The Military's Interservice Physician Assistant Program

PHYSICIAN ASSISTANCE IN THE MILITARY AND THEIR TRAINING PROGRAM

From the line, For the line, the mission of the Army Physician Assistant. Physician Assistants are leaders in the military healthcare system and continue to play an important role in all branches of the Military. I am Lisa D'Andrea Lenell and this is the clinicians round table. Our guest today is Captain James Jones, the physician assistant and the manager of the Inter-Service Physician Assistance Program to discuss the training of physician assistance within the Army Medical Department.

LISA D'ANDREA LENELL:

Hi, Captain Jones. Welcome to ReachMD.

CAPTAIN JAMES JONES:

Hi Lisa, thanks for having me.

LISA D'ANDREA LENELL:

Captain Jones, tell us about the Inter-Service Physician Assistance Program.

CAPTAIN JAMES JONES:

The Inter-Service Physician Assistance Program has been around since the development of PA education and it has evolved to where it is a tri-service program, which means that all military branches now send enlisted soldiers to train at that location and it basically is a consolidated training program at Fort Sam, Houston for phase I, which is a didactic phase very similar to the civilian PA education model with emphasis on military medicine in some areas of the didactic training and then they go out to various phase II sites and currently we have 15 locations that they can go out and participate on hands-on training and they do rotations in accordance with same type of training model that a civilian PA goes through. However, they do have an opportunity for more hands-on contact in some of the trauma skills that may be required on the combat battlefield that civilian PA students are sometimes not able to be exposed to on their rotations. The Army program offers officers, warrant officers, and enlisted soldiers, an opportunity to apply for the program. The army trains approximately 150 active duty soldiers and 10 reserve soldiers and approximately 30 National Guard soldiers each year at the inter-service physician assistant program located at Fort Sam, Houston. That is where the didactic training is conducted. Graduates complete the program and earn a Masters degree from the University of Nebraska and receive a commission upon graduation in Army Medical SOS Core as a first lieutenant and then they go off from there and practice as a physician assistant once they are board-certified and NCC-PA certification and take care of soldiers. The program from the other services also sent enlisted soldiers to participate in the Air Force and the Navy and the coast guard. The Army is the only branch of the service that allows commission officers and warrant officers as well as cadets to apply for the training programs. Civilians are not allowed to apply directly to the program. They have to be in the military first before they can place an application for the training at Fort Sam, Houston.

LISA D'ANDREA LENELL:

Is this a new program?

CAPTAIN JAMES JONES:

No, it is not. The Inter-Service physician assistant program has been around since about 2000 in regards to training tri-service. Initially, the PA-training model in the military was branched out. The Air Force had their own training program, the Navy, and then the Army but then they decided to consolidate it for cost savings and better education and now being inter-service, they rotate the program records, the Army will have it for 4 years, then the Navy, then the Air Force, to give each branch of the service an opportunity to manage it.

LISA D'ANDREA LENELL:

So, let us talk about the civilian versus the enlisted PA. Do you have to be enlisted in the military to apply for this program?

CAPTAIN JAMES JONES:

You do.

LISA D'ANDREA LENELL:

So, as a civilian PA, would I have to then enlist and then apply?

CAPTAIN JAMES JONES:

Well, if you, we do allow civilian PA’s to join the military, but that is done through a different process. They do not have to go through the Inter-Service physician assistant training program to do so. This is only for folks who want to become PA’s but they do not allow civilians who want to seek that training to come in directly to the program. They have to enlist first or commission and then apply and it usually takes 2 to 3 years of military service to become competitive for the training program.

LISA D'ANDREA LENELL:

So, I could not get accepted in to the IPAP program while enlisting

CAPTAIN JAMES JONES:

No, you cannot.

LISA D'ANDREA LENELL:

And so there is a chance that if I enlist, I might not get in the program.

CAPTAIN JAMES JONES:

Absolutely, and we receive multitude of inquiries because PA school is so competitive in the civilian sector to get in to from folks that would love to come in the military to do this training. However, we always advise them that, you know that although it is an opportunity that they can apply for, that they should consider other options if in fact being a PA is their primary goal.

LISA D'ANDREA LENELL:

Are most of the people who get accepted medics?

CAPTAIN JAMES JONES:

The mass majority of them have medical background. They do not necessarily fit in the category of medics, but there will be licensed practical nurses, respiratory therapists, pharmacy techs, ENT trained, or you know base paramedic type training from the civilian sector that gives them the medical training that makes them competitive on the board.

LISA D'ANDREA LENELL:

And what are the prerequisites required for an enlisted to apply for the IPAP program.

CAPTAIN JAMES JONES:

The requirements for the program is that you have to have a minimum of 2 years of college, which basically the prerequisites meet the same type of prerequisites that you see at most PA schools. They have to have anatomy and physiology, chemistry I and II and the basic prerequisites of English I and II to qualify for a bachelor degree, psychology, college algebra, and then the other courses that they are required to have can be a mixture of humanitarian type guidelines in history and things like that, which sets a normal degree process in order to qualify for the bachelor degree. However, about 80% of the applicants that are accepted in the program have a bachelor or masters and some even a PhD in a variety of different fields that have been accepted for the program.

LISA D'ANDREA LENELL:

If you are just joining us, you are listening to the Clinician's Roundtable. I am Lisa D’Andrea Lenell and I am speaking with Captain. James Jones, a physician assistant and manager of the Inter-Service Physician Assistant Program. We are discussing physician assistance in the military and their physician assistant training program.

Captain Jones, let us talk about recruiting civilian physician assistants. What is the process for them to work as PA’s in the military?

CAPTAIN JAMES JONES:

Well, the civilian physician assistants that are board-certified and are already practicing that wish to join the military, they meet with the health care recruiter in their local area and initiate an application, they have to meet the physical standards to join the military. For example, the part of the screening process is to ensure that folks that join the military are able to deploy at Iraq and Afghanistan. So, they do a health screening looking for diseases that would not be suitable for example, diabetes, bipolar disease, conditions that could be aggravated by military training as well and then they do an application, which requires 3 letters of recommendation and all their transcripts and they are sent to a central processing area at Fort Knox, Kentucky, where they are boarded by peers, other physician assistants, and always a physician is on the board and they evaluate to determine that individual is qualified to practice medicine in the military and that they have the right background to be clinically prepared to serve in the roles that we are looking for in the military. Once they are selected, they are offered an opportunity to commission and their commission rank is driven by their years of experience. If they are new graduates, they come in as first lieutenants, If they have a masters degree, if they are practicing physician assistants, they get half credit for their civilian work experience, which equates to rank in the military, so they can come in as captains, majors, depending upon their level of clinical experience and we currently offer 2 incentive packages, one for active duty and one for part-time. The active duty option allows civilian physician assistants to come in for what a 120,000 dollar loan repayment package, which requires a 3-year active duty commitment and then the reserves is a 60,000 dollar accession bonus or a 30,000 dollar loan repayment for a 3-year commitment or they can combine them to get a 60,000 accession bonus and a 50,000 dollar loan repayment to join the reserves for a 6-year commitment.

LISA D'ANDREA LENELL:

Do the civilian PA’s need to have at least a bachelor’s degree or can associates degree get them in?

CAPTAIN JAMES JONES:

No, they have to have a minimum of a bachelor’s degree. It does not have to be in PA studies, but they have to have the bachelor degree in order to qualify for the commission.

LISA D'ANDREA LENELL:

And what percentage of the civilian PA’s continue a career with the military after the commitment has been reached?

CAPTAIN JAMES JONES:

Well, this is new area for the Army and 2006, was the first year that we have actively started recruiting civilian physician assistants to join our team and since then we have had 214 civilian PA’s join the military. This year 43 of them were eligible to leave and to date, we have not had anybody submit a resignation letter, but we suspect based on the normal trends if you look in previous past years that generally about 50% civilian accessions leave the service at some point before 6 to 10 years and go in to the civilian sector and practice. Many of them join the reserves to finish up the retirement, but we really do not know what the trend will look like for the coming years. We hope many of them will stay on board.

LISA D'ANDREA LENELL:

How does the training of a PA in the military transfer over to civilian life?

CAPTAIN JAMES JONES:

It is exactly the same training model, so I do not think that there is a big difference and really the didactic education that the civilian PA’s receive that varies from the military. I think the big difference comes in as some of the hands-on experience that our military PA’s receive that you may not experience in the civilian sector. For example, a multitude of inhibition experiences, chest tubes, cut down, things like that you may not experience in a normal ER fast track setting that you would get while deployed and within the military structure.

LISA D'ANDREA LENELL:

So, in the civilian world wrapped every day, what is a PA. PA’s are very well respected in the military. How do you think the role of the PA is different in a civilian world versus the military?

CAPTAIN JAMES JONES:

I think this is an easy question to answer and it rolls down to the fact that the military PA’s primary role is to train the combat medics in order to prepare them to do their jobs when they are deployed forward with the soldiers and that’s their major difference between a civilian PA and a military PA is that responsibility relates to the quality of care that is going to be received by a soldier that is injured in deployed setting and if they are not efficient at that training, then those medics are not prepared to do their jobs and equates to whether people are able to return home after being hurt and we have done a great job and we are really proud of the PA’s that have trained those medics and if you look at the wound rates and the death rates for those that have been injured, they are drastically reduced in today’s Army compared to Vietnam, World War II and that is directly related to the training that our PA’s provide the combat medics.

LISA D'ANDREA LENELL:

But the demand for the PA’s in the military had varied through the years and with the ongoing conflicts in Iraq and Afghanistan, has the need for PA’s increased?

CAPTAIN JAMES JONES:

Absolutely, in fact that is what drove the requirements to start recruiting civilian PA’s in 2006. Prior to the war, we had a requirement for approximately 450 PA’s to meet the requirements for a peacetime Army. Today’s requirements are double that and they continue to grow. There is a continual need and desire to have physician assistants work within the military units. Many of the units that did not previously have a direct physician assistants assigned to them have now been restructured and are required to have that medical asset with them, which shows the level of understanding of how we provide medical care and our importance to the Army’s Health Care Team and what we do both in peace time and war efforts have been dramatically changed over last 7 years.

LISA D'ANDREA LENELL:

Have you found that more PA’s have retired given the recent conflicts?

CAPTAIN JAMES JONES:

Absolutely, that has been a big challenge for the military is that, you know, when you retire over 20 years of military service, you are eligible to draw 50% of your retirement pay with full medical bill for the rest of your life and it becomes very attractive for them to look at taking on a civilian job creating a secondary retirement since they have their huge benefit package. So, it is a challenge for us once some body hits 20 years of service, to retain them and the military has done a few things recently in the last 2 years to actually attract that population to stay on board. They are offering a 25,000 dollar a year retention bonus for that group. It actually applies to other PA’s as well, but the target audience is those that are eligible to retire.

LISA D'ANDREA LENELL:

We would like to thank our guest, Captain James Jones and all of the military medical professional for taking care of our American heroes. I am Lisa D’Andrea and you are listening to the Clinicians Roundtable on ReachMD XM160, The Channel for Medical Professionals. Please visit our web site at reachmd.com, which features our entire library to on-demand podcast and thanks for listening.

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