1. MEDEX Northwest Briefing For the Department of Family Medicine
Terry Scott, MPA, PA-C
Director
MEDEX Northwest UWSOM
September 2011
The MEDEX PA program was founded in the late 1960’s to meet the needs in society for primary care providers. At the time their was a shortage of primary care physicians that was only expected to get worse due to the expected retirement of a large portion of the current workforce.

2. “Physician Assistants were created BY Physicians FOR Physicians.”
Richard Smith, MD
Founder, MEDEX Northwest
Richard Smith: In 1968 he relocated to the University of Washington to create the first MEDEX program in the country. In doing so, Dr. Smith joined Dr. Eugene Stead, Jr. at Duke University and Dr. Hu Myers at Alderson Broadus College as one of the early pioneers introducing a new health care provider - the Physician Assistant - into the American Health Care System. However, Dr. Smith's approach was to develop more than a training program. Using a systems approach, he set out in 1968 to create a collaborative model for health care change to accompany supportive enabling environments at the local community, state and national levels. Along with others, he successfully demonstrated on a significant scale that the physician assistant profession could be developed, flourish and make needed contributions to an ailing health care system.

3. Founders of the PA Profession
Dr. Stead is recognized as the founder of the PA profession. Dr. Stead began to formulate his two-year curriculum to expand the prior education and experience of these corpsmen to become competent physician assistants. With the support of the Duke faculty and administration, he launched the first formal educational program for physician assistants at Duke University in For the next seven years, Duke University and later the University of Washington (Dr. Richard Smith's MEDEX program) became focal points for the development of the physician assistant profession.
As Professor of Pediatrics, Henry K. Silver, MD joined Loretta C. Ford, EdD, Professor and Chair of Public Health Nursing, to begin the first pediatric nurse practitioner (PNP) training program in the USA. The program opened in 1965 at the University of Colorado's Schools of Medicine and Nursing with Susan G. Stearly, MS enrolled as the first student. In 1968, Dr. Silver launched the Child Health Associate Program at the University of Colorado Medical Center. Individuals with 2-3 years of college education enrolled in the 3-year training program to become physician assistants (PA) to provide primary health care services to children.
John Kirklin: The founder of the nation’s first formal educational program to train surgeon assistants at the University of Alabama at Birmingham . His concept of training surgeon assistants as a new type of physician assistant in the late 1960s was based upon his contention that physicians were maldistributed by region and by specialty, even if there were no actual shortage of them. He believed that physicians were over-trained in many respects for tasks they performed and envisioned qualified assistants, properly trained and supervised, performing some of the more routine tasks traditionally performed by physicians.
Dr. Hu C. Myers established the first baccalaureate degree program for Physician Assistants (PAs) at Alderson-Broaddus College in Philippi, WV in Besides being a surgeon of the highest caliber, Dr. Myers lead the Myers Clinic Hospital, held state related offices, and developed nursing and allied health education programs at Alderson-Broaddus College.
Richard Smith: In 1968 he relocated to the University of Washington to create the first MEDEX program in the country. In doing so, Dr. Smith joined Dr. Eugene Stead, Jr. at Duke University and Dr. Hu Myers at Alderson Broadus College as one of the early pioneers introducing a new health care provider - the Physician Assistant - into the American Health Care System. However, Dr. Smith's approach was to develop more than a training program. Using a systems approach, he set out in 1968 to create a collaborative model for health care change to accompany supportive enabling environments at the local community, state and national levels. Along with others, he successfully demonstrated on a significant scale that the physician assistant profession could be developed, flourish and make needed contributions to an ailing health care system.

4. The MEDEX Reputation - Then
Early Leadership – Dick Smith, David Lawrence, Robert Harmon, Andrew Penman
Primary Care Models
Strong links with physicians/physician organizations
Diversity
Early Legislation
Supreme Court Decision
MEDEX has a rich tradition of being and incubator for leadership, locally and nationally.
Dr. Lawrence is former CEO and Chairman of the Boards of Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, retiring in Lawrence began his career with Kaiser Permanente with the Northwest Permanente Medical Group in 1981, and held the positions of CEO and Chairman since He currently serves on the Boards of Agilent Technologies, Pacific Gas and Electric Corporation, Raffles Medical Group of Singapore, McKesson Corporation, and the RAND Health Advisory Board, among others. He also serves in advisory roles to the biotechnology industry. Prior to joining Kaiser Permanente, Lawrence worked in academic medicine, public health, and international health. He is board certified in general preventive medicine, attended the Advanced Management Program at Harvard, and is a member of the Alpha Omega Alpha Society and the Institute of Medicine. Lawrence earned his MD at the University of Kentucky and his MPH at the University of Washington.
Robert Harmon became HRSA administrator (Health Resources and Services Administration).
Andrew Penman: A Graduate of the University of Queensland Medical School, Dr Andrew Penman subsequently pursued training in internal medicine and public health in the US. Between 1978 and 1982, as Director of the MEDEX program at the University of Washington in Seattle, his major interests were in the development and training of physician assistants and nurse practitioners and in health services research. During this period he acted as a consultant to US AID and the World Health Organization on primary health care development projects.
1978 Washington State Supreme Court upheld the authority of PA’s to prescribe medications after it was challenged in a suit from the State Nursing Association.

5. MEDEX Class 1
All male with prior military experience in Vietnam.

6. The MEDEX Reputation - Now
National PA Leadership
Publication: Physician Assistant: A Guide To Clinical Practice
Regional Program – Decentralized Training
Continued Primary Care Focus
Educational Innovation
Health Workers – Dental Therapists
International PA Development
MEDEX continues to provide leadership in the realm of Physician Assistants.

7. Seattle Class 43

8. MEDEX History 1969 - 1970 - School of Medicine
School of Public Health
Present - School of Medicine
We originally started in the School of Medicine

9. Mission Statement
MEDEX Northwest, the University of Washington School of Medicine's Physician Assistant Program, is committed to educating experienced health personnel from diverse backgrounds to practice medicine with physician supervision. The program provides a broad, competency-based curriculum that focuses on primary care with an emphasis on underserved populations. MEDEX encourages life-long learning to meet ever-changing health care needs. As a pioneer in PA education, MEDEX continues to be innovative in identifying, creating and filling new niches for PAs as a strategy for expanding health care access.

10. STUDENTS
WWAMI State Breakdown of accepted students
25% of the MEDEX class entering in Summer 2010 are from outside the WWAMI region. Many of these students have ties to the region with prior military service, work experience or, family in the area. Several students have direct ties to the Native populations in the region and most stated they wanted to continue to work with rural and underserved populations.

11. STATISTICS FOR 2010 MEDEX CLASS
Total applicants 589 Total number of applicants interviewed 204 Total Offers Made 126 Number of students expected summer quarter 107 Master of Clinical Health Services Degree Option Seattle Class Students + 1 returning Spokane Class Students + 1 returning Bachelor of Clinical Health Service Degree Option Yakima Class Students + 4 possible returning Anchorage Class 2 19 Students + 1 possible returning Re-applicants to MEDEX Northwest 34 (31.7%) New Applicants 73 (68.3%) SEX AND AGE Median Age: Male Students (46.2%) 57 Female Students (53.8%) MILITARY EXPERIENCE 26 Students with Military Background (24%)

12. Statistics for 2010 MEDEX Class
Ethnic Background
American Indian/AK Native Am (1.9%)
African American (2.8%)
Caucasian (74%)
Asian / Other Asian (3.7%)
Mexican American/Chicano (9.3%)
No Answer (6.5%)
 The Five Most Common Patient Care Experiences among MEDEX Students
* Military Medic / Corpsman 26 students
* Emergency Medical Technologist 8 students
* Medical Assistant 8 students
* RN / LPN 8 students
* Paramedics 8 students

13. Selection Process Peace Corps Model A Full Day Experience
3 Group Interviews
Community-based Primary Care Interviewers

14. Graduate Data 1800 graduates
Prior to 1981: All graduates in primary care (20 students per class)
2011: % in primary care (100 students per class)

15. Curriculum Timeline
MEDEX PA training is 2 years long. The MEDEX curriculum time-line includes:
a. On-line Anatomy & Physiology —Spring Quarter
b. A&P laboratory and basic science review—Summer Quarter-Seattle
c. MEDEX Didactic training—Fall, Winter and Spring Quarters Didactic Sites
d. Masters Specific Coursework—Summer—Seattle and Online
e. Clinical Rotations: Fall, Winter, Spring, Summer—WWAMI region.

16. Didactic Sites Seattle – 40 Students [Master’s Degree]
Yakima – 20 Students [Bachelor’s Degree]
Spokane – 20 Students [Master’s Degree]
Anchorage – 20 Students [Bachelor’s Degree]

17. Clinical Rotations Family Medicine Preceptorship [4months]
In-patient Medicine [4 weeks]
Behavioral Medicine [4 weeks]
Emergency Medicine [4 weeks]
Underserved [4 weeks]
General Surgery [4 weeks]
Elective [4 weeks]

18. Licensing/NCCPA Certification

19. Salaries in Primary Care
Starting: $75,000 Average: $85,000

20. MONEY MAGAZINE RANKS PAS AS #2 IN "BEST JOBS"Terms:
Money Magazine lists PAs as the #2 "Best Job," the same rating it achieved in prior year's list. The magazine also calls the profession the #3 "hottest (fastest growing)" job. The article is also available on the CNNMoney.com website.

21. PAs in Primary Care MEDEX Graduates: 60% National: 36%
Washington: 42% (Emergency Medicine 11%)
Wyoming: 70%
Alaska: 65% (Emergency Medicine 9%)
Montana: 52% (Orthopedics 11%)
Oregon: 47% (Orthopedics 11%)

22. Fastest Growing Areas Northwest
Orthopedics
Emergency Medicine
Hospitalists

23. NPs and PAs

24. PA MD
This is typically hpw the three professions relate to each other in day to day practice. NP

25. MD – PA - NP Supervision NP MD PA
This is how they relate in term of supervision.

26. The MEDEX faculty/staff includes:
Seattle: Faculty: 16 FTE, Staff: 13 FTE
Yakima: Faculty 3 FTE, Staff 1 FTE
Spokane: Faculty: 3.5 FTE, Staff 1 FTE
Anchorage: Faculty: 3.5 FTE, Staff 1 FTE

27. Faculty Appointments:
All MEDEX faculty have regular faculty appointments in the Department of Family Medicine as of July 1, Ranks include Associate Professor, Assistant Professor, Senior Lecturer and Lecturer. MEDEX has its own representative in the Faculty Senate.

28. Faculty Leadership
4 Presidents of the Washington State Academy of Physician Assistants 1 President, Physician Assistant Education Association 1 Former AHEC Director 2 Members of the Accreditation Review Committee on Physician Assistants 1 Commissioner, National Commission on Certification of Physician Assistants 1 President, 1 Board Member, Society for Preservation of PA History 1 Board Member, Veteran’s Caucus of the AAPA 1 Member of the Pew Commission on Health Professions Education 1 Member of the National Health Services Corps Advisory Committee 1 Member HRSA’s Title 7 Advisory Committee 1 Deputy Mayor/City Councilman City of Shoreline WA

29. Scholarly Activity Health Workforce Topics Veteran’s Roles as PAs
PA Program Specific Educational Issues
International Roles for PAs

30. MEDEX Fiscal Resources
Self-Sustaining tuition
State support for Yakima and Spokane sites
Federal Grants and Contracts
Contracts for specific initiatives
(e.g. Dental Health Therapists)

31. Current MEDEX Issues/Concerns
Clinical Sites
Implementation of New Master’s Degree
Succession Planning/Implementation

32. Other MEDEX Initiatives
In addition to direct PA educational activities the MEDEX Program also participates in a number of other projects and activities including consultations to health worker training programs internationally and the development of the Dental Health Therapist with the Alaska Native Tribal Health Consortium.

33. Questions/Discussion