Unlimited Options Springfield College’s Physician Assistant Grads Meet Growing Need

Several students are gathered around a hospital bed where a man is sweating, wheezing, and struggling to breathe. His lips have turned blue, and although he can still talk, if they don’t recognize quickly that he is having an asthma attack and initiate treatment, he could die.

The scene is one of many medical crises that occur weekly in a simulation laboratory used to help students in Springfield College’s Physician Assistant graduate program test their classroom knowledge in a real-life setting.

The ‘patients’ are sophisticated mannequins controlled by an instructor who sits behind a window of one-way glass. He or she talks for the mannequin and can make it cry, moan, and react to drugs while changing its vital signs and altering its bodily functions.  “

“The mannequins are used to see how students perform under stressful situations, as well as to enhance and evaluate their interpersonal and communication skills,” said program Chair Charles Milch, adding that instructors use theater makeup to mimic bruises, lacerations, bullet wounds, and other signs of trauma on the mannequins’ bodies before students arrive.

It’s an important part of a difficult course of study, which includes rotations in a number of medical specialties. But although the curriculum is extremely challenging, the rewards and career possibilities for graduates are almost unlimited, and include jobs in a host of medical settings. Starting salaries range from $80,000 to $105,000 and are enhanced by the satisfaction of helping people.

In fact, the demand for physician assistants, or PAs, is greater than the supply, and in 2012, the federal Bureau of Labor Statistics cited physician assistant as one of the fastest-growing occupations in the U.S. The number of jobs is expected to increase by 38{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} between now and 2020, due in part to the aging population, the increasing number of people with healthcare insurance, and a projected shortage of primary -are physicians.

“It’s a wonderful profession for people interested in the healthcare field,” said Meghan Migeon, an assistant professor of PA studies at Springfield College. “A physician assistant is a bridge between being a nurse and a doctor and is the perfect job for people who want to do more than nursing allows, but don’t have the time or money to go to medical school.”

Milch explained that PAs can easily move from one type of medicine to another. “Once they are working in the field, there is a tremendous amount of flexibility, and people can change their specialty without having to go back to school,” he said, citing family practice, pediatrics, psychiatry, and emergency-room medicine as a few of the many choices available.

But although the profession offers a plethora of benefits, the work required to earn a master’s degree is extremely intense and rigorous. Milch said students are in the classroom from 8 a.m. to 4 p.m., have at least four hours of homework each night, and enough to fill at least eight hours of every weekend day. Courses are highly technical and range from Human Anatomy and Physiology to Medical Microbiology, Organic and Biologic Chemistry, and Pharmacology.

The clinical portion of the program is equally demanding, and students typically spend 40 to 70 hours a week in a hospital.

“But it’s a rewarding career,” Milch told HCN, adding that he works as a PA in a family practice in addition to his job at the college.

Migeon also works in the field. She is a PA in the emergency room at Baystate Franklin Medical Center, and says she finds the work satisfying. “The program is very challenging, but it’s a rewarding career and worth the time and effort required.”

There are two ways to enter the PA program at Springfield College. The first is to start classes during the pre-professional phase, which is the route the majority of students take. It consists of a six-year course of study that begins during a student’s freshman year at the college with a full schedule of prescribed courses.

Students transition into the professional, or graduate, portion of the program during January of their senior year of college and receive a bachelor of science degree in health science/pre-PA in May of their fourth year of schooling. The second phase of their education takes 27months and includes mandatory, full-time summer sessions. At graduation, students are awarded with a master of science degree and a physician’s assistant certificate. They also become eligible to take the Physician Assistant National Certifying Exam, which they must pass before they begin working in the field.

“But 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of our students pass their boards,” Milch said, adding that PAs must retake the exam every 10 years and also must earn 100 continuing-education credits every two years.

The second way to enroll is to be accepted directly into the graduate program. But there are very few seats, because the program is limited to 35 students, and those who entered the program as college freshmen and have met all of the requirements are granted automatic acceptance.

Candidates vying for the remaining slots must have a bachelor’s degree that includes prerequisite science courses. They need to have earned a minimum grade of C+ in those classes and have a career grade-point average of 3.0.

In addition, they need a minimum of 470 hours of clinical experience that involves direct patient contact. They also must have spent at least 30 hours shadowing a PA who is not related to them.

“Last year, the competition was intense — we had 120 applicants for 10 open seats; we interviewed 30, and each of the people we accepted had more than 1,000 hours of direct patient contact,” Milch said, adding that the strongest candidates are typically nurses, paramedics, lab technicians, medical technologists, and/or emergency-room technicians.

Once students are accepted into the program, they begin their coursework, which includes 116 credits and eight six-week rotations in emergency medicine, surgery, inpatient medicine, pediatrics, psychiatry, primary-care medicine, and obstetrics and gynecology. They also have one elective that can be chosen from any medical field, including disciplines such as plastic surgery, dermatology, or cardiothoracic surgery, and many students work with a doctor in a local practice they have chosen themselves. “We also offer an elective in Costa Rica,” Milch said.

But before they begin their rotations, the students’ book learning is reinforced in sophisticated laboratories.

“Students must complete a significant amount of work in our cadaver labs, simulation lab, and history and physical-skills lab,” Migeon said. “Integrating medical lectures with hands-on experience enhances their critical-thinking skills, which is really important for a physician’s assistant.”

She explained that students do a complete dissection of a human body in the cadaver lab, which is not part of many PA programs. “But it allows students to see the inside of the body, all of its organs, and how they relate to each other. They need to understand the human body to make a diagnosis, and working on a cadaver brings book learning to life.”

The simulation lab is also important, and students begin putting their classroom knowledge to the test during the third semester of the 27-month program.

Migeon said their first encounter with a ‘patient’ who reacts to their diagnosis and/or treatment can be stressful.

“It’s very different than sitting in a classroom,” she noted. “When the students start working in the lab, they are apprehensive, but the more time they spend there, the more comfortable they become dealing with patients and diagnosing problems.”

Milch agreed. “We have three high-fidelity mannequins that are highly sophisticated; their eyes blink and contract, and they breathe and have heart and lung sounds. They also cry and sweat.”

Dynelle Longto, the medical simulation lab coordinator, explained that the mannequin can be programmed to simulate any situation a PA would encounter with patients in a hospital, clinic, or doctor’s office. “The mannequins even respond to medication. It’s critical that they are prescribed the correct dose, as the wrong dose could potentially kill them,” she told HCN.

Other lab work allows students to take patient histories and conduct physical exams. “They also learn how to give injections and insert catheters and chest tubes,” Milch said. “But what they accomplish in the labs is about far more than just medicine. They develop the professionalism there that they will need in order for them to deal appropriately with serious situations.”

Students often work in small groups, which foreshadows the teamwork often required on the job. For example, Milch is a PA at Atkinson Family Practice in Amherst, where he works with two physicians and two physician assistants. “We take a team approach to patient care although we have our own patients,” he said.

Once the students have advanced enough to be assigned to a hospital, they take part in a special white-coat ceremony, where they are presented with the white lab coats they will wear while they work with patients. At the conclusion of the ceremony, they take the Physician Assistant Professional Oath.

Milch said the program requires students to study seven days a week and up to 12 hours a day. “It’s very difficult, and we advise all of our students not to work at all while they are in the professional phase.”

This total dedication is necessary due to the amount of responsibility each graduate will have once employed as a PA.

“Medicine is a dynamic profession, and physician assistants do everything that a doctor can do, except surgery; they work under the supervision of a physician, but they have people’s lives in their hands,” Milch said. “It’s a calling, as opposed to an occupation, and students who enter this field have to like people, want to help them, and be able to solve problems.”