Covid 19 and its effect on Physician Assistant Education and future.

Elizabeth Massey, PA-C

Corona virus 19 first entered the US via social media and its effects on Wuhan, China. As an emergency Medical Provider and PA school educator I first thought, “Uh, Wow! That sucks.” Never did I think the virus would spread to the states. Then Covid-19 completely shut down China. There were news reports on how their citizens were coping with isolation and decrease in food supply and the fear of leaving their homes. This was startling and surreal to me even though I was not yet affected. The virus progressed to Italy with devastating effects. Now it is in the United states. Surely, we the smart people of the United states would learn from the other countries in the fight against this virus.

As a full time, Physician Assistant Educator and a part-time PA in the ER, I had colleagues at the CDC who related how BIG this was and knew the shutdown was coming soon in the US.

But did the US really shut down? No. It was left to local government with different opinions on the severity of the issue. I digress.

The PA school where I was busting my hump went virtual about a week and a half before finals. My world changed in more than one way – as I’m sure it did for many others. I was now a virtual educator full time.  I chose to furlough my part time position in the ER. My ER colleagues needed all the hours they could get to help support their families. The full time ED employee hours were shortened to 10 hours a month. Other facilities and companies were reducing the hourly or salary pay and cutting hours. I commend the ER staffing company I was and am working for with how well they treated all their employees during this hardship.

Meanwhile, I was learning new online platforms like zoom, and trying to figure out HOW we could test students while still maintaining test integrity. Special testing was required and still is – and this costs schools money that was not previously used on testing.

In a medical program it is important to learn physical skills. Skills like how to properly examine a patient, or how to perform certain procedures. This became exceedingly difficult and time consuming. As if working 50-60hrs a week in a medical program was not enough.  Now there was the extra time factor of staggering 8 students at a time in a lab (masked and gloved). Once the students left all the equipment and the room was disinfected.  Do not forget to add the wait time so the disinfectant could dry. Repeat for the next set of students. This was done for every class that required a lab. Labs that usually took 2 hours for a group of 40 students now took almost 2 days to complete.  This took one instructor out of the mix for 2 days’ worth of normal teaching and preparing. One might say it was a big change for schools and students. But this was only the didactic troubles medical programs were having.

The Clinical aspect of learning medicine was impacted the most by Covid 19. At first, only ER rotations were affected. Before long Clinical sites all around the country were cancelling their rotations, and some schools were pulling students out of their rotations. There were national meetings on how to keep the students in their sites or how the student could still get their required patient care hours, so graduation time was not altered. Rotations were shortened, flipped, changed, and postponed. The hardest hit rotations were the rotations that occurred in hospitals: Emergency Medicine, Surgery, OBGYN, or any Inpatient rotation. Then there were facilities that were just concerned for lawsuits should the student become Ill. There were very few rotations that allowed PA students to rotate and many of those required a N-95 mask. As the country is aware, there was a PPE shortage. Honestly, there is still – As I have ONE N-95 in a brown paper bag that I use when I am on shift. There were preceptors who simply didn’t feel comfortable with a student now. Some of the prior preceptors were furloughed or relieved of their duties entirely. Now there were fewer preceptors employed in general, and Many willing preceptors found themselves at facilities that were not.

There was a point when our program only had around 10 students on rotation while the other students were to study or do CME until a rotation became available. How would we decide which student would be allowed to graduate on time and which would not?

A few months later some facilities gradually began letting medical students back into certain rotations only. Hospital rotations were still a problem, but then Physician Assistant students began to have another problem. Select facilities would only allow Medical students or Medical students and Nurse Practitioner students, but not Physician Assistant students. Physician Assistant students are trained via the same model as Medical students and not the nursing model.  Thankfully, schools have learned ways around these difficulties, but many providers are burned out from Covid 19.  As Physician Assistants graduate, they will have a difficult time finding jobs as the market is saturated due to the layoffs of Physician Assistants and Nurse Practitioners. Now many of the positions available are Covid related–precisely what many facilities were preventing these very students from learning.  Some employers chose to only interview Nurse practitioners because of the autonomy level they have in some states – they do not need a physician to independently practice.  Now, 7 months later, some facilities are keeping Physician Assistants students out and will until spring of 2021.

What does this mean for the future of Physician Assistants? New graduates will have a difficult time finding employment and may not be as ready as they could have been due to reduced patient contact. Previously employed PA’s will have a difficult time finding employment with the pay they previously had. Nurse practitioners will continue to have a better lobby for themselves then PA’s will – which will make employment easier for them -thus driving PA pay down with it. Again, I digress. Physician Assistants around the country need to join together and help the students and schools still struggling to find meaningful rotations and Physician Assistants need to join together with their local Chapters to help fight for a better PA lobby for our profession. Don’t forget we can PIVOT in any direction- good or bad. Let’s pivot up!

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