There are many excellent programs from which to choose. The following three are among those with a special interest in recruiting and supporting indigenous students and providing health care to underserved populations.
University of Washington MEDEX Northwest
One of the oldest PA programs in the United States, MEDEX Northwest has a long, successful tradition of preparing PAs to practice primary care in medically underserved areas, particularly in the Northwest and Alaska. More than one-third of the program’s approximately 1,500 graduates are working with the underserved. Most of the Indian Health Service facilities in the Northwest have MEDEX graduates.
Ruth Ballweg, Director of the MEDEX Northwest program, says, “The mission of serving the underserved is woven into every cell of the program.” Most of the people who help select new students are PAs from underserved health care facilities. During the screening process, they explore the candidates’ knowledge of health care disparities as well as the candidates’ commitment to helping to end these disparities. Significant attention is given to health care disparities during the didactic part of the program. In the clinical phase of the program all students work for at least four weeks in a clinic for underserved people. In addition, the students’ projects typically focus on the underserved.
MEDEX Northwest actively recruits indigenous and other minority students as well as medical corpsmen. MEDEX staff members sometimes work for years with candidates who have great promise but need to take extra courses and/or resolve challenges in their lives before they can enter a PA program. “Many programs would write these people off,” says Ballweg, “but we believe in high risk, high gain.”
The MEDEX curriculum helps equip students to be life-long learners who can meet the ever-changing health care needs. The program leaders are continually looking for new niches for PAs as a way of expanding health care access.
To date MEDEX has 58 American Indian graduates with 5 current American Indian students. The program has 23 Alaskan Native graduates with 3 current Alaskan Native students. A large percentage of these graduates are working in American Indian health centers in Washington, Oregon, Montana, Arkansas and Oklahoma. Others are working in community health aide training programs or Native corporations in Alaska. Most tend to be in primary rather than specialty care.
University of North Dakota PA Program
American Indians are well represented at the University of North Dakota (UND) PA Program. Since January 2000, 32 American Indian students have graduated from the program, receiving the master of physician assistant studies degree (MPAS). On average 12% of the class have been American Indians. Students come from tribes throughout the United States.
UND is committed to educating health professionals who serve rural and underserved areas. The unique curriculum makes it possible for all students to do the first half year of work online, spending no more than four weeks at a time on campus, and completing all their clinical work in their home area.
For many years, applicants to the program needed to be registered nurses (RNs) with several years of experience. Now a pilot program is accepting other licensed health care workers with extensive clinical experience. On average students are 42 years old.
Unlike most other PA programs, candidates must identify a primary care physician who agrees to serve as the applicant’s preceptor for the clinical portion of the program. During the application process, UND faculty visit the applicants and their identified physician preceptors in the physicians’ clinical settings. Faculty seek to ensure that the physicians and the sites can provide what is needed for the candidates’ education.
After the first 6 months of online learning, students begin a pattern of spending a few weeks on the UND campus working on knowledge and skills that they subsequently practice using for the next couple of months or so in their clinical setting under the supervision of their physician preceptors. While in their home clinical setting, students are in touch with a faculty advisor from the UND campus, and they continue doing online courses as well as a research project. In the final 10 weeks of the 22- month long program, students take individually-tailored clerkships in settings that enable them to work on knowledge and skills that they could not easily learn in their primary clinical settings. While on the UND campus, students are evaluated and given instruction in office practice and management.
In 2004 the PA faculty invited Elders from two nearby Indian communities (Turtle Mountain Band of Chippewa and Spirit Lake Nation) to identify the health care needs of Elders. Leander McDonald, Spirit Lake, PhD, facilitated a group of 25 Elders who identified and later prioritized their health issues. These issues were incorporated into the teaching cases in the curriculum. In addition, some Elders serve as “standardized patients” in the experiential examination that the students must pass in order to progress in their studies. As standardized patients, the Elders simulate real patient problems that the students have to identify and solve. The grandparents of PA student Audrey Bercier, were among the Elders who contribute to the UND program.
Arizona School of Health Sciences, A.T. Still University
The 26-month long physician assistant studies program, which leads to a Master of Science degree, has a Native American Physician Assistant (NAPA) track dedicated to increasing the number of Americans Indian, Alaska Native, and Native Hawaiian PAs who provide health care in Indian Country.
All of the PA students, including the NAPA students, spend the first 14 months of the program in didactic studies. During their clinical year, NAPA students spend several rotations in Indian Health Service hospitals, tribal clinics, and other sites that serve indigenous people, including, if possible, the students’ home communities. Students are encouraged to do their master’s project on an Indian community health issue.
Since 2003, when the NAPA Charter Class graduated, 28 American Indian people have graduated from the program. Most of the graduates are caring for indigenous people or plan to do so as soon as possible. For example, Kirby David, Navajo, works at Sage Memorial Hospital and its clinics, which serve the Ganado area of the Navajo Nation that includes most of his relatives. Heidi Morgan, Cherokee/Creek, works for the Creek Nation of Oklahoma in the same clinic she visited as a child. Brandy Tiger, Cherokee, lives at the Navajo Sage Complex where she works in family practice and assists with appendectomies, caesarean births, and emergency trauma.
Amanda Carey is providing primary care back home in a tribal clinic in Muskogee, Oklahoma. Shanna Geiger is also providing primary care in a facility where she and her family received care, namely Native Health, a small, urban clinic in Phoenix, Arizona
This article was originally published in the Winter 2007 issue of Winds of Change.