January 8, 2013 - University Gazette

“When is Carolina going to get a physician assistant program?”

It’s a question Lee McLean had heard since becoming chair of the Department of Allied Health Sciences, a division within the School of Medicine, 13 years ago. But, with six physician assistant programs in the state, there was no clear need for UNC to start a seventh.

In 2009 a group from the School of Medicine was invited to visit the U.S. Army Special Operations Command Team at Fort Bragg. There they observed the Special Forces Medical Sergeants – or 18 Deltas – and saw an opportunity to honor these medics who had dedicated their lives to service while addressing the shortage of medical care for the state’s underserved communities.

“When these highly trained Special Forces Medical Sergeants finish their tour of duty, no matter what they’ve done in the military, they’re not licensed to do anything in the civilian world,” McLean said. “We knew there had to be some way to recognize that kind of service.”

In December, the School of Medicine announced plans to create a physician assistant master’s degree program within the Department of Allied Health Sciences for veteran medical sergeants. A $1.2 million gift from Blue Cross and Blue Shield of North Carolina will help the University establish a curriculum and hire full-time faculty in preparation for the accreditation process ahead.

“We know that the majority of our Special Forces Medical Sergeants want to continue their careers in medicine to help improve the health and lives of our citizens, but many are unsure of what path to take when they transition out of the military,” said Army Special Operations
Command Surgeon Colonel Peter J. Benson.

“This program gives our veterans the education and opportunity to lend their unique health-care and leadership skills to benefit citizens across North Carolina.”

A new paradigm of medicine

A 2010 national survey of Special Forces Medical Sergeants revealed that nine out of 10 respondents wanted to pursue a career in health care outside a military setting, and close to half were interested in becoming physician assistants.

Chuck Cairns, chair of Department of Emergency Medicine, was part of the group invited to Fort Bragg to visit the 18 Deltas and meet with their instructors. Cairns said his first thought was how these medics could translate such special skills to civilian life. His second was that providing a transition for these medics would be a fitting way to recognize their service.

“I learned what these medics undergo, and I was impressed by the breadth of their training and also this new paradigm of medicine called situational medicine, where we’re treating people in very austere environments,” he said. “This pushed us to see how we could build on that training.”

Special Forces Medical Sergeants are some of the finest first-response health-care providers in the world, McLean said. Beyond medical care, they must be expert swimmers and parachutists, display incredible endurance and the ability to remain calm in the most dangerous situations.

“They have preparation and experience providing care in austere environments and in times of disaster and geographical extremes.” Cairns said. “They’ve already proven to be dedicated to service. This could provide them a long career in medicine when their tour of duty is finished.”

Serving where needed

When Special Forces Medical Sergeants find themselves in communities like Iraq, Pakistan or Afghanistan, they are responsible for not only the troops, but also the entire village. They become, essentially, the town doctor.
A medic might deliver a baby one day and a calf the next, parachute into a village or walk many rough miles to get there.

“They get training in veterinary skills, pediatrics, obstetrics and more. They have to perform their own labs and imaging,” McLean said. “There may be no electricity or place to clean a hypodermic needle, and still be expected to deliver the best health care.”

Many see this kind of training as a perfect fit for North Carolina communities facing a shortage of medical professionals. The ability to provide expert care away from many modern conveniences is great training to serve areas of the state that may be far from a major medical center.

“These sergeants take pride in being a resource for those who need them most, and they have also enjoyed working at a high level with a measure of autonomy.” McLean said. “A physician assistant degree would allow them to practice with the level of responsibility they’re used to.”

In North Carolina, an estimated 1 million people live in areas that do not have enough health-care professionals to effectively serve their communities, and the gap will continue to grow, McLean said. The impending Affordable Care Act will increase the number of people seeking care, expanding the need for providers. In addition, aging health-care professionals are hitting retirement at an amazing number.

“We’ve got a distribution problem,” she said. ”Where we do have adequate numbers, they are centered around the cities, and what we hear is these medics are interested in going where there is a challenge and where their service is needed.”

A new class in 2015

Though years in the making, there are still a few more to go before students fill the chairs. Once accredited, the program plans to admit its first class in 2015.

McLean will retire in August. During the next six months, she will be working on a preliminary set of academic and admissions standards for the program and a formal request to plan a new masters degree that must be submitted to the Board of Governors this spring. She also will start to organize the documents that must be approved for national accreditation of the new program. Once a new program director is hired, that person will take over these essential tasks.

The allied health sciences department houses and administers a number of therapy and diagnostic disciplines related to medicine, offering 13 bachelor’s, master’s and doctoral degrees, McLean said. “Our professional degree programs are all very highly ranked nationally because of the excellence of our faculty and our students, and the strong support of our medical school. This degree is a great fit for us.”

Timothy Daaleman, professor and vice chair of the Department of Family Medicine, has signed on as medical director, and the search for a program director is under way. With the BCBSNC gift, the processes of hiring faculty and writing a curriculum can keep moving.

Cairns said the announcement of the PA program was personally satisfying because it shows how far things have come since that 2009 meeting.

“I’m proud of the partnership with BCBSNC and UNC’s synergy with the very best in our armed forces,” he said. “UNC has shown it is a leader by putting something like this together.”