MTP Podcast episode 2: Anne Dang, CCPA
Anne graduated from Mcmaster University's PA program in Ontario in 2011 and has been working in Orthopedics since that time. She is a true trailblazer with many talents providing irreplaceable assistance to CAPA, a detailed blog delivering vital information for PA students, practicing PAs and to those employing PAs. She has recently been voted CAPA national vice president. (Of note, this interview was recorded just before the voting results were released.) Please join us and listen to Anne's riveting success in the physician assistant industry.
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MTP Podcast Episode 2:Anne Dang, CCPA
Released: September 26, 2017
Length: 36 minutes
Legend: Rebecca Mueller (Becky)=B, Rachael Thompson=R, Anne Dang=A
~MUSIC~
R: Okay so this week, we sit down with Anne Dang, newly elected vice president of CAPA
B: Welcome to Meet the PAs podcast. Here the experiences of seasoned PAs, up and coming development of policy from industry leaders, and the exploration of those new to the career. Interviews done with a Canadian twist and maple syrup
MUSIC
B: Okay, so do you mind first telling us just a little bit about yourself and your background, how you became a PA, and brought you to today
A: Okay, so I was originally born and raised in Toronto, and I attended McMaster University for my undergraduate studies. I studied Health Sciences at McMaster and I decided to do a minor in Psychology. I've been involved with a lot of different executive committees during udnergerad, youth donors of canada. I started a mental heatlh initiative there, so I do like volunteering and being involved in that regard. I got into the PA program as part of the class of 2011 so I believe just a year after you and once I graduated in 2011, I obtained a position through the career start program in orthopedic surgery outpatient practice in burlington. So, I have the contract 2 years, and that was extended for another year, and then another year after that, befire they cut funding. Apart from that, I'm an avid baker, I love to take dance classes, and I’ve had an interest in building websites social media and tech from a very young age so that's always been my interest growing up. And, yeah so that's a little bit about myself
B: So, how did you even hear about the PA profession and the PA program back when you entered?
A: It's really interesting bc I heard about it back in my 3rd year. What had happened was, all of my classmates were writing the MCAT, looking into pharmacy and dentistry. I was attending all these different sessions and booths about different careers, like naturopath, chiro, physio, and I knew that i wanted to do medicine and be in a helping position, but i just didn't know if going to medical school and becoming a physician was the right fit for me. So, I got to the point of almost registering for MCAT prep courses and then I went to my guidance counsellor and she had mentioned that there is a new program that McMaster is offering, the PA program, and again this is back in like 2007/2008, so quite a while back and she had mentioned that one of my former classmates O’Hood Alfeback was actually a student so we were both in the same year, but she finished her undergraduate after 3 years before getting into the PA program. So she was in her first year, and I had this opportunity to sit down and have lunch with her. And, so we talked, she told me about the program, I attended the information session that Dr. John cunnington back in MDCL the 3rd floor and at the time, like, I had heard about the PA program but I didn't want to apply until there was at least one class, just so that they could sort of work out the kinks and perhaps like, because at the time, there were no working civilian Canadian PAs right? So everything that we were looking at were - that I was looking up - were American. So it was definitely, it felt like I was taking sort of a leap of faith in my fourth year. It was the only program I applied to, luckily I got in.
All: [LAUGHTER]
R: That’s awesome
A: Yeah, and the thing is when I entered my first year, and you know how the McMaster PA program the first year is based on the medical school curriculum, they literally take cases from the med school curriculum and use it in the PA program. And I thought to myself you know, if I have the aptitude to get into the PA program, like you know maybe perhaps, like, did I really kind of miss out by not going to medical school? Like, or not even trying to apply? I had to sort of reiterate the reasons why I wanted to choose the PA profession in the first palace and then after doing clerkship and seeing the lifestyle and the schedules of residents and med students, and the differences in lifestyles and opportunities, I knew the PA program was a really really good fit.
R: Probably why we chose it too, the lifestyle it makes a huge difference
A: Absolutely
B: Okay, so could you take us back a little bit if you mentioned that you had funding obviously the first two years at the orthopedic practice you were at, but then a couple years later, they actually discontinued the funding. And, so, how long were you unemployed for a period of time and how did you do that transition.
A: So, what's interesting is that even thought the ministry had cut funding, I suppose within the two years that I had been working there, I had proven my value so what I had done was I took information from an EMR, learned how to do medical coding and billing and determined how much he was making and how much he was seeing prior to PA implementation. And then what it was like after a PA had been implemented. So just doing that quick comparison, I was able to demonstrate he was able to double or triple the number of patients he was seeing. In a day, he was shortening the number of clinics. I was tracking also the hours I was spending on forms, like for every hour that Im spending talking to Patients over the phone, doing patient education, reviewing investigations, doing medical legals, that amount of time is time that the physician is not spending so even though that's not a monetary value I was just trying to demonstrate from you know a quality of life point of view ways I was contributing, because at the very least I wanted to prove that I was at least cost neutral and that there were other benefits. And having brought that information, I think the physician was very, he was very happy with my work, he said this wasn't really necessary for you to do because his wife was extremely happy that he wasn't spending hours after Clinic dictating, or working on forms or anything like that so he was very happy with implementing a PA into the practice. So we found different creative ways to make it work so luckily I haven't, I’m still with the same employer that I started with after I graduated, luckily, but we’ve, in terms of how I've been working with the physician, has somewhat evolved. So, it was primarily in an outpatient setting clinic and then on the day he was in the hospital operating or at the Fracture Clinic at the hospital I would be working on medical legals, forms, triaging, just taking that workload off of his shoulders. What we started to add was I became a research coordinator from some of the clinical studies that he was working on so rather than hiring someone to do that for him he could utilize me in that way. Also taking on students for teaching, I was able to help with that regard. And, lastly, because I'm a full-time employee of this particular physician, the physicians across the hall from us are physiatrists and are like you know ‘we really like the way that your clinics are working perhaps can I work one day a week with your PA’ so he it almost like he sort of rents us out to other physicians and the hourly rate that we charge those other physicians come back and helps pay for our overhead because I'm not yeah I'm not in with him every day of the week. That's sort of different creative ways that we've been able to help pay for overhead. Recently, we were able to get into the fracture clinic so that's been great so I've been able to help him out there and he's been finding it really tremendous in terms of just efficiency and flow.
R: Yeah for sure, fracture clinics are… - patients always complain ‘I was there for like 5 hours and they only saw me for 5 minutes’. To be able to speed that up or get people in closer to their appointment time must be so satisfying
A: Exactly
B: So, to recap, you spend typically about two days a week in the clinic, you spend a couple days a week on doing paperwork and research coordinating, and then the remainder of the time is split between Fracture Clinic and kind of rent-a-PA day?
A: Yeah, essentially. Two to three clinics per week, an admin day, and then one day with fracture clinic, and then sometimes one day is dedicated to teaching so I do occasionally go down to UofT and will do a session here and there
R: Awesome
B: Nice, nice. Could you explain a little bit about your level of autonomy and how that maybe has changed from day 1 or year 1 to now, here we are like year 6 and also talk a little bit about how your medical directives are working especially considering that you are under a couple of physicians one day a week.
A: Sure. So I just want to preface this with… - because of the OHIP billing rules with regards to specialists, my physician has taken the schedule of benefits and taken that General Preamble and we interpret it literally. So in order for a MD to bill for the work a PA has done in a speciality practice, they have to be - there has to be meaningful involvement within that setting. And I’ve seen this model within the ER as well as other orthopedic surgery practices. So how that works is direct supervision, and what that means was within the first year, the first two weeks I just shadowed the physician. Maybe the first one or two clinics, I would shadow him, get a better understanding of what his style was in terms of his history taking, what special tests he likes to use on exams, what he looks for on investigations, and what kind of criteria the patient has to meet in order to be an operative patient versus non operative as well as his spiel he likes to do for his pre-ops to post-ops. I essentially kind of learned how to be an extension of him and that shadowing period was really important cause then I could sort of understand what his workflow was and where a PA could really make a difference in terms of improving the workflow. So, then in the next few weeks, we started with...I was operating very similar to a clinical clerk where I would go in and do a history and physical examination. Come out of the room, case present to the physician and then we would go in together and he would finish off the patient encounter and of course he can bill for that interaction because he was meaningfully involved. So then as that evolved and I got more comfortable with my scope of practice, my abilities and what I was able to do, we started that I was doing the history, physical, I was helping to interpret the investigations, come out case present, and i would do a proposal for a plan so management and plan in terms of physiotherapy, prescriptions whether we're gonna be going for operative management and then the physician would either agree or disagree, now most of the time he just agrees like ‘Yup, I think that’s great’.
He would finish up the patient encounter so he can bill for that and then I start on the next patient, doing their history and physical. So usually what that involves is preparing all of the investigations ahead of time and printing out all of the prescriptions. I’ve developed a lot of patient education handouts because most patients are usually, they kind of draw a blank once they leave the room, they don't really remember what the physician may have talked about so they’re able to take that home, we've been able to develop that as well. So were having two clinicians seeing patients at the same time and I've essentially done 75-80% of the work and the physician just agrees or disagrees and goes in and finishes off the encounter which is great bc it runs very very smoothly. So that's the model that we work under right now. We did try to experiment with the idea of a PA running just a clinic on their own autonomously but right now the physician wouldn't be able to bill for it and I believe he’s…
B: It's the funding is the problem, the funding of that is the problem
A: Exactly
R: The billing in Ontario is the issue, yeah, for sure. Have you noticed like a huge change in wait times for patients to get in and be assessed now that there are two clinicians in the clinic?
A: Absolutely. I would say that it has changed, i would have to ask the administrative assistant the wait times. So, the wait times to see the orthopedic surgeon has gone down substantially. It used to be like 8 months to a year or more at least in our practice in Burlington, I know wait times differ from city to city but we're getting closer to 3 4 months. I mean, if we can add a PA only clinic where we do non-complex, perhaps soft tissue consultations, that'd be even...we could even widdle that down quite a bit more, but...
R: That's awesome
A: Yeah, but the thing is that there's usually two wait times with regards to the orthopedic surgeon, there's the wait time to see the surgeon and then the wait time to surgery. So he still gets only one OR day a week and so that...
B: And thus far, you are not in the OR with him?
A: No, that is something that we are working on and it's been a little bit difficult but, because there's just these hurdles we have to overcome but if PAs were regulated in Ontario, it would be a substantially easier hurdle to overcome
B: We agree
B: Yup, for sure On that note, basically exactly on that note, sort of, what do...other than regulation or speaking to regulation, what do you think are the biggest hurdles that PAs in Ontario and PAs in Canada are facing right now
A: With regards to the biggest hurdles, I would say let me see here, so apart from regulation, I think the next step would be expansion to all provinces. I know that for instance, new brunswick has had a PA pilot project which is great theres like two PAs working in the ER but they haven't really gone beyond that
R: And they've been there for a long time
A: And they have been there for a long time and the evidence is there in terms of the studies that prove that PAs have been integrated. They’ve been integrated successfully into other provinces, into the Canadian healthcare system, and they've been proven to be doing well in the States. So being able to expand it into other provinces is, I think, is something I would like to see happen. As well, as the funding models and billing abilities because I think if there’s a way to pay and integrate PAs, it would make it substantially easier. I think they're almost one in the same actually
R: Yeah
B: We agree. One without the other doesn’t make sense, they need to go together. Do you see the thoughts about PAs and knowledge about PAs are changing over time in ONtario and Canada.DO you feel like things are improving in that direction and what things specifically do you expect to see change around the corner, in the profession? Aside from...like the funding model and regulation is a bit longer term and a little bit more complex within the province, but on a shorter term scale like within the next 1 to 2 years, what specifically do you think we’re going to see change in a positive fashion?
R: What would you like to see change?
All: [LAUGHTER]
All of the above I guess, apart from regular funding, billing, PA integration, I think what I'd really really like to see, is just more excitement about the PA profession, especially when it comes to employers. So, you know, we’re preaching to the choir when we're talking about, you know, how great PAs are. Like, I know PAs know that PAs are impactful
R: Are great! [LAUGHTER]
A: But a huge misconception that I usually talk to physicians and when I speak to other physicians and residents and med students, like they've heard of a PA, they maybe know someone that is a PA but it's just like there’s knowledge of the profession but they're really not in the decision making process of ‘Do I actually need to hire a PA for my practice?’. I would love to get to a point where people feel like it's a huge investment to have a PA come on, where there's going to be an improvement in their workload, quality of life, like everybody needs an assistant, and physicians are already used to delegating to residents, medical learners, PA students. I think that I would love to see more employer awareness and give physicians some kind of working model to show that you know, one reaction I get sometimes is that I can't afford you guys, you guys are too expensive, but actually I believe that is a false misconception. I believe that if you're creative, if you do your research, and if you breakdown the numbers and have certain goals that you're trying to set, that a PA could be cost-neutral, in terms of money, I guess at the end of the day, or even generate money for your practice, depending on how you utilize the PA. So, I guess it's just a selling point for physicians to show that in addition to, there isn't just the monetary value of a PA, like every hour they spend with the patient ding forms, medical legals, is an extra hour you have to focus on other things, whether it's more complex patients, academia, doing research, spending more time with your family, like I think it's definitely a worthy investment, especially if you hire the right PA for your practice.
R+B: Mhm, Yup
A: And I know that a lot of our fellow colleagues are just working examples of that. So, that's what I would like to see more of. I think more physician awareness because at the end of the day, they are our supervisors, in terms of the model that we work with within Ontario
B: Assuming, that you are successful and elected to be CAPA board, what would be your approach to help get employers and get PAs involved with future employers and build that excitement?
A: So, I find that I've been looking to my supervising physicians for examples of sort of this model. I had this idea that basically, we get a couple of inquiries about ‘how can I work with a PA?’ from physicians. When our supervising physicians tell their physician friends about you know I just recently hired this PA, this is great, it makes such a huge difference in my practice, and you know we can sort of preach to physicians, but I feel like it's different when it's coming from fellow colleges. I used to work with a physician Dr. Wong, before he moved to Nova Scotia. And he worked with O’Hood actually, prior to him moving and what they did was they had a presentation so it was an orthopedic surgeon presenting to other orthopedic surgeons and orthopedic surgery residents of how a PA was being used in his practice.
R+B: That’s awesome
A: And they demonstrated the model and there were a lot of good questions afterwards. It would have been neat to see what physicians from that session ended up following up or making communication with that but I think having conversations with physicians, not just like, you know, ‘PAs are great, they save the healthcare system money’, but actually going in and giving them practical tips and examples and models of how PAs have been used used in different practices, whether that's presenting at family med conferences, doing a quick presentation in rounds for instance at different hospitals, or even like if we were to have family health teams meetings or CHC meetings, I don't know, perhaps we can lure them in with coffee or lunch and be like this is a lunch and learn so that way it's not taking up too much of their time and just quickly show them a colleague of theirs that has implemented a PA successfully and these are the tools and these are steps that you follow. I think we're just trying to enable physicians to do that. That’s an idea that I had.
R: That’s be awesome
So I think being able.. Yes I agree. I think having that conversation would be, would actually, I feel like it would be very impactful in terms of PA employment and integration.
R: Cause yeah, when you have your supervising physician, and they're like ‘Oh, this is fantastic, I can't believe this, I didn't know what I did without you before’ bluh, bluh, bluh. It would be nice if they took that out and said that to other physicians and made other physicians think ‘Hey, maybe I should look into this’, like getting them to actually do that instead of just saying it to you or their immediate colleagues, but actually convincing them to make that part of their... something they want to do, would be awesome
A: Exactly
B: Okay, so we know that you do a lot for the PA profession online, could you give...list a short short snippet and introduction as to what you do in the online world and the tech world?
R: And your website
A: Okay, it’s a very loaded question
All: [LAUGHTER]
A: SO I guess, how I just, I love journaling and scrapbooking and I’ve been building websites since I was 12 so I’ve had this thing about documenting my life like it's just something I really enjoy doing so when I got into PA school, it just kind of felt natural to document what I was doing as a PA. But my earlier blog entries about like my rotations were pretty rough, so I’ve kind of put...those are no longer published, but anyway
R+B: [LAUGHTER]
A: So how it started was like many of my fellow PA colleagues, I would get a lot of questions from friends, and family, and former classmates about the PA profession and I found that a lot of the questions were the same. So, what I’d do would save these email drafts of these questions, and it's kind of tedious to have to go in and copy and paste, copy and paste, and answer these same questions over and over. So why don't I just put these on an online platform and answer the questions there. So when I started doing that, it started to get more views and more followings and then the PA community came aware of it. So, through that I was able to reach out to CAPA and volunteer my design services with them. That includes putting together posters, infographics, things like that. I love working with photoshop and design, final cut, like I just love being able to create. I love working with my hands and creating things, I just suppose that I really enjoy doing. So it was just sort of a way to combine my love of social media with the PA profession. And so in addition to that, I started on Twitter, first posting as sort of a general canadian PA account and then as myself and then that started to grow as I started to share more information. And I think a lot of my inspiration comes from American PAs. There are so many of them down there, they have a PA week
B: Yes they do!
A: They’re featured on the news, they're all over social media, they have great advocacy groups. Each state has their own association and there's tons of PA-led businesses, like PA coaching, PA mentoring, PA ...
B: PA owned clinics
A: PA owned clinics, PA recruiting, consulting, publications, like some PAs run their own scrub clothing business. For instance, I recently added myself on instagram and there’s a huge community of PAs on Instagram, primarily students, because I think it's a younger generation thing as well. But, I think that it’d be nice for Canadians to have that as well, I think that we’re starting…
R: Definitely
A: We’re starting to see that. If we’re not on these different platforms, engaging in conversations, then were not part of the conversation, right? So it's good, I’ve been seeing a lot of PA students, and PAs getting on twitter, even engaging in like...Facebook groups are a big thing now, whether you're in the private or public sector in terms of networking because I think we're getting away from working in silos. For instance, Dr. Smith actually works with two physician assistants and I also work alongside Denise O’Leary, who's the Ontario chapter President. And at the beginning of the year when she first...she's taking over maternity, so when she started, she would always tell me about there's more than one oncology PA working in Ontario, but they often think that they're the only one and they don't know where to get resources or collaborate. So we started this idea of these facebook speciality networking groups and often adding people to these groups they're like ‘I had no idea there were 15 of us in Ontario.’ So it's a way of...
R: Yeah, speciality groups are awesome, because you can really ask questions that are relevant to your practice and just generally being a PA in Canada is tricky at the moment so it's nice to have a group to get feedback on and see how other people feel the way if you do.
B: Oh yeah, and Anne that’s exactly how I felt. I thought I was the only oncology and palliative care PA in Canada, let alone in Ontario [LAUGHTER]
A: Yeah, there's quite a few of you actually [LAUGHTER]
B: Surprisingly enough
A: Yeah, it's nice to know you're not alone and that there are other PAs that are having similar challenges in terms of integration or longevity of employment. So, it's good to be able to tackle that and letting each other know of job opportunities
R: And funding models and what's worked in your practice
R: Mhm
B: Just the sharing of ideas, exactly
A: And resources
B: Okay, so you have your blog, could you share the website
A: So it's canadianpa.ca. Essentially, it's a resource for patients, pre-PAS that are interested in getting into the PA program, currently practicing PAs, and I'm hoping to create a section eventually for employers. The idea I had specifically was just downloadable PDFs where they can check things off a list in terms of a needs assessment for their clinic. I think there are a couple of characteristics of the supervising physician that are sort of necessary if you're going to work successfully with a PA
R: Oh, for sure
A: Including the ability to delegate. If you struggle to even hand off work to fellows or residents, and if you're really particular or protective of your practice, it might be a little bit more challenging to integrate versus someone who is happy to hand that off
R: Definitely
B: Okay so right now, it's focused on students, PA students, some current practicing PAs, and you hope to continue to expand that. And that's canadianpa.ca
A: Yes
B: And then you're also all over facebook and part of the facebook groups [LAUGHTER]
A: Yes, you should be able to find me there
R: To all of our benefits
R: You are also on LinkedIn?
A: Yes, I am
R: How do you manage your LinkedIn account in terms of PA awareness and networking?
A: So, if I see that someones a Canadian PA, I will add them on LinkedIn. Regardless of whether or not I've met them, because I feel like sooner down the line, I probably will meet them, whether it's at a conference or if they have any questions. And then from time to time, because I do have some physicians on there just because of my supervising physician, I’ll post updates about PA funding, specifically career start. Like ‘Oh, the funding is out, the deadline is in 30 days, make sure you read over this’ and I’ll link to it, I kind of make it easy to share.
R: That’s awesome
A: Yeah
B: And then you also have an instagram account that people can follow in the PA profession
A: Yup that's @canadianpablog because canadianpa was taken
R: Ahh
A: That's the handle
B: Oh funny, canadianpa was taken. So we should follow whoever canadianpa is
All: [LAUGHTER]
B: Do you plan to attend the CAPA conference in Ottawa in 2017?
A: Yes, absolutely. And I hope everyone attends {LAUGHTER} especially since it's in Ontario. It's not as far as Nova Scotia, or Winnipeg, which is where it's been nin the past
R: Yeah I hope so too
R: Oh, what do you think are the biggest misconceptions of PAs right now in Canada
A: Biggest misconception...I touched on one previously was “i can't afford a PA’ I think the term physician assistant meaning medical assistant or administrative assistant, sometimes I do see job postings on indeed.ca advertising for physician assistant but when you look at the job description it's actually a medical secretary.
B: Yes we see that too
R: Yup, we've noticed that too
A: Yup, so i know that some of us do make an effort to contact those employers and be like ‘ look you should probably take down the posting or modify it’. And, another one is the misconception, I'm not sure if you ladies bump into this a lot but, from a lot of patients I get asked how long are you in school for, what's your next steps, when are you going to be an orthopedic surgeon. And I'm like ‘Actually this is it, this is my job, I have been working for my supervising physician for a long time’. And another thing too, I was speaking with a colleague, a few weeks ago, about speaking with physicians about being just an assistant. I'm sure that there are a lot of PA students who go through rotations, and I've experienced this as well, where the physician will say ‘Well you're basically doing everything that the clinical clerk is doing, why don't you just go all the way, why don't you just become a physician and not just be just an assistant’. But what I think they don't realise is that we’ve chosen the profession…
R: For a reason
A: For a reason. We’re an extension of a physician. There's a lot of ways that we can grow within the profession whether it’s research, teaching, academia, advocacy, entrepreneurship, for instance, joining hospital boards. Like there is a reason. And I know that they’re very well meaning, they're only trying to let you know that you're excellent, you're intelligent, they see you as one of their own, like their colleagues. But at the same time, there's a ways to go in terms of building respect and knowledge about the profession in terms of what were able to do
R: I get that question ‘ When are you done school, because I've seen you here for years?’ all the time. And I’m like ‘No, I’m done, I’ve been done since I've been working here’. Yeah, it's enduring because they're like ‘When are you going to be my doctor’ and I’m like ‘I’m not’ [LAUGHTER]
A: Yup [LAUGHTER]
R: Like, I don't want to be. I can't be, and I don't want to be but I'm happy to help you sort of thing. I mean it's used to really bother me, and now I try to see it as an opportunity to sort of better explain the physician assistant role and what we do and sort of why I chose this because ,yeah, it often leads into that question ‘Oh, so you're not going to be a doctor? Well, why not? You're already doing a lot of the things that the physician would do’ And so, the two questions tend to be fairly linked, at least in my experience. And it used to brother me because I'd have to explain it over and over again and now I take it as an opportunity to really explain it to patients and be like ‘This is why I didn’t do it, this is what we do’.
A: Mhm
R: And be like ‘You should talk to other people about seeing a PA and how awesome they are’.
B: [LAUGHTER]
A: Yup, exactly
B: Promote us, that's good, good. Well, that covers a lot of things. Anything else, Anne, that you feel like we missed and that would be good for the topic of conversation?
A: No, I think we, more or less, covered it. Yeah, this was great
B: Okay, good, so, if people have further questions for you or would like to contact you, you're okay with that, right?
A: Yeah, absolutely
B: And you would like them to contact you through...what's your preferred method of contact?
A: I actually find linkedin really good. So, if people would prefer to message me that way, but I would respond to whatever social media platform you end up choosing.
B: [LAUGHTER] Okay, we will link, when we post this interview, we will link all of your platforms so people can easily contact you and we will preface to go to linkedin
A: Okay, fantastic!
B: And of course should check out canadianpa.ca. It's really quite a fabulous blog, you obviously put in a lot of effort
R: It’s excellent
B: You obviously put in a lot of effort.
A: Thank you, I appreciate that
B: Great thank you so much for talking with us!
R: Thank you
A: Yeah, absolutely. All right, take care
~MUSIC~
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