NewsNewsOfficial Publication of the California Academy of Physician AssistantsOfficial Publication of the California Academy of Physician Assistants

March/April 2012

A Head’s Up on New Lawsby Beth Grivett, PA-C, Legislative Affairs Committee Chair

The Magazine\

D aniel Seeman, Legislative Aide to California Senator Fran Pavley received CAPA recognition as Legislative Staff

Person of the Year. This special award was given for Daniel’s unwavering support of the physician assistant profession and his commit-ment to the betterment of health care for our patients. CAPA Legislative Affairs Chair, Beth Grivett, PA-C presented the award at CAPA at Napa Conference on February 25, 2012.

In 2011, new laws passed which may af-fect your practice. Remember it is your responsibility, as a licensed professional

in California, to be aware of new State laws, as well as existing laws. Although some laws do not affect your license specifically, they can affect your patients and what you can do for them. And, some laws are important to be aware of since your patients may be unaware and may need to be educated about how a new law affects them or their health plan coverage.

The last edition of the CAPA News high-lighted the CAPA sponsored legislation regarding PAs working in ERs or consulting in the ER – please refer to the Nov/Dec edition if you missed it. Past issues are ac-cessible to members on the CAPA website http://www.capanet.org/publications.aspx.

Please familiarize yourself with the following new laws which may affect you this year. I have provided the links from the California

Legislative Staff Person of the Year

State website to the actual bill language for clarification as needed:

Consent for Preventive Treatment – AB 499 (Atkins) allows for children 12 and older to receive the Human Papillomavirus Vaccine or other medical care related to the prevention of a sexually transmitted infection, without a parent’s consent. Much like the laws which protect a health care provider when treating an adolescent for pregnancy or sexual transmitted infections, this law allows a health care provider to order and administer the vaccine for HPV on the request of a consenting adolescent.http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_0451-0500/ab_499_bill_20111009_chaptered.pdf

Sales of Dextromethorphan (DXM) – SB 514 (Simitian) prohibits the sale of any substance containing dextromethorphan (the dextrorotatory isomer of 3-methoxy-N-methylmorphinan, including its salts, but

not including its racemic or levorotatory forms) to a person under 18 years of age in an over-the-counter sale without a prescription. http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0501-0550/sb_514_bill_20110831_chaptered.pdf

Independent Contractors – SB 459 (Corbett) requires new fines for businesses that misclassify employees as independent contractors. If you are currently being paid as an independent contractor, rather than an employee, this is a good time to reconsider whether your agreement meets the criteria as an independent contractor, as defined by the State’s Labor and Workforce Development Agency. CAPA General Counsel, Mike Scarano has written an article which is avail-able to members on the CAPA website at www.capanet.org/PA-Laws_Regs/pas-as- independent-contractors. http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0451-0500/sb_459_bill_20111009_chaptered.pdf

Booster Seats – SB 929 (Evans) requires a child to remain in a booster car seat until they turn eight years old or reach at least 4’ 9”.http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0901-0950/sb_929_bill_20111004_chaptered.pdf

Insurance Mandates – SB 222 (Evans) requires health plans to provide maternity coverage through individual plans. AB 210 (R. Hernandez) is a similar bill per-taining to group health insurance policies. SB 946 (Steinberg) requires health plans to cover behavioral health treatment for

Continued on page 2

2 CAPA NEWS

Editor

Gaye Breyman, CAE

Managing Editor

Denise Werner

Proofreaders

Kimberly Dickerson

Editorial Board

Eric Glassman, MHS, PA-CBeth Grivett, PA-CBob Miller, PA-CLarry Rosen, PA-CMichael Scarano, Jr., Esq.

CAPA Board Of Directors

President

Eric Glassman, MHS, PA-Cpresident@capanet.org

President Elect

Adam Marks, MPA, PA-Cpresidentelect@capanet.org

Vice President

Jeremy A. Adler, MS, PA-Cvicepresident@capanet.org

Secretary

Cherri Penne-Myers, PA-C, MSCSsecretary@capanet.org

Treasurer

Bob Miller, PA-Ctreasurer@capanet.org

Directors-At-Large

Margaret Allen, PA-Cdirmargaret@capanet.org

Roy Guizado, MS, PA-Cdirroy@capanet.org

Greg Mennie, PA-C, MSeddirgreg@capanet.org

Larry Rosen, PA-Cdirlarry@capanet.org

Student Representative

Joy Dugan, PA-Sstudentrep@capanet.org

The CAPA News is the official publication of the California Academy of Physician Assistants. This publication is devoted to informing physician assistants to enable them to better serve the public health and welfare. The publisher assumes no responsibility for unsolicited material. Letters to the editor are encouraged; the publisher reserves the right to publish, in whole or in part, all letters received. Byline articles express the opinion of the author and do not necessarily reflect the views or policies of the California Academy of Physician Assistants.

The CAPA office is located at:3100 W. Warner Ave., Suite 3Santa Ana, CA 92704-5331Office: (714) 427-0321Fax: (714) 427-0324Email: CAPA@capanet.orgInternet: www.capanet.org©2012 California Academy of Physician Assistants

NewsNews At The Table

Top Left: Michael De Rosa, MPH, Ph.D., PA-C, and Scott Clark, MPA, Research Associate at the CMA; discuss PA regulations relating to PA preceptors at the February 6, 2012 meeting of the Physician Assistant Committee in Sacramento.

Top Right: Julie Theriault, PA-C; Colleen Wight, PA-C and Ed Arias, PA-C attended a Californians for Patient Protection (CAPP) fundraiser for California State Assemblymember Joan Buchanan in Sacramento on February 6, 2012.

Bottom Left: Brian Costello, PA-C, attended a CAPP fundraiser for California State Assemblymember Susan Bonilla in Sacramento on December 5, 2011.

pervasive developmental disorder or autism. http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0201-0250/sb_222_bill_20111006_chaptered.pdf, http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_0201-0250/ab_210_bill_20111006_chaptered.pdf, http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0901-0950/sb_946_bill_20111009_chaptered.pdf

A Head’s Up on New LawsContinued from page 1

CAPA Ships Over 50,000 Prescription Drug Discount Cards to CAPA Members!

The response from CAPA members has been fantastic. The NeedyMeds* cards are helping patients! CAPA launched a prescription drug discount card that helps

Californians lower the costs of their medications. The dis-count card is free and can be used by all California families to save up to 80% off the cost of prescription medications. Contact CAPA if you would like NeedyMeds cards sent to your office, (714) 427-0321 or email at capa@capanet.org.

*This is not an insurance program.

MARCH/APRIL 2012 3

At the Table .........................................................................2

CAPA Ships Over 50,000 Prescription Drug Discount Cards to CAPA Members! ...............................................................2

Renew Your CAPA Membership Today ...................................3

Defining Essential Benefits ...................................................4

Congratulations to Dr. Middleton ..........................................5

Did You Know? ....................................................................6

Where Do You Fit? CAPA Needs You! .....................................8

Controlled Substances Education Course ................................9

Get Registered with the CURES Program .............................10

Stay Connected with CAPA ..................................................12

Burnout! ...........................................................................13

PAs Caring for the Underserved: Day Workers and Occupational Health ................................14

CAPA at Napa 2012 ...........................................................15

CAPA PAC Activities at the CAPA at Napa Conference ............15

Good Marks For Monterey, A Win-Win For CAPA ..................16

Heard Any Great Speakers Lately? .....................................17

Tips for Communicating With a Patient from Another Culture .................................................................18

NCCPA Awards First Certificates of Added Qualifications .......19

Q & A With National Health Service Corps PAs .....................20

Congratulations to the 2012 CAPA Scholarship Winners!!!....21

USC PA Toy Drive Benefits Children’s Hospital LA! ................21

Keck School of Medicine of USC PA Program Director Attends Joining Forces Initiative Events ...............................22

USC PA Program White Coat Ceremony ...............................22

Touro PA Program White Coat Ceremony.............................22

Welcome New Members .....................................................23

Local Groups......................................................................23

Inside This Issue

Renew Your CAPA Membership Today! Renew Online at www.capanet.orgThere are many reasons to support CAPA. The number one reason for most is that you have a desire to see things change for PAs in California. Change for the better! CAPA is here to promote and protect California PAs. Remember, there are those who want to change things to limit PAs’ ability to practice. Each and every day we are your eyes and ears. We have a dream team working to make PA practice here in California better for you. Your membership dues are what makes this possible.

It is surprising that many PAs don’t realize that our operational budget is funded by dues dollars. Without membership dues, we don’t exist. The more members we have, the greater our ability to serve your needs. We need every member to renew and we need your non-member colleagues to join and pay their fair share. Together we are stronger!! Our numbers and our strength must continually grow.

Growth (strength) can’t happen with intermittent membership as issues arise. We need every PA in the state to be a member each and every year.

Remember — Momentum Is Key To Our SuccessWe Need Your Support Year After Year

Your Dues Dollars At Work:Thank you for being there to make the day-to-day operation of CAPA possible. Because of you and dedicated PAs like you, we are able to keep:

• CAPA’s wonderful staff to answer your questions and take care of your needs.• CAPA’s amazing legal counsel, Mike Scarano, watching out for your interests.• CAPA’s exceptional Public Policy Director, Teresa Anderson, working for you every day in Sacramento. • CAPA’s phones on, our magazine published, our website up, etc., etc.

4 CAPA NEWS

O ne of the fundamental goals of health care reform is to cre-ate a comprehensive benefits

package, known as essential health benefits (EHB), that ensures access to quality affordable health care for all American citizens and legal residents. Beginning January 1, 2014 all non-grandfathered insurance plans in the individual and small group markets, Medicaid benchmark, Benchmark-equivalent and Basic Health Plans

will be required to cover, at the very least, EHB. The Affordable Care Act mandates ten general categories that must be covered in EHB and they must be considered equal in scope to benefits provided by a typi-cal employer plan. It further directs the U.S. Department of Health and Human Services (HHS) to

define the services covered within those ten categories. The mandated categories include:

A) Ambulatory patient servicesB) Emergency servicesC) Hospitalization D) Maternity and newborn careE) Mental health and substance

use disorder services, including behavioral health treatment

F) Prescription drugs G) Rehabilitative and habilita-

tive services and devices H) Laboratory servicesI) Preventive and wellness

services and chronic disease management

J) Pediatric services, including oral and vision care

As the process of defining EHB began much of the conversation

revolved around what a typical em-ployer plan covered, both in terms of scope of benefits and actuarial value. Several resources were used to guide this discussion including a Department of Labor (DOL) Report, Institute of Medicine (IOM) Report and stakeholder input. HHS request-ed the IOM recommend a process that would help define EHB as well as a process for updating benefits as advances in science, gaps in access, and cost variances are identified.

The IOM recommendations were submitted in a report entitled Essential Health Benefits: Balancing Coverage and Cost. The report re-sulted in several recommendations:

1) EHB should reflect plans in the small employer market

2) EHB should be guided by a national premium target (simply stated a premium based on a national average of small employer plans) and adjusted annually based on medical inflation

3) Development of a framework for updating EHB and by 2015 updates should include benefits that are evidence-based, specific, and value promoting

4) Flexibility across States as long as the plans were actu-arially equivalent

5) Establishment of a non-partisan National Benefits Advisory Council

Stakeholder input came following the release of the IOM Report in a series of listening sessions with HHS representatives. Stakeholders were asked to consider several is-sues throughout these sessions that included: balancing the goals of com-prehensive coverage with affordability, balance among mandated categories,

Defining Essential Benefitsby Teresa Anderson, MPH, Public Policy Director

preventing discrimination against individuals based on age, disability status and expected length of life, cri-teria for updating EHB, uniformity of EHB, state flexibility options, and needs of diverse populations. Some of the IOM recommendations drew criticism from a variety of consumer groups as well as some provider groups as they felt the IOM em-phasized cost over a comprehensive benefits package. Critics also felt that there was not enough specific direc-tion or detail in guidance on defining benefits within each category.

On December 16, 2011 HHS pub-lished an Essential Health Benefits Bulletin to provide information and solicit comments on the regula-tory approach they plan to propose to define EHB. It should be noted that for the purpose of this bulletin, established under section 1302(b)(4) of the Affordable Care Act, the Secretary is directed to establish an appropriate balance between catego-ries, therefore plan cost-sharing and actuarial value will be addressed in a future bulletin. The findings pre-sented in this bulletin indicated that small group plans did not differ sig-nificantly in what they cover however they did differ in cost-sharing provi-sions. The most reported variations in coverage included: preventive and basic dental, acupuncture, bariatric surgery, hearing aids, smoking cessa-tion programs, and medications.

HHS has stated their intended regu-latory approach is to follow recom-mendations put forth in the IOM report. They intend to incorporate plans and benefit coverage typically found in the small group market, define EHB using a benchmark ap-proach, allow for state flexibility, and propose a process to evaluate the benchmark approach. The bench-mark approach means using the

The Affordable Care Act mandates ten general categories that must be covered in EHB and they must be considered equal in scope to benefits provided by a typical employer plan.

MARCH/APRIL 2012 5

Defining Essential Benefitsby Teresa Anderson, MPH, Public Policy Director

Congratulations to Dr. Middletonby Bob Miller, PA-C, Treasurer and Professional Practice Committee Chair

state’s largest small group plan based on enrollment, the largest private market HMO or one of the three largest plans covering state or federal employees in the state as a reference plan. HHS further intends that if a benchmark is missing any of the mandated categories the state must supplement the missing category us-ing benefits from another benchmark option using the largest plan in that benchmark type.

What does the process of defining essential health benefits mean to CAPA and PAs in California? We are actively engaged in the stakeholder process as several CAPA members and staff formed a workgroup in September 2011 to begin tracking the process of defining EHB. In November 2011, we attended and gave public comment at the HHS listening session on EHB. As we fol-low the process we seek to ensure and

advocate for balanced coverage across all categories of EHB, increase access to high-quality care, and benchmark plans in California that allow PAs to work at the top of their license. We will submit comments on the most recent pre-rule bulletin, as HHS is seeking guidance on defining habili-tative services, an approach that allows plans to define pediatric oral and vision

services, and input on substitutions across benefit categories. Though many in the health policy realm assumed we would see a Notice of Final Rulemaking sooner rather than later, we are glad to see HHS seeking further guidance and clarification on such critical issues. We are eager to see what the Final Notice will bring!

I t was a beau-tiful day on November

27th at the Mission Inn Hotel and Spa in Riverside when col-leagues, friends, students, and

family gathered to honor Dr. Dolores Middleton. Having known Dolores for many, many years, I was happy to be a part of this surprise celebra-tion in honor of her retirement. The famous Mission Inn provided the perfect surroundings to offer our

congratulations for all that she has done for the physician assistant pro-fession here in California.

A large gathering was present to honor her career achievements and contributions to the PA profession and her tireless dedication and com-mitment to excellence in education. She has had a richly positive impact in the lives of so many spanning over 30 years. Since 1999, Dr. Middleton has served as Program Director for the Riverside Physician Assistant Program located in Moreno Valley, California and had spent earlier years at the USC PA Program. Over several

years, I’ve had the opportunity to lecture at her program. One particu-lar pleasure was stopping in to see Dolores – with her smile that lights up a room – as you see in the photo. In her honor, CAPA made a dona-tion to the Dr. Dolores E. Middleton Scholarship Fund, which was estab-lished to support physician assistant students who possess a commitment to helping the medically underserved community.

We wish her well as she enters a well deserved retirement.

Bob Miller, PA-C presenting Dr. Dolores Middleton with CAPA donation to her scholarship fund.

CAPA FACTDid You Know?We have not raised CAPA membership dues since 2006!

6 CAPA NEWS

factors or family history of dyslipidemia.

When I first read this new cholesterol screen-ing recommendation, I was a bit apprehensive in checking all children for a potential problem that perhaps, if at all, would not have a con-sequence for another 50 years. Initially I had more questions and concerns. What should a provider do with

the normal results when there’s 50+ more years to be concerned? If the results are abnormal will this create problems with health and life insur-ance coverage now or in the future? Will a parent or child be left thinking they will have heart problems? After my initial concerns, I began to see a much larger benefit for patients and providers, as (in my humble opinion) this new recommendation is a firm signal to move from reactive medi-cine to real, preventive, and protec-tive medicine. Certainly, it seems if one knew early on that there were significant cholesterol issues (contro-versies aside), having that informa-tion with appropriate counseling and oversight may be enough for a parent to move towards a different and per-haps healthier set of environmental choices for their child.

Did You Know?by Greg Mennie, PA-C, MSed, Director-At-Large

In 1992 the American Academy of Pediatrics (AAP) recommended that providers screen cholesterol

in children ages 2 - 10 years of age with a family history of high cholesterol and heart disease, or any child who did not know their family history. Recently, the AAP has enhanced its recommendation.

I would imagine most of us have never seen a child have an MI because of plaque rupture from high cholesterol. Since risk factors for the plaque development have

been shown to begin in childhood and get worse with time, it makes sense to consider screening and offer an intervention earlier to reduce that risk. In November 2011, The Journal of Pediatrics (online) published new pediatric cholesterol screening guidelines developed by the National Heart, Lung, and Blood Institute (NHLBI) and endorsed by the AAP1. These new guidelines are quite exten-sive and include cholesterol screening even for those patients without risk

The chair of the expert panel that reviewed the guidelines, Stephen R. Daniels, MD, PhD, FAAP, noted that by working with families, we can keep kids at a lower lifetime risk and prevent more serious problems in adulthood. Perhaps the most sig-nificant change, and possibly most controversial for some providers, is the recommendation to perform a one time cholesterol screen on all children between the ages of 9 and 11 and then again between ages 17 and 21. A non-HDL screen is recommended to avoid the need to fast, and if abnormal (Table 1), a fasting lipid profile should be or-dered. Its anticipated that abnormal tests would only require counseling and environmental modifiers, as the panel notes only less than 1% of children would actually need medication in lieu of environmental and health lifestyle modifications alone. The new guidelines have an Integrated Cardiovascular Health Schedule as well as Evidence-Based Activities such as counseling to pro-tect the child from tobacco smoke, encouragement and review of regular physical activity, as well as other ways to prevent the development of cardiovascular risk factors and opti-mize cardiovascular health including continued emphasis of breastfeeding for at least the first six months of life and a low saturated fat intake start-ing at the age of one.

Table 1

American Heart Association Cholesterol Levels in Children Ages 2-19 Years of AgeTotal cholesterol (mg/dL) LDL cholesterol (mg/dL)Acceptable — less than 170 Acceptable — less than 110Borderline — 170-199 Borderline — 110-129High — 200 or greater High — 130 or greater

…possibly most controversial

for some providers, is the

recommendation to perform

a one time cholesterol screen

on all children between the

ages of 9 and 11 and then

again between ages 17 and 21.

MARCH/APRIL 2012 7

Did You Know?by Greg Mennie, PA-C, MSed, Director-At-Large

Connect your patient with the right therapist.

Sponsored by the California Association of Marriage and Family Therapists

To receive free patient information about

CounselingCalifornia.com, call (888) 892-2638.

Change will always beget controversy and concern. I remember cholesterol high, fat high, sugar ladened faire throughout my entire childhood. Gone are the days of Saturday morn-ing cartoons with a box of chocolate, marshmallow, sugar filled cereal. No longer do we dine on triple ham-burgers, chili dogs, and pizza at little league, soccer practice, and school. Replacing these dangerous (but delicious) eating behaviors are the balanced school meals, nutrition labels, and gourmet salads in dispos-able picnic-esque boxes for weekend kids soccer or baseball games. Out is the pyramid and in is the plate2. Some of us may miss the nostalgia

of our childhood meals, but the payoff of being proactive in our fight against disease is just another posi-tive step-forward towards a healthier population.

References:1. Kavey R-EW, et al Expert panel

on integrated guidelines for cardiovascular health and risk reduction in children and adoles-cents: Summary report Pediatrics 2011; 128: DOI:10.1542/peds.2009-2107C.

2. http://www.choosemyplate.gov An online PDF version of the new guidelines is available at

http://pediatrics.aappublications.org/site/misc/2009-2107.pdf

California Academy of Physician Assistants

3100 W. Warner Ave., Suite 3

Santa Ana, CA 92704-5331

PRESORTED

FIRST CLASS

U.S. POSTAGE

PAID

SANTA ANA, CA

PERMIT NO. 949

BALLOT

ENCLO

SED

CAPA Member

1234 Main St., #3

Anywhere, CA 90000

VOTE IN THE CAPA ELECTION – YOUR VOTE COUNTS

VOTE IN THE CAPA ELECTION – YOUR VOTE COUNTS BALLOTS MUST BE RECEIVED BY CAPA BY MAY 3, 2012

8 CAPA NEWS

Where Do You Fit? CAPA Needs You!by Roy Guizado, MS, PA-C, Director-At-Large and Student Affairs Chair

and Napa. The committee is also charged with ongoing evaluation of the CME needs of CAPA members. The committee is dedicated to ensure that CAPA’s relationships with phar-maceutical companies promote the highest ethical standard.

The Diversity Committee addresses the needs and special interests of minor-ity PAs and students. The aim of the committee is to promote a diverse representation and leadership within the physician assistant profession and CAPA. The committee wants to fa-cilitate an awareness of cultural di-versity issues among practicing physi-cian assistants and physician assistant students. The Diversity Committee and the Public Relations Committee share a common interest of promot-ing public awareness of the physician assistant profession.

The PA Programs Relation Committee serves as a liaison to the California PA programs. The committee de-velops areas of common interests between PA Programs and CAPA through meetings. The committee enables faculty development activities regarding CAPA resources for stu-dents, recent graduates, and faculty.

The Professional Practice Committee serves to monitor trends in PA prac-tice. The committee identifies general concerns affecting the professional practice of PAs such as issues regard-ing reimbursement, credentialing, scope of practice, and the application of laws and regulations regarding PA practice. The committee provides education to all PA stake-holders to promote compliance with laws, regu-lations, and policies.

The Student Affairs Committee coordi-nates the CAPA Scholarship program and maintains an alliance with California PA student organizations.

As I write this article, CAPA is holding its general election for the CAPA Board of Directors

and Delegates to the AAPA HOD. These are elected positions. You, the CAPA members vote to elect the members of the board who will guide the course of CAPA over the next 12 months and beyond. In addition to the CAPA Board, there are CAPA Committees whose work is directed by the Board of Directors. These are all volunteer positions. The spirit of volunteerism is an important aspect of our professional and personal lives. Opportunities within and outside of the PA profession to volunteer one’s special talents and time for a worth-while cause are readily available.

CAPA provides leadership service op-portunities, and for those not inclined toward leadership, there are also other volunteer opportunities. CAPA spon-sors nine committees to help the elect-ed leadership and all nine committees are populated by volunteers.

The Nominating Committee serves to identify and encourage new leaders in CAPA. The aims of the commit-tee are to encourage CAPA member participation in leadership activities. The committee also provides op-portunities to develop leadership in CAPA members. The last duty of the Nominating Committee is to ensure the integrity of the annual election process for the CAPA Board of Directors and AAPA House of Delegates.

The Legislative Affairs Committee serves to monitor the legislation which governs the PA profession. The aims of the committee include monitoring of legislation and regulatory change and formulating recommended actions to the Board of Directors who direct CAPA’s legislative efforts. Another important duty is to educate

legislators, their staff, and other government workers about PAs. The committee is dedicated to establish-ing and nurturing liaisons with other health care professional organizations throughout the State.

The Political Action Committee (CAPA PAC) is responsible for identifying appropriate recipients of the com-mittee’s contributions. The CAPA PAC facilitates support for California State legislators who are advocates of the physician assistant profession and good health care policy. The com-mittee is dedicated to encourage indi-vidual PAs to be active in public pol-icy issues. Another aim of the CAPA PAC is to raise funds for support of candidates who support CAPA’s goals for quality and cost-effective health care for Californians.

The Public Relations Committee helps PArtners in Medicine share the profession through contacts with various professionals, community service organizations, and the public. While the aim of the committee is to promote the physician assistant profession in California, they want to insure a coherent and consistent message to media services interested in health care. The committee creates projects and events which support physician/physician assistant team practice. To strengthen the PA pro-fession’s relationship with physicians, the committee seeks out and devel-ops conduits of communication with California physician communities.

The Continuing Medical Education Committee develops CME oppor-tunities for PAs in California and provides non-dues revenue for the operating expenses of CAPA. The committee works with CAPA staff to develop and organize CAPA spon-sored conferences, which include the conferences held in Palm Springs

MARCH/APRIL 2012 9

Where Do You Fit? CAPA Needs You!by Roy Guizado, MS, PA-C, Director-At-Large and Student Affairs Chair

The committee seeks to encourage student activity within CAPA and to provide CAPA with student-related issues. The committee reviews ap-plicants and determines recipients of various student scholarships.

All are invited to participate on a committee. To get more information about the committees or how to join, please contact us at the following CAPA link: http://www.capanet.org/about_capa_leadership.aspx. Most committees’ term of service is July 1 through June 30.

There are volunteer activities outside of CAPA that contribute to the ongo-ing development of the PA profession. One area of volunteerism that is in high demand is being a student pre-ceptor. The number of applications for each PA program is increasing every year. There are about 150 PA pro-grams in the United States and that number will keep growing in order to provide an adequate number of PAs

needed for future health care. New preceptors are essential to assist the educational process of future PAs.

If you are already a practicing PA, speak with your supervising physi-cian to allow a PA student to com-plete a clinical rotation at your site. As preceptors, you and your supervis-ing physician can precept as many students in a year as you feel com-fortable. Some preceptors will only educate four students per year, while others educate more or less students. Contact any of the PA Programs to find out how to become a preceptor.

If you are a new graduate seeking employment, consider adding a Preceptor Clause in your contract. The clause will stipulate when and how many students you and your supervising physician are willing to accept. A typical clause will state that after one year of practice at a site (the time frame is variable), up to three students (the number of students is

variable) will be provided with clini-cal rotations. Precepting is a reward-ing volunteer service that is appreci-ated and needed.

There are volunteer opportunities that contribute to one’s personal development, outside of the PA profession. These types of oppor-tunities can be found in formal organizations such as Habitat for Humanity, Meals-on-Wheels, the Salvation Army, etc. Other volunteer opportunities are less formal, such as helping out at a local school, reading to children in a library, or visiting a senior center. All these volunteer ex-periences are worthwhile to you and to those you help.

Volunteering appeals to our basic humanistic feelings that we have ex-perienced as health care professionals. Please consider what volunteer oppor-tunities suit you and start them. Help yourself by volunteering for others.

Controlled Substances Education CourseA Course Which Upon Successful Completion Will Allow You To Write

For Controlled Substances Without Patient Specific Approval*

*California Code of Regulations Sections: 1399.541(h), 1399.610 and 1399.612. A PA may administer, provide, or issue a drug order for Schedule II through V controlled substances without patient specific approval if the PA completes specified educational requirements and if his/her Supervising Physician delegates the authority to them.

6 Hours

Cat. ICME

Courses will be canceled if minimum number of registrants is not met.

Saturday, April 28, 2012University of Southern California

Health Sciences CampusMayer Auditorium, Keith Admin. Bldg.

1975 Zonal AveLos Angeles, CA 90089

Saturday, August 25, 2012Samuel Merritt UniversityFontaine Auditorium,

Health Education Center450 30th St

Oakland, CA 94609

Wednesday, October 3, 2012Renaissance Palms Springs

(prior to the Annual CAPA Conference) 888 Tahquitz Canyon WayPalm Springs, CA 92262

10 CAPA NEWS

I t is not a secret that controlled substances are provided to pa-tients for pain and other condi-

tions more often than ever before. The Centers for Disease Control (CDC) published alarming data in the Morbidity and Mortality Weekly Report on November 1, 2011 regard-ing some of the harms coinciding with this increased trend. The report found that during 2007, nearly 100 persons died per day of prescription

drug overdoses in the United States. In the same report, the CDC also noted that in 2010, enough hydrocodone was pre-scribed to medicate every American adult with 5mg taken every 4 hours around the clock for a month. Despite the rising problems, a legiti-mate medical need for these medications continues to exist.

Many health care providers are surprised to learn that govern-mental data from the Substance Abuse and Mental Health Services Administration (2005) reports that only 17% of people using prescrip-tion opioids for nonmedical pur-pose, received them as a prescription from a single doctor. This means the majority of nonmedical use occurs through drug diversion or doctor shopping. Drug diversion is when a drug leaves legitimate medical practice. Examples of drug diversion could include: a patient giving away or selling their medication, hav-ing someone take their medication because they left it in a non-secure location (i.e. medicine cabinet), or through theft from a pharmacy. Doctor shopping is when a person deceptively visits several prescribers

in order to obtain a large quantity of prescription drugs. Doctor shopping is a serious crime. The California Health and Safety Code 11173(a) states: No person shall obtain or at-tempt to obtain controlled substanc-es, or procure or attempt to procure the administration of a prescription for controlled substances, by fraud, deceit, misrepresentation, or sub-terfuge; or by the concealment of a material fact.

Given the enormity of the public health crises with prescription drug overdoses, the CDC has made rec-ommendations to health care pro-viders that state-based prescription drug monitoring programs be refer-enced in order to help identify inap-propriate use by patients. California has the oldest prescription drug monitoring program in the country. The current system is electronic and is called the Controlled Substance Utilization Review and Evaluation System (CURES). The California Academy of Physician Assistants (CAPA) urges all Physician Assistants (PAs) to register and rou-tinely use the CURES database in the care of patients.

PAs in California are in a strong position to be leaders in navigating the balance between the appropriate and inappropriate use of controlled substances. Since the establishment of Assembly Bill 3 (AB 3) into law on January 1, 2008, PAs meeting certain requirements, have the abil-ity to provide controlled substances to patients without patient specific approval from their supervising physician. The requirements consist of taking an approved Controlled Substances Education Course, pass-ing a post-course exam, having the supervising physician delegate the service to the PA, and being properly licensed in California

and registered with the Drug Enforcement Administration. There are also ongoing supervising physi-cian requirements of chart co-sig-nature. Although AB 3 established this pathway for PAs regarding controlled substances, it is not re-quired for PAs to provide legitimate controlled substances to patients. The patient specific approval from their supervising physician pathway remains in effect for those PAs who do not take the course or meet the other requirements.

CAPA has been successful in pro-viding an approved Controlled Substances Education Course for its membership and other PAs. Since the first course in 2008, nearly half the practicing PAs in California have chosen to take the course and suc-cessfully meet the requirements of AB 3. Although other health care providers have had requirements for continuing medical education for pain management, such as Assembly Bill 487 for physicians, the course established by AB 3 is unique. There has not been any similar, large scale, content controlled, evidence based controlled substances educational program delivered to such a diverse group of health care providers.

The course focuses on controlled substance pharmacology, as well as proper patient selection and monitoring strategies. The content for the course is compiled from the best practice guidelines of the Medical Board of California and recent evidence-based guidelines from the American Pain Society and American Academy of Pain Medicine. One of the most impor-tant tools highlighted in the course, is the CURES database.

By educating California’s PAs with best practices and encouraging PAs

Get Registered with the CURES Programby Jeremy A. Adler, MS, PA-C, Vice President

Despite the powerful

information held within

the CURES database, many

health care providers are

not currently using this

resource.

MARCH/APRIL 2012 11

Get Registered with the CURES Programby Jeremy A. Adler, MS, PA-C, Vice President

to use tools like the CURES da-tabase, it is hopeful these PAs will become model clinicians on how to expertly manage controlled sub-stances in patients.

Despite the powerful information held within the CURES database, many health care providers are not currently using this resource. As prescribers, PAs are authorized for individual registration with the Department of Justice who oversees the CURES program. Information on registration can be found on the CURES website.

After registering, access to the CURES database is real-time on the Internet. The database is reported to contain over 100 million pre-scription drug entries of Schedule II-IV controlled substances. Despite this incredible resource, health care providers annually make only around 60,000 requests for the information. The information is provided to the health care provider in a report called a Patient Activity Report (PAR). The PAR lists all the California dispensed controlled substances, prescriber identification,

and pharmacy information. Up to the prior 12 months of data can be requested for an individual patient.

Please don’t put off registering with CURES another day. Identifying a doctor shopper may save a life. The combination of California’s PAs armed with the latest best practices

and routinely using the CURES database, will lead to better patient outcomes. Through thoughtful pa-tient selection and routine monitor-ing, controlled substances can be provided appropriately, and, at the same time, reduce our contribution to the public health crisis associated with prescription drug overdoses.

CAPA FACTDid You Know?That up until July 1, 2001 physicians who wanted to utilize a PA in their practice were required to complete an application to supervise physician assistants, submit a fee, and receive approval from the Medical Board of California. The effect of the change was that any California licensed physician, except those who are expressly prohibited by the Medical Board from supervising a PA, is able to supervise a PA. CAPA was a proponent of this change.

For more information (All accessed 3/27/2012):

CURES Database Information and Registration:http://ag.ca.gov/bne/cures.php

CDC Report:Morbidity and Mortality Weekly Report, November 1, 2011Vital Signs: Overdoses of Prescription Opioid Pain Relievers --- United States, 1999-2008http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w

SAMHSA Data:National Survey on Drug Use and Health: National Findings, 2005http://oas.samhsa.gov/nsduh/2k5nsduh/2k5results.htm

California Medical Board Guidelines:Guidelines for Prescribing Controlled Substances for Painhttp://www.mbc.ca.gov/pain_guidelines.html

APS/AAPM GuidelinesClinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Painhttp://www.jpain.org/article/S1526-5900(08)00831-6/abstract

12 CAPA NEWS

I am able to tell a lot about you right now if you are reading this article: 1) You are most likely a

PA; 2) You are a member of CAPA; 3) You are passionate about the PA profession and you would love to see this profession advance even further than it is today; and 4) If getting involved was just as easy as staying connected with CAPA and it would help tremendously, you would undoubtedly do it! I am hoping that you answered yes to all four of these questions. If not, hopefully by reading this article you will be motivated to stay connected with CAPA and work together as a team to advance the profession.

We all are busy. I don’t hear many people, especially PAs these days, say they are bored and wish they had more to do and less free time. We all have our jobs, sometimes even second or third jobs, we have our family and friends, we have our hobbies, we have our volunteer work, and we also need our down-time just to relax. In the midst of all this is CAPA, your State PA or-ganization. We work hard for your best interests to make sure that you still can go to work every day. We have staff working at the CAPA office in Santa Ana and also in Sacramento making sure our mem-bers are being taken care of, getting their questions answered, meeting with other health care stake hold-ers, and servicing our members in any way possible.

We also have CAPA volunteers. These are board members, commit-tee chairs, and committee members. In addition to our busy daily lives, we put in many hours to help all the PAs in California protect what we have now and create a better tomorrow for all of us. We are so fortunate to have these amazing individuals who give up their free time to help do the work of CAPA. Some of these tasks include plan-ning conferences, working with legislators, creating and tracking legislation, working with and rep-resenting all nine California PA programs and students, working with and representing the under-served, and working to spread the word about our profession. We currently have more than 40 vol-unteers working hard every day on your behalf. Thank you to all of you who donate your time and your tremendous passion for CAPA and our profession.

Many of you have not worked directly with or volunteered with CAPA, which is understandable and totally fine. But, I do ask sever-al things. At a minimum become or remain a CAPA member. Secondly, make sure your PA colleagues are aware of CAPA, the benefits of being a CAPA member, and how important it is to maintain CAPA membership. Lastly, and perhaps most importantly, stay connected with us. Know what is going on with your State PA organization,

read the CAPA News for updates (which by this point I know you are and this is a great start), and check the CAPA website. We have a great website with continually updated information to keep you informed about the profession and CAPA. If you don’t have it memo-rized already or haven’t visited for a while, go to www.capanet.org and bookmark the CAPA website as one of your favorites. CAPA also has a YouTube page and a Facebook page. If you haven’t looked us up on Facebook and liked us, there is no time like the present. Just search for California Academy of Physician Assistants and you will find our page. Like it and follow us. This will ensure that you are staying up-to-date and see what is being done on your behalf.

So hopefully, you are able to answer yes to the four statements above. We need your support in so many ways and you can only know how much by staying in the CAPA loop. Make sure to check out the CAPA website, join our Facebook Fan Page and check out our YouTube link. That way, you can know what is going on and how you can help. Most of all, thank you for being a member of CAPA and offering your continued support. Without our members we could not accomplish anything! Thank you again!

Stay Connected with CAPAby Eric Glassman, MHS, PA-C, President

Find us on:

MARCH/APRIL 2012 13

S ince starting my training as a PA I have found that those in the field are continually talking

about patient health and rightfully so, as our profession revolves around providing the best patient care in our specific clinical setting. Recently, I have found there is a lot of conversa-tion revolving around the health of those taking care of patients. Upon entering the profession, I continu-ally heard providers talk about pro-vider burnout or fatigue. Not well versed in the subject, I looked to the Internet for typical symptoms. Typically burnout has three classic characteristics: emotional exhaustion, loss of enthusiasm for work, and de-personalization or a tendency to treat people as objects. As a relatively new PA, I found this concept to be for-eign, I couldn’t imagine feeling that way. As a new grad, I was thrilled with each new patient interaction, stressed at times, but every day ended with fulfillment and each new day brought continuous excitement.

It was about six to eight months into my job that the long hours seeing patients and the overtime shifts start-ed to catch up with me; what was once an exciting daily experience had turned into monotonous work and, in essence, a chore. My first thought

well-being on all levels: physical, emotional, psychological, and spiri-tual. The board even established a Wellness Committee to further ad-dress the wellbeing of its licensees. I understand that every situation is different and this article is in no way a supplement for the well developed resources that already exist. However, I think it is important to bring greater public awareness of the sub-ject. We, as a profession, should be talking about burnout; educating our students, current providers, and or-ganizations on how to recognize and prevent this common occupational problem.

was maybe my Generation X gene finally began to express itself; maybe I would never regain the passion I felt when I first started.

A couple of months later our or-ganization had a site visit from the National Health Service Corp and one topic that they specifically mentioned was job burnout. As a loan repayment recipient, I was able to access numerous webinars, read articles, and speak to actual medical providers who had similar experienc-es at various points in their careers. Diving into my newfound resources, I realized that there has been a lot of research documenting burnout. There were well-documented studies across all specialties, practice set-tings, and age groups. Upon doing more research, I realized that it is not something that strictly affects the provider, but it also affects the pro-viders’ ability to deliver quality care and establish a good provider-patient relationship.

Like many other medical condi-tions, prevention is key. In 2007, the California Medical Board published information on Physician Wellness as Constrained by Burnout; they stated the best way to prevent burnout is to promote personal and professional

Third Edition of the California Physician Assistant’s and Supervising Physician’s Legal Handbook*

M ichael Scarano, Jr., Esq. authored the California Physician Assistant’s and Supervising Physician’s Legal Handbook. Newly updated, it answers scores of questions in a concise, clear fashion, with citations

and appendices that will permit practitioners to read the operative statutes and regulations for themselves. A must have for all California practices employing PAs. Visit the CAPA website at www.capanet.org for more information or to order the book online.

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Burnout!by Adam Marks, MPA, PA-C, President Elect

14 CAPA NEWS

How do Occupational

Health PAs who uncover

chronic disease in their

uninsured patients ensure

they get the primary care

services they need?

E very morning at dawn, my pa-tient, Agustin begins his wait for work in the parking lot

outside the local hardware store. It’s a tough job. There’s competition, so he must be alert. He only has a one-in-ten chance of getting work: perhaps digging ditches in the freezing rain or spreading hot mix asphalt on a broiling rooftop. Most are dangerous jobs, the ones that no one wants. It’s a risky business – there are injuries and, of course, no insurance.

According to the Public Policy Institute of California about 40,000

men and women look for day labor on any given day in California. Most day work is in construc-tion, landscaping, moving, and clean-ing. 70% say their jobs are unsafe, con-firming one study which found that day laborers have rates of injury five times higher than those with regular work. Another study

calculated that sidelined injured workers, more than half of whom have no insurance, labor in pain for an average of 20 days a year.

PAs throughout the state treat un-insured day workers like Agustin. In Federally Qualified Health Centers and Community Clinics they tend to injuries that have gone on too long. They accommodate day workers who cannot make ap-pointments ahead of time; they add patients on at the end of the day; and they take their health care ser-vices to the places where workers

congregate. Along the way, they may uncover chronic disease and the inevitable sequelae of a sud-denly sedentary lifestyle: insomnia, weight gain, depression, diabetes or hypertension. Despite limited resources, these PAs find ways to help their patients and get them back to work.

Some men and women who have regular jobs in high-hazard occupa-tions have Workers’ Compensation insurance but no insurance cover-age for primary care. What then? How do Occupational Health PAs who uncover chronic disease in their uninsured patients ensure they get the primary care services they need? PAs like Christa Bradley and her supervising physician are working together to try to solve this problem.

The majority of her patients are lucky enough to have Workers’ Compensation insurance but have no insurance coverage for any other health care. Claims are frequently delayed or challenged, she says

and with long waits for study and treatment authorizations, many patients find their jobs just disap-pear. Christa can only sit by as her patients see their chances of getting another job plummet. She wants to get people healthy again – and back to work.

Along with her supervising physi-cian (SP), she has developed a pro-gram of basic screening and prima-ry care for those without insurance. They have written grants and ob-tained additional funding. Her SP is generous and community-mind-ed – not only does he give her the time and resources for this primary care initiative, he also donates $200 a month for a food box for unem-ployed patients and their families. She hopes that, working together as a team, the patients of this occupa-tional health practice can return to regular employment and avoid the indignity and anguish of competing for work as day laborers.

PAs Caring for the Underserved: Day Workers and Occupational Healthby Margaret Allen, PA-C, Committee on Diversity Chair

Christa Bradley, MPH, PA-C

Christa Bradley, MPH, PA-C is a health care pioneer. Originally from Alaska, she was a Peace Corps volunteer in Africa and traveled extensively before becom-ing a PA in 2003. Upon graduation, she took a job in Occupational Health for NMCI Medical Clinic in Santa Clara, California. Fluent in Spanish, she quick-ly developed a practice that serves mostly Hispanic patients.

MARCH/APRIL 2012 15

On February 25th we held our annual CAPA at Napa CME conference. It was another

fabulous conference in a spectacu-lar venue. This coveted conference sold out several weeks before the conference day arrived. The Napa Valley Marriott has become CAPA’s Northern California home away from home. This newly renovated hotel has been our home now for many years and the newly remod-eled lobby, patios and conference spaces makes us want to stay there forever. The hotel staff knows us so well and treats the attendees and CAPA leaders incredibly well.

You really can’t go wrong with a conference in Napa, CA. The setting is beautiful and this year we lucked out with unseasonably warm 70 degree weather. The newly renovated patio with couches and chairs was a perfect setting to meet up with friends and/or grab a drink after lectures.

We had six amazing speakers this year covering: Perspectives in Rheumatoid Arthritis, 5 Can’t Miss EKG’s, Look Behind the Mask of Depression, Choosing Empiric Antibiotic Therapy in Children, Evaluation of Liver Tests, and Vascular Complications of Type 2 Diabetes. With rave reviews by con-ference attendees, many of the speak-ers will be back in Palm Springs and Napa for years to come.

We had a record-breaking number of exhibitors this year and all at-tendees were able to spend quality time learning about new products and services, and getting some great book deals. Our exhibitors continue to tell us how much they love work-ing with the PAs of California.

Our Napa Conference has such a great feel and people tell us how

much they love the smaller, intimate setting in Napa along with super CME. We will be back there next year so mark your calendar now and remember to sign up early as this conference will sell out again next year. And, don’t forget about the CAPA Conference in Palm Springs. It will be here before you know it. The dates for Palm Springs are October 4-7th. See you all there!

CAPA at Napa 2012by Eric Glassman, MHS, PA-C, President

CAPA PAC Activitiesat the CAPA at Napa Conference

by Cherri Penne-Myers, PA-C, MSCS, Secretary and CAPA PAC Committee Chair

Wow, what a spectacular CAPA at Napa conference. It was great to meet everyone! This year we added a little Wine Silent Auction with a bottle of Jessup Chardonnay and a bottle of

OC Red. Thank you to everyone who bid on the wines. I had fun watching PAs trying to outbid each other. We did get 2 lucky winners: Paul Miniter and Jessica Joslyn. Congratulations!!

Of course we held the CAPA PAC Opportunity Drawing again. A fun favorite! This year there were 2 prizes. A free 2013 CAPA at Napa Conference Registration and a one year CAPA membership. We had great fun finding the tallest individual for the special $25 opportunity drawing deal: your height in drawing tickets! Adam, thanks, but we found Samuel who was 6’ 4. Our lucky winners were Leonard Leimbach who won the free membership and Mohammed Kahn was the winner of a free registration for CAPA at Napa, 2013. Congratulations!

The CAPA PAC appreciates and thanks all the PAs for their contribu-tions. If you haven’t had the opportunity to contribute, please consider a donation when you renew your CAPA membership.

16 CAPA NEWS

Good Marks For Monterey, A Win-Win For CAPAby Larry Rosen, PA-C, Director-At-Large and Public Relations Committee Chair

this provide essential services to her patients, it attracts more patients to her multi-physician practice without burdening her supervising physicians. Innovations such as this present another dimension to family practice that serve to challenge and inspire new graduates who may look upon family practice as too mundane or devoid of creative advancement opportunities.

With the passage of the Patient Protection Affordable Care Act, mil-lions more patients will enter the health care system by 2014. Health care providers in all specialties, most prominently in family practice and psychiatry, will be needed to meet the demand. CAPA and AFPPA are working together to find solutions. Wendy has volunteered to use the re-sources of her organization to explore the possibility of a family practice focused weekend retreat. This was the first of our win-win elements in Monterey. The second relates to the intentional pun in this article’s title: Adam Marks.

Adam is CAPA’s youngest President Elect. He was born and raised in the small town of Exeter, CA near Sequoia National Park. A gradu-ate of the SJVC Physician Assistant Program, he received degrees in biol-ogy and public administration and is currently practicing family medicine in Visalia. Undocumented farm workers make up a large percentage of his practice.

Dinner, walks along the waterfront, meetings with AFPPA members and leaders gave Beth and me an opportunity to get to better know this young man. The results were impressive.

Adam loves being a PA. He takes pride in his commitment to family

T he Academy of Family Practice Physician Assistants (AFPPA) held their annual conference in

Monterey this year. The CAPA board approved three of us attending the conference to exhibit and represent CAPA. It was a good move.

Family practice remains the center-piece of health care in the United States. Maintaining it, espe-cially as it relates to PA participation, is becoming increas-ingly difficult. Large debt loan repayments after graduation and the seduction of higher salaries have lured many new PAs into specialty practice. How do we incen-

tivize more PAs to consider family practice as a profession? How do we make the practice more appealing and challenging to the new gradu-ate? These are some of the issues we wanted to discuss with AFPPA lead-ers and members.

Good news. The majority of PAs we talked to in Monterey love their jobs. They were attracted to family practice by the continuity of care it offers with their patients. They have formed close attachments with the communities in which they work. All feel the gratification of providing a fundamental service to their patients on a daily basis and all experience the frustration of needing more help to continue to do so.

Beth Grivett, CAPA’s Legislative Affairs Committee Chair; Adam Marks, CAPA’s President Elect; and I, met with Wendy Macey, AFPPA’s President and Chuck Dillehay, their Executive Director. They struggle

with the same issues as does CAPA: membership, conference planning, and protecting and preserving the job environment for its members. Family practice growth is akin to health care reform; everyone knows we need it but resolving the barrier issues raises more questions than solutions.

One approach that evolved from our conversations with Wendy and Chuck was the potential of putting together a weekend retreat to explore better ways to make family practice increasingly appealing to the physician assistant population. It would be attended by family practice PA leaders across the country as well as legislative, physician, and other medical community stake-holders. The goal would be to create a targeted dialogue that focuses on what is right about PA family practice and what persists as deterrents to this rewarding service.

Beth Grivett brings an attractive op-tion to the table. Like others across the country, Beth has become a physician assistant coordinator in her practice in Laguna Niguel, CA channeling PA service into multiple preventive and chronic care models within her practice. Not only does

Family practice growth is akin to health care reform; everyone knows we need it but resolving the barrier issues raises more questions than solutions.

Adam Marks, MPH, PA-C, Beth Grivett, PA-C and Larry Rosen, PA-C manning the CAPA booth.

MARCH/APRIL 2012 17

Good Marks For Monterey, A Win-Win For CAPAby Larry Rosen, PA-C, Director-At-Large and Public Relations Committee Chair

practice and to the patients who represent the cultural and social values of the communities that have become so much a part of his life. He is a compassionate provider and insightful observer. He is making a difference where it counts the most.

When we talked about leadership, Adam is appropriately cautionary about assuming the role of CAPA President. Like all those who have preceded him, he knows the awe-some demands of the office. The challenge, rather than intimidating him, energizes him. His two years on the board as Student Representative and President Elect has given him ample exposure to CAPA’s needs and goals directed at fulfilling its commit-ment to our members.

Adam is bright and probing. As he should be at this stage, he is a man of more questions than solutions. He absorbs the issues, listens to the debates and forms his opinions thoughtfully. He is finding his voice.

There is clarity in his reasoning and conviction in his evolving construct on how he wishes to lead CAPA.

Eric Glassman has been doing a re-markable job over the past two years, not only serving as CAPA President but as CME Chair for the 2011 CAPA Conference in Palm Springs and 2011 and 2012 CAPA at Napa Conferences. Each President brings his or her own style to the gavel. Each term presents challenges, foreseen and unforeseen, that impact California PA practice in every medical specialty.

On July 1st, Adam Marks will be ready. Never losing sight of the entire canvas of PA practice, Adam has made the issues facing family practice a priority. A vigorous and experienced board and staff will support him in his efforts to keep CAPA successful and aggressive in protecting physician assistant prac-tice during the tumultuous times ahead for health care reform. He will serve us well.

E very year at the CAPA Conference in PAlm Springs we hear it said: You guys have the best speakers. How do you do it? The answer is we

hand pick them based on referrals, feedback and firsthand experiences.

Please help us identify the great speakers out there. Keep your ears open for interesting topics and excellent speakers. Please let us know what/who they are. You can email us, call us and/or fax us the information.

CAPA’s Conference Planning Committee is com-prised of CAPA members who help us identify gaps in medical knowledge of PAs working in various practices/specialties. Once we identify the needs of our potential audience, we will come up with lecture topics. We will then need to find exceptional speak-ers to address those topics. We are very discerning in our speaker selection which makes for an excellent program and ensures a quality conference for those who attend. This is no easy task, but with the help of every CAPA member, it is manageable. If you know of an exceptional speaker; one who is knowledgeable, entertaining and engaging, please let us know. We will add them and their lecture topic to our list. Once our conference program topic wish list is developed, we can start to match speakers with topics. We hope you will take a moment, throughout the year as you hear speakers to let us know the names of the ones you enjoyed and learned the most from.

Please give us a call or send us an e-mail!Email: capa@capanet.orgPhone: (714) 427-0321Fax: (714) 427-0324

If You Can Only Attend One CME Conference in the West This Year – It Should Be the

Heard

Any Great

Speakers

Lately?

2012 CAPA Conference!October 4-7, 2012

18 CAPA NEWS

Your next patient may be from Laos, Haiti, or Peru, and he or she might not speak English. Will

you know how to communicate with these patients and their families in a culturally sensitive way? This article will discuss techniques that will help you become skillful at communicating with patients from other cultures.

More Trust, Less StressGood cross-cultural communication enhances your practice by:• Building the patient’s confi-

dence in the provider/patient relationship

• Improving patient safety and clinical outcomes by minimiz-ing misunderstandings

• Making more effective use of time spent with your patient

• Increasing patient satisfaction and decreasing stress for you and your patient

Your first step toward cultural com-petence is simply being aware of your own cultural beliefs. For instance, think about your own views to help you identify your prejudices or atti-tudes that could be a barrier to good communication.

Next, learn what you can about other cultures by participating in cultural competency programs offered by some hospitals. You can also increase your awareness of other cultures through information from a library, on the Internet, by talking with oth-ers, or become involved with various cultural groups.

Bring Down Language BarriersIf your patient speaks a different language than yours, use a trained medical interpreter. A professional interpreter not only knows the pa-tient’s language but is also well versed in medical terminology and has been trained to present information in an unbiased way. When you’re work-ing with an interpreter, look at the patient, not the interpreter, when you ask questions.

Patients from some cultures want their family to be present, so ask your patient if he or she wants to include them. But beware of asking them to interpret for you. Although family members can be effective interpreters in a pinch, they sometimes edit what

Continued on page 19

Tips for Communicating With a Patient from Another Culture

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This program is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company, and is offered through the Healthcare Providers Service Organization Purchasing Group. Coverages, rates and limits may differ or may not beavailable in all states. All products and services are subject to change without notice. This material is for illustrative purposes only and is not a contract. It is intended to provide a general overview of the products and services offered. Only the policycan provide the actual terms, coverages, amounts, conditions and exclusions. CNA is a registered trademark of CNA Financial Corporation. Copyright © 2012 CNA. All rights reserved.Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services, Inc.; (AR 244489); in CA, MN & OK, AIS Affinity Insurance Agency, Inc. (CA 0795465); in CA, Aon Affinity Insurance Services, Inc., (0G94493), Aon Direct Insurance Administrator and Berkely Insurance Agency and in NY and NH, AIS Affinity Insurance Agency. ©2012 Affinity Insurance Services, Inc. CAPA112

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MARCH/APRIL 2012 19

R ecently 232 certified physi-cian assistants (PAs) became the first to earn Certificates

of Added Qualifications (CAQs) from the National Commission

on Certification of Physician Assistants (NCCPA) by meeting licensure, education and experience re-quirements and pass-ing a specialty exam.

Recognition was offered in cardiovas-cular and thoracic surgery, orthopaedic surgery, emergency medicine, nephrol-ogy and psychiatry, specialties selected

after discussions with PA and phy-sician specialty organizations and consideration of needs and trends in health care. Across these five

specialty areas, 94 percent of exam-inees earned the CAQ.

“The certified PAs who took the in-augural exams are to be commended for their willingness to be among the first to try to earn this recognition,” said NCCPA Chair Patricia Cook, MD, FACP.

The program has broad support in the health care arena; 66 percent of physicians agree that a CAQ is a valuable credential for certified PAs, according to a survey conducted by The Bantam Group in 2011.

“I felt strongly about supporting this because I felt it would garner more respect for us as PAs,” said Jennifer Carlquist, PA-C, one of 142 who earned a CAQ in emer-gency medicine. “We know how hard we work, but until now, there was really no way to document our

expertise. This is another way to show the medical community that PAs are held to high professional standards.”

The 2012 CAQ exams in the same specialties will be conducted on September 10. Discussions regarding the addition of other specialties to the recognition program are ongoing.

“We are excited that the first Certificates of Added Qualifications have been awarded and expect the program to grow as certified PAs find this a valuable way to document spe-cialty experience, skills and knowl-edge,” said Janet J. Lathrop, NCCPA president and CEO.

Details regarding the requirements for each of the specialty CAQ pro-grams and content blueprints for the exams are available at http://www.nccpa.net/SpecialtyCAQs.aspx.

NCCPA Awards First Certificates of Added QualificationsNCCPA Press Release, January 17, 2012

Continued from page 18

2011 CAQs Awarded in California

CVT Surgery .................... 3Emergency Medicine ......14Nephrology ..................... 1Orthopeaedic Surgery ..... 2Psychiatry ....................... 4

Tips for Communicating With a Patient from Another Culture

they interpret or convey their own biases to the patient.

Slow Down and Get to the PointUse short, simple sentences and speak in the active voice. Use simpler words, such as pain or hurt instead of discomfort. Simple sentences, such as “Do you hurt?” or “Do you have pain?” are best. Avoid using medical jargon and slang terms.

Assess the patient’s nonverbal com-munication, including posture, amount of eye contact, facial expres-sions, and signs of anxiety.

Discuss one topic at a time and avoid giving too much information in a

single sentence. Instead of saying, “Are you cold and in pain?” panto-mime or gesture while saying, “Are you cold?” and then, “Do you hurt anywhere?” To assess the patient’s un-derstanding, have him or her repeat instructions, demonstrate the proce-dure, or act out the meaning.

Finally, document the communica-tion strategies you’ve used and the patient’s response in the medical record.

A Matter of RespectTo build a good relationship with a patient from another culture, focus on conveying empathy and showing respect. Without stereotyping, you can build on your experiences to be

more effective each time you commu-nicate cross-culturally.

This risk management information was provided by Healthcare Providers Service Organization (HPSO), the #1 provider of professional liability insur-ance for over 1 million healthcare pro-fessionals, and is now offering the same quality coverage, financial strength and level of service to Physician Assistants. The professional liability insurance pol-icy is administered through HPSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohib-ited. For questions, send an email to service@hpso.com or call 1-800-982-9491. www.hpso.com.

Students Students Students Students Students Students

20 CAPA NEWS

In the last CAPA News article, “PAying for PA school,” various options for funding your PA edu-

cation were described. Two recent graduates that work at Federally Qualified Health Center (FQHC) were willing to share their experi-ences as a full-time National Health Service Corps (NHSC) loan repay-ment recipient.

Liza Hollo, PA-CTouro University, Class of 2011La Maestra Community Clinic San Diego, CA

Adam Marks, PA-CSan Joaquin Valley College, Class of 2010Family Health Care Network Visalia, CA

What is the NHSC commitment like?

Liza: 2 years minimum. There are a variety of eligible sites, includ-ing FQHCs, IHS [Indian Health Service], and Correctional facilities.

CAPA Note: There are part and full-time options available.

What is the application process like?

Adam: Online, easy, with quick turnaround.

Liza: It is nowhere near as exten-sive as PA school! You do need to compile all of your individual loan information and have letters of recommendation.

How did you choose your site?

Adam: It was where I did my preceptorship.

Liza: It was the first job offer that fit my requirements of location, salary,

FQHC, and [personal] mission.

What is your experience as a PA at a NHSC site?

Adam: Excellent so far, NHSC has done a site visit and asked us for input on how to improve their program.

Liza: We work predominantly with refugees and immigrants. My first day on the job I saw almost 20 patients, and only 3 spoke English. The train-ing phase was quite short and within two weeks I was seeing a full load of patients. Unfortunately there is so much unmet need, an extensive training period is simply not feasible. Developing treatment plans for the under and un-insured is like putting together a puzzle; you are constantly trying to find the best treatment that is still affordable. Often times the “gold standard” is not possible, so you try your best to work within their budget to adequately treat their condition. There are many challenges involved with working at a commu-nity clinic. That said, my patients are fantastic and I can’t imagine working with a more appreciative and diverse population.

What is your favorite part about working at a NHSC site?

Adam: Added bonus of loan repayment and it was the setting I was looking to practice in as a new grad.

Liza: The patients [because they are] diverse and eager to learn about their health. The complexity of what you see on a daily basis - it’s amazing!

What is your least favorite part about working at a NHSC site?

Adam: Slight reduction in flexibility. You are committed for the time that

Q & A With National Health Service Corps PAsby Joy Dugan, PA-S, Student Representative

you put in. If you terminate early, there are stiff penalties.

Liza: Constantly battling with insur-ance! The frustration that comes with treating an uninsured patient that desperately needs specialty care, yet cannot afford it.

Is it possible to go from full to part time loan repayment?

Adam: Yes, but it extends your ser-vice and it is subject to approval by NHSC. It’s possible that it would be denied.

Is it possible to change sites once accepted?

Adam: I was able to transfer within my network without a problem be-cause they all have the same Health Professional Shortage Area (HPSA) score.

What happens if I need to take time off for a medical reason or maternity leave?

Adam: They allow a certain amount of days a year and any time beyond that is added to your term of services.

Can you take a vacation while a NHSC member?

Liza: Yes, you are expected to follow the vacation allotment of your place of employment. Full time service is 40hr/wk.

How can I prepare myself for work-ing at a NHSC site during PA school?

Liza: Try to secure as many rotations as possible at community clinics, cor-rectional facilities, and rural sites.

Adam: Rotate through a FQHC or RHC, get to know the patient

Students Students Students Students Students Students

MARCH/APRIL 2012 21

Q & A With National Health Service Corps PAsby Joy Dugan, PA-S, Student Representative

population, and decide if you would enjoy working in primary care in an underserved area.

Did you apply for the NHSC loan repayment before starting your posi-tion? Can you apply while in school or do you have to be a PA-C?

Liza: You can apply once you have secured a job at a qualified site, even if you have not yet started.

Adam: I applied three months after starting my job. They paid the inter-est I accrued once I was accepted.

Which qualifications offer you better chance in becoming a loan repay-ment recipient: personal qualifica-tions (e.g., bilingual, experience at a FQHC) or the “score” of the site?

Adam: HPSA score is more important.

Liza: The score of the site is involved in the decision. However, a proven commitment to working with the underserved (before PA school) will emphasize the fact that you will most likely remain in an underserved clin-ic after the NHSC [service commit-ment]. The commitment to working in an underserved clinic, in addition to an underprivileged background, are the key characteristics of an ideal candidate.

CAPA Note: The HPSA Score deter-mines the amount of loan repayment received for 2012 application cycle.

Score of 14 and above- Full Time: $60,000- Half-Time 4 Year Contract:

$60,000- Half-Time 2 Year Contract:

$30,000

Score of 13 and below- Full Time: $40,000- Half-Time 4 Year Contract:

$40,000- Half-Time 2 Year Contract:

$20,000

The loan repayment program is a competitive application process so it is important to apply early. If you are not accepted the first time, you are allowed to reapply in future applica-tion cycles. For more information about the NHSC loan repayment and scholarship options, check out the website: http://nhsc.hrsa.gov/.

USC PA Toy Drive Benefits Children’s Hospital Los Angeles!by Kimberly Ward, PA-C, MPH

On Friday, December 9, 2011, the USC, Keck School of

Medicine, Primary Care PA Program brought joy to the children and teens in the Hematology/Oncology clinic at Children’s Hospital Los Angeles with lots of donated toys and gift cards for the holidays! Through a well-

organized toy drive, spearheaded by the first year class of 2014, an extraordinary number of donations for the children were collected from all of the student classes and staff of the program. Many thanks to Sadia Quidwai, PA-S and her classmates for helping to make a difference in the lives of many sick children.

The PA students joined the PAs from Hematology/Oncology to distribute the nu-merous gifts, while listening to holiday songs. The students pictured above are from the class of 2014: Lauren Layson, PA-S, Jeanette Trejo, PA-S, Sadia Quidwai, PA-S, Debbie Tanedo, PA-S, Natane Runningfox, PA-S, Joy Lin, PA-C, Kimberly Ward, PA-C, Jed Sejismundo, PA-C, Bob Miller, PA-C, Julia Robinson, PA-S, Angela Cecil, PA-S, Ashley Cadondon, PA-S.

Congratulations to the 2012 CAPA Scholarship Winners!!!

Community Outreach ScholarshipJessica Lee, PA-S University of Southern California

Ray Dale Memorial ScholarshipJohn Waite, PA-SUniversity of Southern California

Ruth Webb Minority ScholarshipMaria Fuchs, PA-STouro University - CA

Students Students Students Students Students Students

22 CAPA NEWS

The USC Keck School of Medicine’s own

Kevin Lohenry, PhD, PA-C, Director, Division of Physician Assistant Studies and former Physician Assistant Education Association President, attended several events for the Joining Forces Initiative on Monday, January 9 and Tuesday, January 10, 2012. The events,

hosted by Admiral Winnefeld, Vice Chair of the Joint Chiefs of Staff and the First Lady’s Joining Forces team aimed to bring together several repre-sentatives from all parts of the health professions to focus their attention on the various ways health care professionals can work together to educate members of their field when it comes to caring for wounded war-riors and their families. Represented

at the events were members speaking on behalf of the fields of medicine, physician assistant, and nursing, among others.

First Lady, Michelle Obama, ad-dressed the attendees about the Initiative and spoke of the various issues wounded warriors and their families encounter, including employ-ment, education and wellness.

While the Joining Forces Initiative does embody several issues that wounded warriors and their families are faced with, the focus was pri-marily about ways to improve care throughout the country for military service members and veterans who suffer from Post Traumatic Stress Disorder, Traumatic Brain Injury, and Post-Deployment Depression.

The events included a reception at the former home of General Patton, a tour of the National Intrepid Center of Excellence (NICoE) and

culminated in a meeting at the White House where representatives from the health professions com-mitted to make this issue a primary focus for their organizations.

Lohenry stated of his visit, “The National Intrepid Center of Excellence provided all of us with the opportunity to see what is possible in healing our wounded warriors from their invisible wounds of battle.  I look forward to the PA profession providing tremendous help to these warriors and our nation’s veterans.”

USC’s Physician Assistant Program is currently working on incorporat-ing training into the curriculum that includes a half-day seminar in the spring. The training received in this seminar will enable students to recognize signs of Post Traumatic Stress Disorder and Post Deployment Depression allowing them to provide better care for their future patients.

Keck School of Medicine of USC PA Program Director Attends Joining Forces Initiative Eventsby Elise Herrera-Green

Kevin Lohenry, PhD, PA-C and AAPA President, Robert Wooten, PA-C.

USC PA Program White Coat Ceremony

USC had the honor of having both AAPA President Robert Wooten, PA-C and Congresswoman Karen Bass in attendance. Both are pictured here with Kevin Lohenry, PhD, PA-C, USC Director, Division of Physician Assistant Studies.

Touro PA Program White Coat Ceremony

MARCH/APRIL 2012 23

Welcome New MembersNovember 29, 2011 through March 20, 2012

Aadil AbowathOgbanedi Abu, PA-CJessica Adamich, PA-SJennifer AfariMelody Afvari, PA-SLauren AlbertAmanda AndersonMark Ashby, PA-CRobert Baber, PA-SH. Baker, PAWhitney Barns, RDJames Barrett, PA-S, MPTNusha Bashardoust, PA-SMeagan Bathurst, PA-SBrandi Baughcum, PA-CMargarita Bautista, PA-CMalaika Bayer, MPH, PA-SJosh Benson, PA-SChristina Berry, PA-SAnne Marie Bisson, PA-CAmy Blackard, PA-CBenjamin Bradley, PA-CJames Brinkman, PA-SThomas Brookshire, PA-CRaena Brown, PA-CAmber Brown, PAChristopher Buckley, PA-CDiana Cantero, PA-SCatherine Cantrell, PAVanessa Cascio, PA-SJoann Chan, PA-CGarrett ChanRobert Chavarin, PA-STiffany Chavez, PA-SMelinda Chiem, BSElizabeth Chui, PAKaren Claes, PA-CLindsey Clark, PA-CJanelle Colangelo, MSNatalie CraigMelissa Crist, PA-SJulia Cser, PA-SStephanie Cullinane, PA-CRoger Cummins, PA-CCathy CurrieOanhTuyet Dao, PA-SLynne David, PA-SJustin Davis, PA-SLinda Deivert, PA-CDerrick Del Rosario, PA-SSimerjit Dhaliwal, PA-CCarmen Diaz, PA-CDaley Dodd, PANicole Doran, PA-SMichael Doyle, Pre-PAShirree Eberhart, PA-SRyan Ellis, PANicholas Entsminger, PA-SLizbeth Escobedo, PA-S

Colleen Farnum, PA-CGisele Fassino, PA-CKathryn Finch, PA-SCheryl Fowler, PA-SJeremy Freitas, PA-SNyssa Fromuth, PA-SPaul FruhnerRobin Fuessenich, ATC, PA-SChristine Fujinaka, PA-SDiana Garcia, PA-SLulu Garcia, PA-CMary Gausephol, PA-CMegan Gebhardt, PA-CErin Geiger, PA-SSilvie Georgens, PA-CAmy Gerson, PAKimberly Gin, PA-SIndira Grey, PA-CAmy Grubert, PA-CAlba Gutierrez, PAEugene Guzman, PATamara Harman, PA-SChristopher Hart, PARyan Hartogh, PA-SNicholas Haskell, PA-SKasaundra Heiberger, PA-SGary Hollinger, PA-CRebecca Hu, PA-SShaoxing Huang, PA-SIan HuynhCecilia Jang, PABrian Jarman, PA-SRobert Jazwin, PA-CAnthony Johnson, PADarcy Johnson, PA-CLaTasha Johnson, PA-SYeh Johnson, PAJason Johnston, PA-CKatharine Joseph, MPA, PA-CRachel Kalter, PA-SCrystele Kammerer, PA-CTracy Kennelley, PA-SLara Kroepsch, PA-SChien-Wei Kung, PA, RDGanna Kuvaldina, PA-CJaclyn Kwan, PA-SSamuel Lagunas, PA-SBrett Larson, Pre-PAAnita Lavaisse, PA-CJonathan LeeAlisia Lee, PA-CLeonard Leimbach, PA-CMichael Leon, PAKathleen Lew, PA-CChung Li, PA-CJoy Lin, PA-CMendeleev Locquiao, PA-CChris Lugo, MPAS, PA-CLinda Ly, PA-S

Moira Lynn, PA-CFelicia Ma, PA-SJoseph MacPhee, CPAKristin Mancuso, PA-CBrenda Mann, PA-CGreg Martinez, PA-CChristy Mayfield, PA-CJamie McCoyStephanie McDonald, PA-CStory Mcdonald, PAMaureen McGhee, PAHeather McKelvey, PA-SLisa Melody, PA-CHannah Mertens, PA-CMena Mesdaq, PA-SStacy Mierau, PA-CScott Miller, PA-CPeter Miranda, PA-CJennifer Moreno, PA-SMichael Morley, PA-CSara Morton, PASherie Murray, PA-SRyan Nakasone, PA-C, DCMatt Nedresky, PA-CBrandon Nelson, MSBryan Nelson, PA-CThanh Trung Nguyen, PA-S, MSAnh Nguyet Nguyen, PA-SElena Nicola, PA-CDeborah Noriega, PA-SAshley Oakley, PA-CBahareh OmraniChristina Pangborn, PA-SStephen Papa, PAKevin Pape, PAMargarethe Pappademos, PA-CJosh Parent, MSAshley Patchell, PA-SShawn Plowman, PAMichelle Pollitt, PA-SBhavana Prakash, PA-SSabina Privett-Pokorney, PA-CSarah Purdy, PASam Rabi, PA-CElisa Rea, PA-CJaidesh Reddick, PA-CHolly Reece, PA-CJohn Reid, PA-SWilibaldo Reyes, PA-CJoseph Ricci, PA-SBrant Richardson, PA-CKent Riemer, PA-SMichelle Rebecca RihaniLindsey RistowArleada Robertson, PA-CLillian Rodich, PA-SKelley Rodolff, MSPA-S, MPHBriseida Romero, EMT-BShelly Romo

Sarah Rossall, PA-SJason Ruby, PA-CRay Ruiz, PA-STeeJay Rull, PA-SNatalia Sanchez, PA-SJennifer Scarborough, PA-CJana Schade, PA-CErica Schlackman, PA-SKristen Schlegel, PA-SRyan Schmitt, PA-STrina Sheedy, PA-SMayra Silhy, PASarah Smith, PA-SEric Smith, PA-SErik Smith, PA-CLindsey Smith, PAMichael Smith, PA-SAseema Songstad, PAOdessa Speirs, PAShannon Spiller, PA-CChristina Spina, PA-C, MPHLisa Spitalewitz, PA-CStephanie Starritt, PA-SSamantha Stevenson, PA-SJeanne Szarzynski, PA-CAcacia TatumCarla Thompson, PA-CAnna Tilt, PA-CAlfred Tobias, PA-SEmily Tognozzi, PA-CGina Tortosa, MPAKristin Tracy, PA-SKimOanh Tran, PA-SAmy Trautman, PA-CMichael Trias, PA-SMartha Tsabetsaye, PA-SLinh Tsan, PA-CWilliam Tsu, PA-SMichael Tulgetske, PA-CBryant Uy, PA-C, MPHPhilippe Vasquez, PA-CRyan Wada, PA-SJason Wagner, PA-SAngela Wangyal, PA-CSonja Washington, PA-SAshley WebberBrie Willett, PA-SKam Wong, PA-CKristen Wong, PA-SJennifer Wurz, PA-CLue Yang, PA-CDanny Young, PA-CLinda Yu, PANaz ZanganaJulianne Zimlich, PA-SJennifer Zimring, PA-C

1. Redding Area PA/NP AllianceSummer Ross, PA-C; (530) 275-5747summerross@hughes.net

2. Physician Assistant Society of Sacramento (PASS)Carlos De Villa, PA-C, PASS President; (916) 973-6185, pasocietyofsac@yahoo.comAtul Sharma, PA-C, MMS, MPH, CHES; (916) 397-6035, pasocietyofsac@yahoo.com

3. Contra Costa Clinicians AssociationBrian Costello, PA-C; (707) 651-2705, contracostapas.com

4. San Francisco Bay Area Physician Assistants (SFBAPA)www.sfbapa.com, PO Box 14096, San Francisco, CA 94114-0096Martin Kramer, PA-C; (415) 433-5359, Fax: (415) 397-6805, mkramersf@hotmail.com

5. Bay Area Mid-Level PractitionersRose Abendroth, PA-C; (650) 697-3583, Fax: (650) 692-6251, rosepard@aol.comMatt Dillon, PA-C; (650) 591-6601, mattdillon42@hotmail.com

6. Bay Area Non-DocsLinda O’Keeffe, PA-C; (650) 366-2050, lindapac@aol.com

7. Northcoast Association of Advanced Practice CliniciansJohn Coleman, PA-C; (707) 845-6008, streetdrag49@sbcglobal.net

8. Stanislaus County NP/PA NetworkBrian Cormier, PA-C; (209) 605-4966, briancor@verizon.net, www.nppanetwork.org

9. Stockton MidlevelsEmma Calvert, PA-C; stocktonmidlevels@gmail.com

10. Journal Club for PAs and NPs (Fresno area)Cristina Lopez, PA-C; (559) 875-4060; Fax: (559) 875-3434, clopez875@aol.com; 2134 10th St, Sanger, CA 93657

11. Tulare/Kings NP/PA AssociationSteve Henry, PA-C; Pager: (559) 749-4348, msh649@sbcglobal.net

12. Central Coast Nurse Practitioners & Physician AssistantsKris Dillworth, NP; ccnppa@yahoo.comSharon Girard, PA-C; (305) 803-1560; ccnppa@yahoo.com

13. So Cal PAsLinda Aghakhanian, PA-C; want2heal@hotmail.com

14. Orange CountyHung Nguyen, PA-C; (714) 846-8178; nhy52@yahoo.com

15. San Gabriel Valley Local GroupM. Rachel DuBria, PA-C; (818) 744-6159, racheldca@aol.com

16. San Fernando/Santa Clarita Valley GroupJonah Tan, MPT, PA-C; (818) 634-0007, jotptpa@yahoo.com

17. Coachella Valley Physician Assistant GroupMatthew Keane, MS, PA-C; mkeanepas@gmail.com

18. San Diego AreaJeremy Adler, MS, PA-C; (619) 829-1430, jadler@simplyweb.net

Local Groups

California Academy of Physician Assistants3100 W. Warner Avenue, Suite 3Santa Ana, CA 92704-5331

Address Service Requested

PRSRT STDUS POSTAGE

PAIDSANTA ANA, CAPERMIT NO 949

CAPA’s 36th Annual ConferenceOctober 4-7, 2012

Optional Workshops, October 4 and 6

Controlled Substances Education CourseOctober 3, 2012 – Prior to the CAPA Conference

There is quite simply nothing like the CAPA Conference. The setting: PAlm Springs and the beautiful Renaissance Hotel and Palm Springs Convention Center offer a wonderful, community-building gathering place. And, the group dynamic created

by all of you makes the CAPA Conference a one-of-a-kind conference experience.