Create Learning Opportunities and Optimize Staffing

WHEN A PHYSICIAN begins the arduous task of opening a private practice, they might come to the table with a preconceived notion of what staffing will be needed for their future practice. When Dr. Bradley Hill left his position as Chief of Vascular Surgery at Kaiser Permanente Santa Clara to venture into private practice, community-based health- care, he knew he would be leaving a key component that brought him an incredible amount of joy— teaching Stanford University surgery residents and medical students during their vascular surgery rotations with him.

We knew private practice would provide the opportunity to continue serving vascular patients and would allow the freedom to innovate novel medical devices. However, one critical component was missing… Education.

Like Dr. Hill, many attending physicians feel an inherent need to continue passing their knowledge and skills to residents and medical school students who will become the physicians of tomorrow. However, once they step away academia, academic institutions, or hospitals which support specialty rotations, they lose the ability to continue their joy of teaching.

Creating an Educational Opportunity within the Private Practice Setting

Hiring “gap year” pre-med students is not a new or novel idea. Many gap year students find paid jobs or volunteer opportunities within hospitals, working as medical office receptionists, or medical scribes. But, creating a well-rounded educational opportunity for gap year students which not only
provides hands-on clinical experience arching from patient intake to assisting in interventional procedures, but also encompasses the business of medicine and healthcare from customer service skills, insurance authorizations, and billing basics has provided us at Hill Vascular and Vein Center an opportunity to provide foundational healthcare skills and knowledge within a team of future physicians. We’ve coined these team members “PreMed Medical Assistants”, or more simply, PMAs.

Our PMA Program

Our PMAs join us in cohorts at the end of every semester. Twice a year, the opportunity is posted across university and college career boards appealing to graduating seniors and alumni with medical school aspirations. Each semester we’ve seen the pool of applicants increase in both number and in academic and early career achievements. The applicant pool normally comprises of mostly science majors who need a one-to-two-year gap to complete MCAT testing, gain clinical experience, mentor under a physician who would be willing to write a letter of recommendation, complete personal statements, submit medical school applications, secondaries, and are looking for advice and guidance during interview season. Our most recent application pool comprised of 36 applicants - undergrads and graduate students from public and private, local and out-of-state colleges and universities from across the nation.

We modeled our PMA Program on a circular learning cycle much like that used during residency; the seniors teaching the juniors, but with high-level oversight by Dr. Hill on the clinical side and by myself and other key, experienced staff on the business end. We’ve built in leadership opportunities to broaden the experience of our senior PMA’s while fostering their confidence as teachers and eliminating the potential for educational stagnation. We continually look for new educational opportunities for our PMAs with classroom teaching, occasional workshops, and mock interviews when time allows.

What the PMA Program Offers

We structured our PMA program to meet our staffing needs in addition to the educational opportunities it supports for students. The program is comprised of four main phases: front office, exam room, minor procedure room, and the Office-Based Lab (OBL). With each phase serving as a foundational building block for the next, our bright PMAs learn quickly and function at a high level of competency before progressing to the next phase.

All our PMAs have demonstrated through their resumés, transcripts, and inter- views they are extremely intelligent, eager to learn and believe a career in healthcare is their calling.

Behind the front desk, PMAs learn the business side of medicine. They become familiar with the basics of accounting, the importance of customer service skills, our EMR system, the services we offer, our surgery facility accreditation policies, and the foundational basics of vascular care. Soon, they become well versed in obtaining insurance authorizations, medical billing basics, scheduling, and new patient registrations. By experiencing the struggles to obtain authorizations and scheduling patients for procedures while lending support to our Patient Care Coordinator, we see the PMAs gain a genuine appreciation for these important administrative support roles they will rely on throughout their careers in healthcare.

While scribing, PMAs learn far beyond the clinical components of a physical exam. They are trained in patient intake, obtaining vitals, the fine art of presenting cases to an attending physician. But perhaps more importantly, they are exposed to the importance of the “unteachable” aspect of medicine— bedside manner. They witness and absorb the nuances of broaching difficult patient/doctor conversations as patients age and must make decisions regarding their future healthcare wishes.

In our Minor Procedure Room, our PMAs learn to drop a sterile field, don sterile gloves, prep patients for their procedures, and assist the physician while performing procedures such as vein ablations, micro-phlebectomies, sclerotherapy, tunneled hemodialysis catheter removals, and suture removals. Additionally, during this phase of their training, our PMAs learn how to document procedural notes, and are trained in proper biohazard material handling, soiled instrument handling, and proper sterilization techniques.

For many of our PMAs, the most daunting stage, yet most exciting, is assisting in our Office-Based Lab (OBL). Being tapped to work in the OBL means he or she has demonstrated competency in managing and maintaining a sterile field and a certain level of knowledge in scribing, inventory and medical device knowledge, circulator responsibilities, and emergency protocols. While in the OBL, the PMA works under the supervision of a physician, registered nurse(s), and alongside industry clinical support gaining surgical experiences beyond the majority of their gap year counterparts.

An Added Value to the Practice

As one can imagine, training PMAs is an investment of both time and money. On-the-job training takes energy and the attention of many of our staff and clinical providers. It is a cohesive team effort to train a PMA. Yet, not only do we continue with the program, but we aim to grow the
program by investing more into our PMAs. Why? Because our efforts culminate in new team members who are enthusiastic, attentive, energetic, eager, and who bring out-of-the-box, fresh perspectives and ideas to the practice in a myriad of ways that benefit the practice and the care we provide. Marketing ideas, office inclusivity training ideas, and research knowledge have been brought to our attention, all of which make our office and practice better.

One might ask, given the amount of time and energy spent on training PMAs, is it worth investing in them if they are essentially short-term employees? My answer: Hands- down, YES! Whether they are with us for three, two, or even one gap year/s, they bring a level of intelligence that leads to fast learning and training. Because they come with little experience and they realize the benefits they will receive (training, clinical experience, reference letters, etc.) they are a highly effective and affordable staffing resource.

It is clear our patient population enjoys meeting and getting to know our PMAs. Patients often ask for the PMAs by name and take an interest in their medical school journey. Not only do we receive positive feedback on our PMAs, but our patients also enjoy having a “hand” in participating in a PMAs foundational learning within the medical field.

Will a PMA program work for every practice? No, it won’t. There are certain aspects which must be taken into consideration such as, do you and your current staff enjoy and have the patience to teach and train? Do you have nearby universities and colleges you can recruit from, or are you located in a geographic area to which new graduates would be willing to move given this remarkable opportunity?

These are all factors to be considered. However, if you feel you can create these unique opportunities for these aspiring physicians, our advice is… Do it! There are plenty of highly qualified, fresh graduates looking for a special opportunity and they will help your practice grow.

For more information about the Hill Vascular and Vein Center PMA Program, feel free to email Menée Hill at mhill@ hillvascular.com or visit: hillvascular.com/premed-medical-assistant-program.