where it was. But it was the best two years of my life, as with many things, the benefits of it are hidden to you experience. And I say that often about the PA profession, you experience it, and then you understand how great it is. I was exposed to IDM T's which is independent duty medical technicians. So these are kind of the early pas of the military. And I thought that again, was super cool. And they got to wear a stethoscope suture people up. So these were things I was interested in. And someone told me, you should consider PA school in the military. And I looked into it, and I got the story of sign up for another four years, and we'll talk about it. And I had heard that story. Many times the military said without a guarantee, I'm gonna take my GI Bill and head back home and pursue it to the civilian world. And then returning back to Reno, again, not prepared for college, very underprepared for college, in fact, academically and just just didn't understand the tools needed to be successful in college. But I did have the life experiences that gave me the grit to get through it. So I recall going to my professor in English, and she handed my first paper paper back to me and said, We need to talk. And so at that point, I took on education very seriously and said, this is like the military. It's up to me to make a change. I in for my experience, I worked for a home oxygen company while I went to school. And that's where I expanded my patient interaction skills and apply to PA school. Once I transferred and finished all my undergraduate prerequisites at the University of Nevada, Reno, I applied to two PA programs and got the common Thank you, but no thank you responses. And I always knew if I could just get an interview, I could convince them to take me. To me. That's where I think students should prepare to shine as a program director. That's where I make my final determination is during those interviews, So lo and behold, microbiology professor at UN are moved to Oregon Health Science University, right next to the office of the developing PA program at OHSU

Unknown Speaker  7:30  
with Ted rebec.

Unknown Speaker  7:32  
With Ted roo back,

Unknown Speaker  7:33  
yeah, exactly. Six degrees of separation here. It's amazing.

Unknown Speaker  7:37  
It is amazing, listening to your podcasts, how much we probably have crossed paths professionally, in those who we know and associated with. Sure. So that Professor sent me an application paper application. And I filled it out, send it back. And long story short, I got in my interview, and I convinced them to take the only out of state or for the first class at OHSU, which was 14 Students with 11 of us who graduated, become a PA returned back to Nevada, because I knew that's where I wanted to practice. And I landed a great job in a rural health clinic and spent my first five years there learning all the ins and outs of rural medicine, which if I could develop a course, that would have all those experiences and knowledge and pack them into a course that would be a million dollar seller to PA programs because those experiences are what I think pas often seek and are having a hard time finding unless you do it in a rural community.

Unknown Speaker  8:42  
And that's interesting for me, Brian, because I've always said that the learning curve for PA school is pretty steep, your didactic is pretty steep, but then your clinical experiences are even steeper, but then the first few years of practice are really like climbing Mount Everest and and that's where you gain all of your competence and foundational knowledge after you've had a chance to see something maybe 20 times. So it sounds like for you that first five years in rural medicine really prepared you for life and medicine for that point on.

Unknown Speaker  9:14  
Absolutely. And I would also say prepared me to be a professional, a community that didn't understand what pas were. So my job as I tell my students now, it does not begin or end at the bedside or in the exam room. Being a PA is a 24/7 role. It's a profession, and you have to take it on as such. Otherwise, it's not going to return to you all that you expected.

Unknown Speaker  9:42  
Fantastic. So you're at the real health clinic for the first five years and then what

Unknown Speaker  9:46  
I bounced around I had an opportunity to join an EMT practice again, never had a PA before so that was a great experience. And in fact, if I had my choice to remain a clinical practice, I would stay in e and t. For the rest of my career, I thought it was a great blend of medicine and surgery, procedures and direct patient care. So for me, it was the Holy Grail of practice. But business things pushed me out. And then I went back to family medicine for a little while, and then landed in a fantastic opportunity to join a startup company in the healthcare delivery space, if you will. That to me was, again, another thing that a lot of PAs experiences other than clinical medicine, you bring and learn along the way skills that that I think other clinicians or other professions may not have that wide breadth of exposure. So the startup world was being funded by hedge funds, which we had lots of money to spend lots of ideas to try to execute. But when that money dried up, so did our ideas along with it. So it pushed me back into clinical practice. But at that point in time, I was nearing the idea of part time retirement or early retirement. So I went back two days a week in urgent care, and found myself bored and wanting more out of my professional life, and ended up doing some operational things with the hospital system, developing new clinics, and then became their information technology champion. And I tell students and young pas, that's what's important is being available for those opportunities. And it will lead you in directions that you haven't even imagined yet. So I guess the final leg of this chapter leading up to today was as a practicing pa here in Nevada, since I returned from Oregon Health Science University, I always knew that we needed a PA program, and talked with the School of Medicine since the late 90s. About how to make that happen. And after several meetings that really went nowhere. Most of the challenges where who's going to pay for it? How are you going to bring up the money for it. And what happened is that they had a meeting and they invited a couple of community pas, including myself, and they had a long discussion about our ideas and what we thought would be best. And lo and behold, Ruth ball wave was their consultant, leading them through that process, who happened to be one of the consultants for OHS us development. So sure, again, full circle. And a couple months later at the APA conference in San Francisco. We've pulled me aside we had coffee, and she says you're at the next PA program director at university Nevada Reno. Not asking but telling me that's what I was. Yeah, she's she definitely has some hutzpah. Yes, yes. So after the shock wore off, and recognizing I had really, in my own opinion, zero skill sets to do what she was asking me to do. I made her commit to me to be there for me when I needed her along the way. So from there, I took the role, or at least accepted the idea of the role. And what had happened is that the University took about a year to hire me, which is in true passion for a public institution. And during that year, they gave me the RPA accreditation standards, and put me on a plane to the PAs, program director 101. And I read that manual cover to cover on my flight to that course. And I should have stopped and returned back to Reno after reading that, knowing that the challenges that I faced were innumerable. But I learned a lot at the PA program director one on one. And in fact, I was a repeat attendee the following year, as a slow learner, I needed more information to feel competent in that role. And then we started our program.

Unknown Speaker  14:07  
Fantastic. So how, how rich for you to have grown up in the area to have become a PA to practice in the area. And then to kind of be at the point of that startup that had to be a really rewarding experience for you to get it going. But also talk about bringing in somebody who has some skin in the game, so to speak, you really I would imagine we're very motivated to see the program become successful.

Unknown Speaker  14:30  
Absolutely. I was extremely honored to even be considered for it. And then, as you mentioned, very passionate about what I thought would be the best structure of a program. Returning to the mentor concept is that Ruth helped me develop the program but I also have a number of mentors that I've leaned on to build the program, including Ted who back but back to him and knew that my education was top notch and figured why I'll repeat many of the things that I went through as it's been a long term successful program.

Unknown Speaker  15:05  
Yeah. And to tell the story, obviously, Brian, you're very humble, you've got some significant leadership experience. Beyond the business world, you've been president of the Nevada Academy of PAs, you've been a chief delegate to the aapa. House of Delegates. So you're not new to PA leadership. You're you just renew at that moment in time to PA education leadership. It sounds like,

Unknown Speaker  15:28  
yeah, absolutely. You know, the topic of leadership, I think many of your guests have discussed this, where leaders don't necessarily self proclaim that they're often in a situation where they feel like they can contribute. And then they recognize with support from leaders that they revere they to naturally fall into those footsteps and become leaders. And I have to say, there's a couple that grabbed me early on in my career and said, Hey, you will be a good leader, just just put your toe in the water. And I think you'll be great at what you do. Because if there were a bet that OHSU from faculty, staff and students about leadership or involvement to the level that I have in my profession, I would have lost that that saying that I would have fallen to that path. Because I was there to do one thing, and that's be a PA, but make your own. I don't know if you know her, she was there in Arizona for many, many years. And she was the president of the Nevada Academy. And again, drew me in and said, You're the next president of the chapter. So this is what I you and I are going to do to get to that point, there was a couple of PAs in the state early on, even as I was a prospective student that I was a member of the Academy. And I suggest many students look into that, as they're preparing to apply to PA programs, because it's a wealth of knowledge and contacts and connections going through your state association. And being an involved as a student is what really led me to think coming back and being a leader in the organization.

Unknown Speaker  17:04  
So let's talk about your program. You are a developing program stills I understand is that correct?

Unknown Speaker  17:09  
Correct. And I would say we're all hopefully, always developing and matter how many years you've been doing it.

Unknown Speaker  17:15  
Yeah. And our previous guests who have been part of that, like staff and Creighton illuminated what that process is, so your students who attend your program, while you're under provisional accreditation, are still eligible to take the national certification exam. It's as if the program is up and running, but has not received full continuing accreditation at this point. And that's just part of the onboarding process with our accrediting body.

Unknown Speaker  17:38  
Yes, you just said it perfectly. I it is, I think our PA could look at those statuses of accreditation and perhaps change the wording because it is confusing to anyone who's not actually in PA education, because the concept of provisional is somewhat as if you're not ready to accept students yet. And provisional is a status as I tell students of an accredited program. So it's an accredited program with the status.

Unknown Speaker  18:08  
Very good. So how long is your program? And what would you love to tell our applicants about your program?

Unknown Speaker  18:15  
Sure, we're a small program. So that's one of the things I think that we're highlighting is that 24 students we accept every year and we are 25 months long, we actually initially were planned to be 27. And with some advice from mentors, a set the long view are doesn't necessarily mean it's a better educational program. But find where the amount of time needed to deliver what you want, and minimize the time that the students have to be there. It is a tricky game of how long is perfect. And I have to say I'm not sure if 25 is the right number. But for us, it's working the programs in the public institutions School of Medicine, it's the first VA program in the state of Nevada in a public institution. The only other program is a private institution, Touro University in Las Vegas. So a great thing about Nevada is that we have two PA programs that don't necessarily compete in each other's backyards, because Las Vegas, Reno or geographically quite distant Turkey. We work together as a private in a public program to serve the needs of the state. Other things about the program, I think is important is that both Ruth and Ted, our admissions driven program directors and so I drink that Kool Aid, if you will. And I believe that that is the foundation of any program have the success of the program and the success of the graduates. So understanding who is the right student for this program? I always it's a lesson I learned from the military transitioning from the military life to civilian life, is that when students are interviewing or looking at programs, they shouldn't be assessed. You get that program is it best for them, not if they can get it, not if it's close to home, but it really doesn't meet their needs. Because if it doesn't, then it's a miserable 25 months for everyone involved. I couldn't agree more. One of the things about being a small program is, again, we're nimble, and a newer program is that we listen to our students, and we value their input as how the program evolves and develops. I think some students feel as newer programs are not quality. And I would disagree. Now, some programs do struggle early on to deliver the high pants pass rates. But I think that's a it's a, it's a matter of one, the pants itself changing the environment, a pH Keishon, changing and new programs working out the kinks. But students who contribute and as a person who was part of an initial program, there's no greater joy to know that you actually created the program along with the faculty and staff.

Unknown Speaker  21:06  
And you can speak to that from lived experience, which is super cool for you, I would imagine,

Unknown Speaker  21:10  
it's a story that does provide to the interviewees when they come to campus, a little confidence that I made know a little bit what I'm doing, even though my experience in key education is relatively limited to others, but understanding how to put together a program and deliver what the students are looking for. That is the part where I'm committed to that. And they see that and hopefully, our graduates would agree with that.

Unknown Speaker  21:39  
And Brian, it sounds like you very much believe in a partnership model where those students that are what we would have called in the military plank owners for a squadron or for a ship, the people that that jump in, in the first few classes are really partners in helping to craft the clay into something that's special.

Unknown Speaker  21:57  
Absolutely. I believe that if you're looking for plugging play educational experience, that's probably we're not going to be able to provide that to you. We want you to actively engage not only in the program development, but your learning, because that's where you're going to have the stickiness of your education because it wasn't something you sat down and read and regurgitated on the test, you lived it. And I think your patients deserve all patients deserve that level of commitment to your education that goes lifelong in the profession.

Unknown Speaker  22:33  
Sure, and the program is located up in Reno, which is in the northern North Western part of the state of Nevada, near this year in Nevada Mountains. So do you find that a lot of your students are coming from in state to head to that beautiful part of the state? Or are you getting kind of a good mix of both out of state and in state applicants.

Unknown Speaker  22:53  
Our mission is to serve the needs of the state of Nevada. So we definitely give preference to Nevada residents or those who have connections to Nevada, one way or another. So our student body reflects that mission statement. Not that we don't accept or don't want students from outside of Nevada, because I think it's important to actually have that geographic diversity in in experiences come to a classroom. But our program is primarily made up of those who are connected to that in some way or another, and then others that convinced us just like I did many years ago of why they should select them to be part of our program.

Unknown Speaker  23:33  
Sure, sure. And as you look at the aspects of your program that you've crafted, so far, what would you say are some of those unique things that kind of bring students towards you?

Unknown Speaker  23:44  
Obviously, the first thing is, is that if they're connected to the university, they understand it. So we get a lot of students interested from the university undergraduate pathway. The other thing is that it is a public school of medicine, and its mission again, is to serve the needs so that service component is extremely valuable to some applicants. The other thing is the size of our program. I think we hear that from students very often. Putting 24 students in a room is a quite a different dynamic than it is 70 or 100 students sit around and I tell students houses class 11 So can you imagine not only were we did we know each other we knew what each other smelled like

Unknown Speaker  24:32  
that's fantastic. So and the program is how many months did tactic and how many months clinical rotations?

Unknown Speaker  24:38  
Sure it's split 12, didactic 13 Excuse me, that's the reverse of that. It's 13 of didactic and 12 of clinical. And we have a month there that there is preparation for clinical. So it really becomes 12 and 12 with a month of clinical preparation that we utilize that time to not only in or onboard the new class, but also the graduating class and then the transitioning class.

Unknown Speaker  25:09  
Okay, excellent. And given your rural health experiences, do you have a particular focus on rural health? Since Nevada is a fairly rural state?

Unknown Speaker  25:19  
Absolutely, we definitely focus on primary care is our mission. Not that we don't recognize that students go into other specialties, but we want them to have that foundation of primary care. We're definitely committed to rural, underserved communities. In fact, we actually have a rotation that is in a rural underserved or medically underserved population, we call it and I tell students, that doesn't mean you need to be in a one room shack in the middle of Nevada, it could be downtown Las Vegas, I think the metropolitan areas have tremendous underserved populations. And we want to make sure students recognize that.

Unknown Speaker  25:59  
Wonderful. So your leadership experiences have certainly helped you with this startup. What do you see as the biggest challenge in the state of Nevada in the future for pas?

Unknown Speaker  26:10  
That's a great question. And I'm sure it's a question all of us think about in our own backyards. I think the greatest challenge is the evolution of the profession. At one point in time, it was about being excellent at your craft going in and being excellent at providing medicine to your patients. We've evolved in as a profession, part of that evolution is having self determination, self governance, and I think that's where the challenge is, is training students in the short amount of time that we have to be excellent in medicine, but also recognizing that they're going to have to be equally excellent as a professional, if the profession is going to continue to go in a direction that I believe it should, which is self determining, and self governing.

Unknown Speaker  27:01  
So does that change how you look at applicants and what you're looking for them to have experienced before they get into your program?

Unknown Speaker  27:08  
Absolutely. As I say, with technology and medicine now change, I think, when I was in school, they said that medical knowledge doubled every five years and then went to two years. And now I think I last read it was 73 days medical. And that's right. Yes, it's super scary to think that we're responsible to provide that much information to make them competent, safe practitioners. But equally, as you mentioned, teaching them to be a professional in an environment that has not been super friendly in recent past. And that just demanding what you want is not necessarily the way you're going to get it. And so you have to be crafty in how you address those challenges. But if you're not even in the room, or at the table, your voice is never going to be heard. So you have to, as I did, as a practicing TA in surgery, you got to elbow up to the table. And if you don't know what, you'll be in the back forever. So I tell students need to elbow up to the professional leadership tables, because that's where the conversation starts. And that's where you can represent the professional saying, Oh, this is actually a very articulate, smart, contributing member of our team. Absolutely.

Unknown Speaker  28:31  
Yeah. And you, I imagine your experience and leadership at Health Systems lends itself to the conversations you're having with your students about how to navigate that world of employment and establishing yourself as a professional in a health system or hospital.

Unknown Speaker  28:49  
Absolutely. I think I lean on my experiences in the business world, the startup world, recognizing that it's a eat or be eaten workplace and to some degree, that's how it is currently in the PA profession, along with some of our colleagues out there is that you're either going to be the person who's moving the profession forward, or you're going to be contributing to the lack of movement moving forward. And I think you need some skills and knowledge to be effective at that.

Unknown Speaker  29:22  
So Brian, we're along the spectrum of accreditation is your program currently, how many classes have you matriculated so far? How many have graduated? How are things going so far for you?

Unknown Speaker  29:33  
It's been a bumpy road to be completely honest. But I think it's been very beneficial, a bumpy road to solidify what we want as a program. So we are entering our fifth cohort this summer. We will graduate our third class July our provisional was pushed out further in terms of we were supposed to have our final provisional site visit isn't A and due to COVID, and a variety of other reasons programmatic and personal, we request an extension. So we'll actually have our final site visit next spring, which I think is an advantage because we can demonstrate to RPA with more data and more information that is to really ask the test of their rigor of are we a quality program, deserving of continuing credit?

Unknown Speaker  30:27  
Yeah, I think I just went through the accreditation provisional conference that's required of all new programs last weekend. And I think it's interesting, they're really focused on ensuring the programs can self manage. And so you're right, I think having more data and more analysis and more action plans coming out of that data to demonstrate that you are nimble on your feet, when things shift in the winds, like they so often do, can only benefit you in the long run through for that continuing accreditation status. So that's great, what have you enjoyed the most about the experience so far?

Unknown Speaker  31:04  
The whole P education experience or the program director,

Unknown Speaker  31:07  
the program director.

Unknown Speaker  31:10  
That's a great question too, because I have to remind myself, often what I enjoy about it, because it is a tough job, that you are managing many of the things that you didn't think was going to be part of the job. So it is a human resource, primary job, I make sure that faculty and staff are taken care of, and they receive what they need to do their job effectively. And that's tough, because as you grow as a program, you have different dynamics as people were added to the chemistry. So I, I relish that role. And I think I'm good at that role. But it is one of those things that sometimes it's very tasking. What I enjoy the most, however, is getting into the classroom, and in the labs with the students. My wife is a retired elementary school principal. And the lesson I took from her was, she said many times, she sat in her office, just frustrated with her job. And what she learned was to pick up her laptop, go sit in a classroom and do her work there, which gave her the meaning for those things that were frustrating her it really connect the dots. And I do that anytime I'm frustrated about the operational aspects of my job, I go back and focus on what does this mean to the student? Yeah,

Unknown Speaker  32:32  
I think that's really, really wise advice on her part, I think that it's so easy to isolate yourself in the program director office and get wrapped up in it, the job is challenging enough. In terms of the HR components that you talked about, and ensuring that people are life happens, right, and people, people have challenges that they have to navigate. And sometimes it means you have to find people to replace them, which is not an easy thing I would imagine in a smaller setting like green oak as compared to LA or something like that add on to that you're the middle person between the upper management and the team. You're the chief advocate for the program for budgets for resources for rotation sites, and it's just it would be far easier to hide in your office than to get out. So I agree with you, I think the students for me, at least when I was at USC, the students breathed life into my soul. And not that the faculty or staff took that life away. But they just remind you how incredible an opportunity it is to be able to take somebody that has limited medical knowledge and professional knowledge and guide them through the territory P education and then watch them graduate at with confidence as they head out into the world and, and become a colleague of yours. So that that's cool. What a great, great way to look at

Unknown Speaker  33:54  
it. Yes, it's been helpful in many instances where I need that, that energy from the students to do my job and do it well and wake up and come back and do it again. The next day. You brought up a good point, though, that I forgot to mention was about budget, one of the unique and I think highlights of our program that I think strengthen us as a program is that in a public institution, we created our program has been self funded. So we do not use any state dollars, thus not tied to the politics that are associated with that. And I run it and build it as a business. And I think that has shown to be very wise. When we went through the pandemic with budget cuts. Our budget remained flat and we were able to weather all those challenges, simply because the structure of the program financially was that as long as we have graduates or students applying and students sitting in seats, then we can continue to deliver what they expect. And part of the 20 port number was derived simply from a budgetary perspective, I wanted the fewest students that I could support financially and 24 was the number that fit that budget model.

Unknown Speaker  35:12  
That's that's a great, great opportunity for you. Congratulations on navigating it that way.

Unknown Speaker  35:18  
Thank you. It's one of the things it's also difficult in a public institution, because everything is taught on the concept of state dollars. And I always have to remind everyone from the president down that, yes, it applies, but it doesn't directly apply to what we're doing here and the program. And I get many inquiries from other units in the university that want to replicate what we've done, because it is so protective, their ability to deliver the the education units, not be jeopardized by legislators making decisions.

Unknown Speaker  36:00  
Yeah, I would be remiss, Brian, if I didn't circle back to what you were saying about self governance, I'd love for you to expand upon your thoughts just a little bit related to the future of the profession and where you think it should fit. And why I think a lot of our listeners, you know, I've heard from physician to a very uncomfortable with the Physician Associate movement. I've heard from some who are very comfortable with it, because they have really collaborative relationships with pas, but But I think, you know, change is always uncomfortable for people. So maybe help our audience understand, because I would imagine for future applicants, these are big changes coming down the pike for us. So maybe, can you can you enlighten us a little bit more from your leadership stance on where the profession should be going with self governance?

Unknown Speaker  36:51  
Yes, and I'm not sure I'm the person to tell everyone where it should be going. But I certainly have strong opinions and beliefs. And I'm nearing the end of my career. So a the my skin is a little bitter in this game. But I'm still passionate about where the profession could go. And I would define it as opposed to should go, it's more work could go. And it shows up to our applicants and graduates and young pas, and I just read a statistic the other day, I think it said, less than 13% of practicing pas are between the ages 50 and 59, and 8%, or 60 or older. So this is a young profession. And it's up to them to determine where they wanted to go. And I would hope that they listened to those of us who have been around for a while for guidance in perhaps, to avoid some of the missteps that we have experienced. But where it could go is I think it could go on away is I've always said if we are truly going to call ourselves a profession, we need the ability to self regulate, that's a fundamental characteristic of professionalism. Also, that if our patients and the public are going to trust us as a profession, we need to have that self governance and be able to say we're responsible for what we do. And we also are the person solely responsible for when we do things wrong. And I find that physicians and our partners, which again, delivering medicine is a team sport, no matter what your degree is. And if you are really practicing in isolation, then let me know so I can avoid come to see you. Because really, we all rely on each other in this day and age to deliver high quality care. But again, if we're unable to be responsible for all of our actions, and not have some of that responsibility fall on another profession, I think then we we fall into the trap of saying we're not a professional, we're not responsible. The the supervising physician is responsible. And I always remind everyone that no, yes, right now legally, they're both responsible, but it should be the person who's making the decisions at the time, who is responsible for those decisions.

Unknown Speaker  39:18  
And it's a really interesting point, because if you think about it, we always have the option to refer to a physician colleague, or to seek an expert's opinion on a case that we're struggling with rather than try to calculate ourselves. So I think that there is a strong argument to be to be made for what you're saying.

Unknown Speaker  39:37  
Right? So simply the decision to refer or not refer is a significant professional decision. And too often early in my career, I would hear things like well just go help the physician see the patient, don't worry about it. You're just the PA. And it really bothered me in that. Well, if that's the case, then what am I doing? In here, I can tell you a brief story I worked in emergency room. And for any of those who work with a group of physicians trying to mirror your practice style with theirs, it's hard enough when you do it one to one. But when there are 15 different practice styles, I found myself looking at the physician on shift. And they said, why don't you just see the patient tell me what to do, because I not sure what you want me to do different from your colleague who is uncollapse shift. And I tell students working with physicians and teams, and part of that is is assimilating your practice title into that team. So it's a give and take relationship. But if you want me to be part of the team as a contributing factor, and I need to have some autonomy to be able to do that and be responsible for it, as well,

Unknown Speaker  40:51  
of course, at the core of that is building a trust account with your colleagues. But I would imagine how it was an internal medicine and family medicine, PA. So for me, there was a smaller number of people to do that it was much easier to build that trust account, when you have 15 Doc's that are coming in and out of the ER, over the course of a month. That's a little bit more challenging. Brian, thank you so much for being with us today. We always ask our guests if there's anything else they're hoping to share with our listeners, before we sign off, is there anything you were hoping that we'd covered today?

Unknown Speaker  41:22  
The one thought that I guess I would share here is that, although as I mentioned earlier, that medical knowledge is changing rapidly. And that we heavily rely on data driven decisions. I remind students that it's really about the end of one. And that one is the patient. And statistics are for averages. But they will likely never apply to that end of one in the same fashion as it does to a larger body. And don't forget that although you're making decisions based on a pool of knowledge, you've got to apply that to an individual. And it's important to remember that that you're treating an individual. And from from forgetting that is, to me, the worst thing you can do for your patient. And then finally, again, information and communication is the foundation for healthcare. And I believe that students experiences are being diluted in that area and the skill sets and they're more focused on coming up with the correct answer, and losing the ability to actually talk with patients, which is ultimately the majority of what is deliver is building trust and a bond with the patients.

Unknown Speaker  42:44  
Yeah, yeah, I think that's where the arguments for artificial intelligence are in our favor. Because at this point, it's too hard for a computer to develop the relational aspects that help us build that trust with a patient. So thank you so much, Brian, for your time today. I think, you know, I'm really excited to watch your program grow. And you know, very jealous of your beautiful surroundings. I'm sure it's nice and cool up there right now. And I look forward to seeing you in the future in the PA profession as well at leading on the education side. And, again, can't thank you enough for taking the time to share your story.

Unknown Speaker  43:25  
Thank you so much. And I appreciate all that you're doing for our prospective students and future leaders of this profession. I believe that you've, you've stepped into something that should be should have been done a long time ago. Students who are listening or prospective students or listening to this should be sending you lots of thank yous and kudos.

Unknown Speaker  43:48  
No, thank you. They're unnecessary. It's just It's been fun. Like you. We have learned so much. I mean, I've been a PA for 26 years. And I have learned so much by doing these interviews, and it's just been really rich and rewarding for me and for my colleague, Stephanie. So, again, thanks for participating. Well, we want to thank our guest, Dr. Brian law for taking the time to share his insights about his program at the University of Nevada, Reno, about the future of the profession, and about what makes African shine in their application process. Tune in next week as we speak with Miss Karen Hills who is the Chief of educational development for the physician assistant Education Association. Karen is a professor emeritus from the Department of Family Medicine and community health at Duke University School of Medicine. She is a past president of PA VA and she has significant experience in developing curriculum, both for her PA schools and for the profession at large. Until next time, we wish you success with whatever path you are walking in life. And thank you for joining us and 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.

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Brian S. LaufProfile Photo

Brian S. Lauf

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Professional Goal: Enhancing health care access and improving the health and well-being of all Nevadans through education.

In 2015, Dr. Lauf joined the University of Nevada, Reno School of Medicine, as the Founding Program Director of the developing Physician Assistant (PA) Studies Program. Brian is a 1997 graduate of the charter class at Oregon Health Sciences University (OHSU) in Portland, Oregon. After graduation and returning to Nevada, Brian was fortunate to practice several years in a rural clinic alongside a seasoned rural physician. In 2000, Brian earned a Master of Physician Assistant Studies from the University of Nebraska. He completed his Doctor of Medical Science at the University of Lynchburg in 2020.

Throughout his career, Brian has continuously pursued the evolution of PAs in clinical medicine, leadership, health information technology, and as an entrepreneur in the business of health care.
Brian has held several local and national PA leadership roles, including President (2001, 2020) of the Nevada Academy of PAs (NAPA) and Delegate/Chief Delegate to the American Academy of PAs (AAPA) House of Delegates (HOD). He’s advocated for the PA profession in Nevada and Washington, D.C. He currently serves as NAPA’s Government Affairs Committee Chair and its Delegate to the AAPA HOD.
In his free time, he enjoys being a husband of an amazing wife and father of two beautiful children. Outside of his current all-consuming passion for PA education, he enjoys traveling, the outdoors (hiking, skiing), and basketball.