Full Circle: A New Classroom Site to Facilitate the Veteran to Physician Assistant Pathway
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MILITARY MEDICINE, 179, 12:1444, 2014
Full Circle: A New Classroom Site to Facilitate the Veteran
to Physician Assistant Pathway
Keren H. Wick, PhD*; Vanessa Bester, MPAS, PA-C†;
Drew A. Garcia, MPAS, PA-C†; Henry Stoll, PA-C†
ABSTRACT Introduction: Former military medics and corpsmen face challenges entering a civilian health care
system that underutilizes their training and experience. The MEDEX Northwest physician assistant (PA) program
launched a new classroom site in Tacoma, Washington, near local military bases, to ease entry into the PA profession
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for those in the local military and civilian communities. Methods: To fill the new classroom, the program conducted
outreach to prospective applicants at community colleges, on-base transition and education centers, and education and
career events near local installations. Results: Half of the first Tacoma class members are military veterans, half are
female, 71% are from disadvantaged backgrounds, and the average age is 33. The Tacoma class demographics are
equivalent to the overall 2013 MEDEX entering class with the exception of a higher veteran population ( p < 0.001) and
a higher rate of educational or economic disadvantage ( p = 0.001). Discussion: The MEDEX PA program has met
its mission with the new Tacoma site in terms of access for former military, disadvantaged, and local enrollees.
Offering a pathway to the PA profession for those with prior military medical experience recognizes the training and
skills attained while in uniform and allows entry into a meaningful civilian career.
INTRODUCTION is implemented.5–8 In 2011, the White House launched an
The physician assistant (PA) profession was created in the initiative to facilitate the career path from medic or corpsman
1960s through matriculating former medics and corpsmen to to PA.9 This led to the Joining Forces initiative, which is a
training programs designed to build on their military medical series of programs to promote appropriate employment and
training and experience.1 One of these early programs, educational opportunities for all service members and their
MEDEX Northwest—the PA program at the University of families.10 The Health Resources and Services Administration
Washington—focused on filling gaps in primary care access, responded by adding extra review points to the existing pri-
particularly in the rural northwest, where physician shortages mary care training grant program for proposals that included
were acutely felt. The program founder saw that service veterans activities.11,12 MEDEX—a program with existing
members with valuable field experience gained in the Vietnam classroom locations in Seattle and Spokane Washington and
conflict were being discharged into a civilian environment Anchorage, Alaska—received one of these grants in 2012 and
that used only a fraction of their medical skills. The program applied the funding to start-up activities for a new classroom
addressed both of these challenges at the same time, with the located in Tacoma, Washington (Grant number D57HP24691).
first 5 classes made up entirely of former medics and corps- The new didactic (classroom) site at the University of
men.2 The proportion of PAs with a military background has Washington Tacoma (UWT) campus is approximately 13 miles
diminished since those early years, to the point where only from Joint Base Lewis-McChord (Army and Air Force), and
8% of 2007 (the most recent year for which data are avail- also serves individuals coming from Naval installations in
able)3 entering students nationwide were veterans, and only neighboring counties. This article will focus on describing the
16% of PA programs actively recruited applicants who were methods and preliminary outcomes of this new PA education
current or former members of the military.4 site that seeks to facilitate the pathway for military medical
Once again, the country is welcoming large numbers of personnel to move up the civilian health care career ladder into
military medical personnel home from international conflicts, the PA profession.
and many of them are finding it challenging to translate their
skills and experience into civilian positions. As with the early
METHODS
days of the profession, the nation is also facing a clinician
The MEDEX program began the process of developing a new
shortage, which is anticipated to deepen as health care reform
site by obtaining support from the leadership at the local
university campus. UWT leadership shares the MEDEX mis-
*MEDEX Northwest Physician Assistant Program, University of sion to reach the nearby military community as well as indi-
Washington School of Medicine, 4311 11th Avenue NE, Suite 200, Seattle, viduals in the local area who may have had limited access
WA 98105. to educational opportunities. Additional conversations with
†MEDEX Northwest Physician Assistant Program, University of
Washington, 1900 Commerce Street, Harmon Building 305, Tacoma,
the nursing faculty (the only other health professions pro-
WA 98402. gram on campus) ensured a spirit of collaboration and coop-
doi: 10.7205/MILMED-D-14-00117 eration. These meetings with colleagues on the new campus
1444 MILITARY MEDICINE, Vol. 179, December 2014Full Circle: Veteran to Physician Assistant
established a solid working relationship that fostered effective The Tacoma site received accreditation approval in Octo-
planning and implementation to obtain appropriate classroom ber 2012 and opened in September 2013 as an undergraduate
facilities and access to campus services. option. In the program’s experience, requiring a bachelor’s
The implementation stage began with reassignment of a degree before PA education poses challenges to those cur-
senior faculty member who would become the local site coor- rently serving in the military.13 Deployments disrupt the
dinator. This site leader strengthened ties with on-campus course calendar, and even online courses can become difficult
leadership and potential colleagues. He played a key role in during deployments. For those at home, frequent reassign-
the recruitment committee to identify additional faculty for the ments to new posts can mean collecting a range of courses at
new site. a variety of colleges around the country. On-campus resi-
With the support of UWT leadership, the program was dency requirements for a traditional undergraduate program
successful in negotiating a dedicated classroom on the local can put off degree completion for years. The Servicemembers
Opportunity Colleges program14 and colleges or universities
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campus. This space had been designed with potential clinical
skills training in mind, and included space for physical exam- that compile credits from disparate institutions into a bacca-
ination instruction as well as interview and exam rooms laureate degree both offer options to address this challenge,
along one side. The start-up grant included funds for class- yet the need for undergraduate opportunities remains.
room and office supplies, which facilitated the process of MEDEX considered this as well as demographics around the
equipping the new site before the first day of class. Tacoma area that indicate below-average bachelor’s degree
Outreach activities began as the new application cycle attainment in the general population.15 The program, there-
opened in early 2012 for applications to enter PA education fore, sought to keep PA education accessible through offering
in 2013. These efforts were necessarily general to MEDEX a bachelor’s option for PA school completion at the Tacoma
rather than specific to Tacoma as the accreditation approval campus. As the profession nears 2021, when all PA programs
for the new site was still pending. The program runs a series must be at a master’s level, MEDEX will make the transition
of information sessions during the admissions cycle. These to remain in compliance. The program is developing a bridge
standardized presentations provide details on program his- program involving local community colleges as well as UWT
tory, mission, admissions process, admissions data, and steps that is intended to keep the door open to these otherwise
to build a competitive application. Formal information ses- qualified applicants.
sions take place throughout the 5-state northwest service The program committed itself to have at least one prior
region. The program added supplemental sessions in the service member on the faculty at this site. Part of the
Tacoma area during the 2012 admissions cycle on or near MEDEX program’s success in educating military veterans
the adjacent military installations (Army, Air Force, Navy). comes from hiring PA faculty who have served in uniform.
The program participated in military-sponsored education This faculty presence contributes to appropriate guidance as
and career fairs, which allowed MEDEX to add a Coast students make the transition from uniformed service to a
Guard contact. The program gave promotional handouts to civilian educational setting. Of the 3 initial faculty members
the on-base education and transition offices so counselors at the Tacoma site, one is a veteran, one has practiced in
could provide details on PA education to appropriate poten- military medicine as a civilian, and the third is the son and
tial candidates. MEDEX also offered informal information brother of career military officers. A fourth PA faculty mem-
booths at nearby military medical facilities. ber will join the team in time for the start of the second
Fostering contacts in the local community as well as offer- MEDEX Tacoma class. He is a veteran who has spent his
ing information sessions in the military and civilian commu- entire PA career in military medicine.
nities resulted in several opportunities to publicize the Demographics of the overall MEDEX program (across its
MEDEX program and the PA profession in general. During didactic sites in Seattle, Spokane, and Tacoma, Washington;
the year before enrolling the first class, the program partici- and Anchorage, Alaska) see minor variation from year to
pated in 4 formal or informal information sessions or booths year. A comparison between the new Tacoma class and the
on military bases, 6 formal information sessions near military rest of MEDEX 2013 enrollees determined whether Tacoma
installations, 8 military-sponsored networking events, 2 on- students displayed any key differences from other MEDEX
post education and career fairs, and 4 other meetings with students. c2 tests were applied to dichotomous variables and
military educators or contractors. The program estimates that a t test compared average ages between groups using SPSS
it made approximately 325 contacts with prospective appli- version 19.
cants and approximately 20 contacts with military transition The University of Washington’s Institutional Review
or education personnel. Education and transition counselors Board (IRB) determined that this report does not require
either took handouts to distribute or relayed information IRB review (communication on October 24, 2013).
about the program verbally to an unknown number of addi-
tional contacts. Program faculty noted a high proportion of RESULTS
prospective applicants who were planning 1 to 3 years ahead MEDEX held interviews in January 2013 at the new didactic
for application to PA education. location (UWT). Of the 88 qualified applicants who indicated
MILITARY MEDICINE, Vol. 179, December 2014 1445Full Circle: Veteran to Physician Assistant
TABLE I. Demographics of Tacoma Class 1 TABLE III. Preliminary Demographics of Tacoma Class 2
Characteristic Number (%)a Characteristic Number (%)
Sex Sex
Male 14 (50%) Female 10 (40%)
Female 14 (50%) Race/Ethnicity
Race/Ethnicity Racial/Ethnic Minority 8 (32%)
White 22 (79%) Educational Attainment
African American/Black 1 (4%) Less Than Bachelor’s Degree 18 (72%)
Hispanic/Latino 3 (11%) Disadvantaged Background
Asian 2 (7%) Economic or Educational Disadvantage (or Both) 14 (56%)
Age (Average Age 33.3) Average Age 33.2
25–29 8 (29%) Military Service 9 (36%)
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30–39 15 (54%)
40–50b 5 (18%) Tacoma Class 2 is accepted but has not yet begun coursework. More detailed
Educational Attainment data reporting and cross-site comparisons will begin after the class composi-
No Degree (Some College) 8 (29%) tion is finalized.
Associate Degree 15 (54%)
Bachelor’s Degree 3 (11%) female. The average age is 33. Twenty, or 71.4% of the
International Medical Graduate 2 (7%) Tacoma class self-declared either educational or economic
Military Background
Army 12 (43%)
disadvantage (or both) when provided federal definitions of
Navy 2 (7%) these categories.
No Military Background 14 (50%) When compared with the rest of the 2013 entering
Disadvantaged Background MEDEX class (in other didactic locations), the Tacoma
Economic Disadvantage (Only) 9 (32%)
class was no different in terms of ethnicity, sex, and age
Educational Disadvantage (Only) 5 (18%)
Both Educational and Economic Disadvantage 6 (21%)
(Table II). The Tacoma class was more likely to have
Not Disadvantaged 8 (29%) a military background ( p < 0.001) and to come from a
Urban Background disadvantaged background ( p = 0.001). MEDEX cur-
Urban (³50,000) 20 (71%) rently offers both a master’s-level and an undergraduate
Non-Urbanc 8 (29%) option. When disadvantaged status was compared with
a
Some sections will not total 100% due to rounding of percentages. bOnly other undergraduate students only, Tacoma students remained
1 student was age 50 upon acceptance to the program. cCategorization into significantly more likely to have a disadvantaged background
non-urban utilized zip code at the time of application or graduation from a ( p = 0.04).
high school in a nonurban town.
Tacoma Class 2 is now accepted to enter the MEDEX
program in the 2014–2015 academic year. Preliminary demo-
an interest in Tacoma, the program interviewed 36 and graphic data describing this class are shown in Table III.
selected 26 for the first Tacoma class. Other students Initial results indicate that the accepted class will be 40%
accepted to the program in another location subsequently female, 32% minority, 56% from disadvantaged back-
transferred for a total of 28 students in the first Tacoma class. grounds, and 36% current or former military. These figures
Table I describes the demographic composition of the class, will be adjusted as students who are accepted declare their
which began its PA education in the 2013–2014 academic intent to enroll in the 2014 entering Tacoma class or to attend
year. In addition to the 14 military veterans shown in the school elsewhere.
table, 6 students are military spouses (some fall into both In qualitative terms, the faculty has assessed the Tacoma
categories). Half the class is female and 4 of the veterans are class as a positive, collaborative, team-oriented group. The
TABLE II. Comparison of Tacoma Demographics with Other MEDEX Students Entering in 2013
Characteristic Tacoma Class 1 (n [%]) MEDEX Non-Tacoma (n [%]) p-Value
Sex
Female 14 (50.0%) 51 (49.0%) 1.00
Race/Ethnicity
Racial/Ethnic Minority 6 (21.4%) 21 (20.2%) 1.00
Average Agea 33.3 (SD 6.3) 32.6 (SD 6.8) 0.64
Veteran
Military Service 14 (50.0%) 12 (11.5%)Full Circle: Veteran to Physician Assistant
class has already contributed to the MEDEX outreach Services and the Veterans Center at the main Seattle campus
program by participating in special events. The PAs at offer assistance with applying for military tuition benefits
the local Army hospital invited MEDEX to join in their and other support services such as social connections or cul-
PA week celebration (early October). The students suc- turally appropriate counseling. For students in the National
cessfully obtained status as a registered student group at Guard or the Reserves who may be deployed, the program
UWT and have received financial support to send 6 stu- has established procedures to integrate them back into PA
dents to the American Academy of Physician Assistants education upon their return from duty assignments. MEDEX
conference. The class also participated in a Pat Tillman also collaborates with nearby military hospitals for selected
Run and a Habitat for Humanities project that benefitted clinical rotations, allowing some of these former service
a disabled veteran. members to learn in familiar surroundings.
This article described one classroom location of one PA
DISCUSSION
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program in a region of the country that may not find direct
MEDEX Tacoma Class 1 is currently in its first, didactic parallels elsewhere. For this reason, it will have limited appli-
year of PA education. The MEDEX program views the cability to PA programs that do not have the internal or
composition of Tacoma Class 1 as a good representation external resources to add new distant sites or to access poten-
of its mission and its goals for the new classroom site. tial applicant populations on or near military installations.
Half of the first class and approximately one-third of the However, some methods may be adaptable to PA programs
second class have a military background or family con- in differing circumstances, allowing other programs to both
nection. The program has met its goal to offer a pathway expand and reach out to a valuable resource: our returning
into the PA profession for those who have served their medics and corpsmen who are looking for a civilian career
country in uniform as well as their spouses. Students in where they can apply their military medical training and
the new location with rural and disadvantaged backgrounds experience.
(a group that includes some veterans) also fulfill the MEDEX This article focused on the methods for implementation of
mission. Future classes will include veterans who, after a new site that focused on specific applicant populations.
speaking with MEDEX faculty during initial outreach activi- Since Tacoma Class 1 has not completed training at this time,
ties, have begun the process of obtaining the prerequisite only preliminary outcomes are available at this time. Aca-
coursework needed to apply to the program. These are pro- demic performance, national board pass rates and practice
spective students even though they have not been ready to characteristics will be examined as these data become avail-
apply in the site’s first 2 years. able in future years.
The even distribution of men and women in Class 1 The immediate next steps for the MEDEX Tacoma site
reflects the usual demographics of MEDEX classes, although include increasing the development of additional community-
MEDEX overall tends to differ from the national average, based clinical training sites in the local area. The program
where approximately 70% of each entering class (nationally) will continue its outreach activities on and around local mil-
is female.3 The percentage of military veterans enrolling in itary installations, which will be particularly important as
MEDEX across all sites tends to range from approximately military forces draw down and discharge large numbers of
20% to 33%, and Tacoma became home to the majority of service members. An important step for the future will be to
military veteran enrollees in the overall 2013 MEDEX class. establish a pre-PA educational track that facilitates the path-
The prospective second Tacoma class falls at the top of the way for service members to earn a bachelor’s degree with
usual range (one-third) for MEDEX in general across the past appropriate course distribution to prepare them to apply to, be
several years. The distribution of current Tacoma students in admitted and succeed in PA education.
terms of service branch leans heavily toward Army. This may In keeping with the program’s focus since its inception in
be a result of the location near a large Army installation. 1969, MEDEX Tacoma opened its doors with the goal of
However, it is more likely part of a routine fluctuation that increasing access to PA education for those with military
the program sees across all 4 of its educational locations. medical experience and also those in the local community
Over time, and in keeping with the usual program demo- who faced economic and educational challenges. The health
graphics, it is expected that the Tacoma site will see students workforce in the region and local patient population will
from all branches. benefit from the veterans’ military training and experience,
MEDEX emphasizes support for veterans throughout the and this opportunity allows these former service members to
program. One method discussed above is to have veterans on make the transition into a meaningful civilian career.
the faculty. This offers an experienced resource as veterans
acclimatize to a civilian classroom. The fact that the average ACKNOWLEDGMENTS
age of a MEDEX student is in the mid-thirties means that the
This project was supported in part through a grant from the Health Resources
veteran students, who are older than most college students, and Services Administration, U.S. Department of Health and Human Services
will have colleagues who also have life experience (although (Grant No. D57HP24691). This grant funds specific start-up activities for the
of a different type). The UWT office of Veteran and Military new Tacoma, Washington site of the MEDEX Northwest program.
MILITARY MEDICINE, Vol. 179, December 2014 1447Full Circle: Veteran to Physician Assistant
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