Physician Assistant Subspecialty Code = 1893 Billets: Primary - 284; Secondary - About 115 “Mob To” platforms End Strength = 304 Billets types: USMC: 68 Joint Forces: 2 MTF: 170 (includes 21 Ortho and 07 EMED) Operational: 45 (includes 25 SPECWAR, 11 Sea, 9 APA)

Specialty Spotlight: Physician Assistant

by CDR Ed Owens and LCDR Clifton Butler

The Navy has provided the backbone of the Physician Assistant (PA) profession since its inception in 1967. This year, the PA profession celebrates 50 years of existence and will officially celebrate the birth of the profession on 6 October 2017. While the PA profession officially marks 50 years, Navy PAs have an equally impressive history, beginning their presence seven short years later in 1974. Originally appointed as warrant officers, the community was tasked with providing primary care services to Navy and Marine Corps forces. An incorporation of mid-level providers was thus built into the Navy Medicine construct. In 1989, the first Navy PAs were commissioned as Medical Service Corps Officers. Currently, the PA specialty serves as one of the 31 specialties within the Medical Service Corps (MSC). While one of the youngest MSC specialties, the PA community has grown to become the second largest overall and the largest clinical specialty within the Medical Service Corps, numbering over 300 active duty and 50 reservists.

PA LEADERSHIP

CDR Ed Owens, the Physician Assistant Specialty Leader, has made tremendous strides for the community and stands on the shoulders of all prior specialty leaders. Leadership within the community is based on diversity and inclusion. Recognizing the rapid growth of the PA community, this past year, the Chief of the Medical Service Corps authorized an increase in the number of Assistant Specialty Leaders (ASLs) from one to four. LCDR Kishla Askins, LCDR Clifton Butler, LCDR Rich O’Kane, and LCDR Chris Owston were competitively selected among their peers and they have done a fantastic job. The diversity of leadership within the community provides for a broad array of skillsets and knowledge to provide the best guidance and mentorship to the community population at-large.

READINESS, VALUE, AND PARTNERSHIPS

Physician Assistants play a vital role in meeting the Navy Surgeon General’s three priorities of Readiness, Value and Partnership. PAs serve in every setting within the Department of the Defense to include Medical Treatment Facilities, Marines, overseas, and on the high seas. From a Forward Operating Base (FOB) in the middle of Afghanistan with the United States Marine Corps to a large medical center in San Diego, PAs deliver the highest quality of health care to its active duty personnel, their dependents, and retirees. PAs practice in the primary care setting but also are utilized in specialty clinics, delivering safe high-quality care to our patients as Primary Care Managers on Navy Medical Homeport and Marine Centered Medical Home teams. PAs serve on various key clinical committees such as Pharmacy & Therapeutics, Medical Executive Committee, and Quality Council, to name a few. PAs also serve in leadership capacities such as Battalion Surgeons, Division Officers, Department Heads, and Directors bringing a wealth of both clinical and military experience to the table.
PAs are one of the most operationally-centric medical professions in the United States Navy. Out of the 297 authorized billets, over 68 of them are with the United Sates Marines, 11 are on Aircraft Carriers, 25 are with special forces, and 20 serve in oversea billets.
Most recently, the Medical Service Corps and the Medical Corps, namely the Aeromedical community, partnered an endeavor to send PAs to the Flight Surgery residency in Pensacola, Florida. Nine operational Carrier Air Wing (CVW) billets were created and the 6AB Advanced Qualifier Designator was established. Aviation PAs (APA) will fill critical operational billets as invaluable flight surgeon extenders in areas of direct patient care, preventive medicine, safety and readiness. On September 21, 2016, LT William Grisham graduated from the Naval Aerospace Medicine Institute Training Program to become the first Navy Aviation Physician Assistant.

CHANGING LANDSCAPE

Historically, PAs in the Navy originated from the enlisted ranks of the Hospital Corps, attending the service-specific Physician Assistant school. In 1996, the military services combined their various [PA] programs to form the Inter-service Physician Assistant Program (IPAP), located at the Army Medical Department Center and school (AMEDDC&S), Fort Sam Houston, Texas. During this time, the IPAP program managers reached an agreement with the University of Nebraska Medical Center to provide administrative and faculty oversight. The program now grants a Master’s of Physician Assistant Studies degree to all graduates of the program. Navy and Marine Corps Personnel may apply for the program through the Medical Service Corps Interservice Procurement Program, which selects candidates for the IPAP Program once a year.
While the Navy does offer the MSC-IPP, we have seen a change in demographic of PAs within the Navy. Increasing numbers of PAs are being commissioned through the Direct Accession (DA) authorization after completion of a civilian post-training program and via the Health Services Collegiate Program (HSCP) authorization, a program designed to provide financial incentives for students in designated health care professions to complete degree/certification requirements and obtain a commission in the Medical Corps (MC), Dental Corps (DC), or Medical Service Corps (MSC). PAs from MSC-IPP, DA, and HSCP now make up the community of PAs within the Navy and serve on almost every platform.
As the PA profession has grown, the demand for PAs across Navy Medicine has also grown. The growth of the profession not only extends to our active duty members, but reservists, General Schedule employees, and contractors. With the expansion and capacity of Military Treatment Facilities and operational platforms, the demand in the Navy for specialty-trained active duty PAs has allowed for increased training opportunities and augmentation of theater operational units supported by Navy Medicine.
The Navy PA Specialty now has three fellowship opportunities, which consist of the Orthopedic PA Fellowship, Emergency Medicine PA Fellowship, and will have the General Surgery PA fellowship added this year. The Navy screened for the first class of a General Surgery (GS) Fellowship, and will soon select the first GS PA personnel for the training program. The selected personnel will attend school at the Baylor Program in San Antonio, TX. Upon completion of the program, the GS PAs will proceed to their utilization tours at an MTF or operational unit. While the GS PA program is in the inaugural stage, the two historic PA fellowships have already produced a number of specialty-trained PAs in the areas of Orthopedics and Emergency Medicine.
The Orthopedic PA Fellowship is conducted at the Naval Medical Center, Portsmouth, VA, and the Emergency Medicine PA (EMPA) fellowship is located at the Naval Medicine Center, San Diego, CA. during this past year, the PA Community established the Aerospace. Medicine PA training program, which allows for the training of PAs to support and augment the medical capability of Carrier Air Wings.

50th YEAR CELEBRATION

While attending the 2017 American Academy of Physician Assistants (AAPA) Conference in Las Vegas, NV the Academy commemorated the 50th Birthday of the profession. Also during this period, the MSC Corps Chief visited with PA Leadership and the 35 PAs who attended the PA Social on 15 May 2017. PAs enjoyed the informal atmosphere and asked questions of the Corps Chief, Specialty Leader, and other senior PAs gaining valuable career advice and informal mentorship. Following the Social, the Naval Association of Physician Assistants (NAPA) held a formal meeting for Navy affiliated PAs. The AAPA Constituent Organization and Outreach Advocate, Mrs. Penny Gaillard, briefed all PAs on Federal Advocacy and Legislations affecting PAs. CDR Ed Owens addressed the group regarding career advice and progression, and LCDR Clifton Butler provided information regarding NAPA, the future of the organization as a constituent of AAPA, and advocacy for all Active, Reserve, Retired, and GS PAs.
PAs attending represented a diverse cross-section of our profession. Our Navy PAs are changing the paradigm of the PA profession: from IPAP graduates, Direct Accessions, HPSP graduates, HSCP graduates, Directors, Doctoral students, Fellowship Selectees, Regimental Surgeons in USMC billets, selectees for Aerospace Physician Assistant, White House Medical Unit PAs, MARSOC PAs, NSW PAs, PAs from Overseas, to Instructors. By pursuing Doctoral degrees, publishing papers, holding various leadership positions, serving on the AAPA House of Delegates and NAPA among others, our PAs are changing the face of Navy Medicine and doing great things. While many are pursuing personal and professional goals, the community is still performing by working in Medical Homes, serving in leadership capacities, and mentoring for the future.
We have an outstanding community and are proud to be a part of Navy Medicine. The PA community is happy to celebrate 50 years as a Profession and 43 years in the Navy. PAs Navy-wide are looking forward to the PA Profession’s 50th Birthday on 6 Oct 2017, and the Navy PA 50th Birthday Celebration in 2024.

CDR Ed Owens and LCDR Clifton Butler. "Specialty Spotlight: Physician Assistant." The Rudder 5.7 (1 July 2017): 8-10.